Search Results (104)

Aortic stenosis (AS) is a progressive valvular heart disease marked by a restriction of blood flow through the aortic valve, resulting in considerable morbidity and mortality if not addressed. AS has historically been managed through surgical aortic valve replacement (SAVR), but there is a growing trend towards the use of transcatheter aortic valve replacement (TAVR). TAVR has transformed the management of symptomatic severe AS and is currently authorized for patients with varying levels of surgical risk. The rising application of TAVR in patients under 65 years presents a challenge for heart valve teams (HVTs) managing younger individuals whose life expectancy may surpass the durability of the valve. Patients over 65 years are typically treated with bioprosthetic tissue valves; however, there remains significant uncertainty regarding the selection between TAVR and SAVR. Full article

Aortic stenosis is the most prevalent valvular disease globally. Transcatheter aortic valve replacement (TAVR) has become a well-established treatment for aortic stenosis, offering outcomes comparable to surgical aortic valve replacement (SAVR). Its use has expanded to include younger, lower-risk patients and those with more complex anatomies. Recent advancements in TAVR include the increased adoption of transfemoral access, prosthesis designs optimized for challenging anatomies, enhanced delivery systems with repositioning capabilities, and outer skirts to minimize paravalvular leaks. Despite these innovations, several challenges remain. This review highlights recent updates in transcatheter heart valve (THV) systems, leaflet modification devices, and the current limitations of TAVR. Full article

Introduction: Prosthesis-patient mismatch (PPM) in surgical aortic valve replacement (SAVR) is known to be a poor prognostic factor. However, the parameters for preventing postoperative PPM in SAVR have not been established. Materials and Methods: Two hundred and five patients (mean age 72.5 ± 7.4 years, 129 males) who underwent SAVR were analyzed. Preoperatively, we determined the recommended prosthesis valve size from the mean aortic valve (AV) diameter derived from the AV annulus area by preoperative three-dimensional transesophageal echocardiography (3D-TEE). We investigated the association between pre- and postoperative changes in annulus diameter and the occurrence of PPM. Results: PPM was present in 6 patients (2.9%). Pre- and postoperative AV annulus diameter change ratio was greater in the group with PPM than in that without PPM (10.4 ± 3.6% vs. 3.0 ± 5.6%, p = 0.002). The use of prosthetic valve rings smaller than the recommended size was higher in the group with PPM than in that without PPM. (83.3% vs. 20.6%, p = 0.002). On multivariate logistic regression analysis, use of a valve smaller than the recommended size was an independent predictor of PPM (odds ratio 19.3, 95% confidence interval 2.14–174.5, p = 0.008). Conclusions: The recommended prosthetic AV size based on preoperative 3D-TEE is useful for determining the optimal prosthetic AV size to prevent PPM after SAVR. Full article

Transcatheter aortic valve replacement (TAVR) was first introduced as a minimally invasive treatment for patients with severe aortic stenosis (AS) who are at high or intermediate surgical risk. Recently, its application has expanded to include younger and lower-risk patients, establishing TAVR as a less invasive alternative to surgical aortic valve replacement (SAVR) across the entire surgical spectrum. The expanding utilization of TAVR has driven significant advancements that have greatly enhanced its safety and effectiveness, resulting in a substantial reduction in complications such as paravalvular leak, conduction abnormalities, and periprocedural strokes. Numerous trials have demonstrated the potential superiority of TAVR over conventional surgery in achieving favorable clinical outcomes. Furthermore, the increasing number of long-term trials has provided valuable insight into TAVR outcomes in previously under-studied populations, including patients with complex anatomies. However, significant challenges remain, particularly in ensuring the long-term durability of transcatheter valves, with younger patients likely to outlive their bioprosthetic valves. Consequently, the focus is shifting towards lifetime management strategies, including considerations for coronary re-access, the risk of coronary obstruction, and prosthesis–patient mismatch. This review explores key developments in the field, including TAVR for aortic regurgitation and bicuspid anatomy, the emerging role of TAVR in moderate and asymptomatic AS, and innovations in valve design and procedural planning. We also examine novel imaging tools, adjunctive technologies, and strategies to address coronary access and re-intervention. As long-term data accumulate, these evolving trends will shape the future of TAVR and its role in managing aortic valve disease across increasingly complex clinical scenarios. Full article

Background: Despite its high prevalence, little is known about the effect of sex on the management and outcomes of aortic stenosis (AS). We sought to characterize the effect of sex on the clinical evaluation for and provision of aortic valve replacement (AVR), including surgical (SAVR) and transcatheter aortic valve replacement (TAVR), and the subsequent morbidity and mortality outcomes. Methods: A comprehensive chart review was conducted on all patients with a first diagnosis of severe aortic stenosis (AS) at Vancouver General and University of British Columbia hospitals from 2012 to 2022. Exact chi-square and Kruskal–Wallis tests were used to evaluate the variables of interest. Results: A total of 1794 studies met the inclusion criteria, comprising 782 females (44%) and 1012 males (56%). Females were significantly older than males at the time of the first diagnosis (79 versus 75 years, p < 0.001). Females were significantly less likely to be evaluated by the TAVR clinic or cardiac surgeon or to receive aortic valve intervention (p-value ≤ 0.001). Females were significantly more likely to be rejected for TAVR due to older age (OR 0.23 (0.07, 0.59)), comorbid conditions (OR 0.68 (0.47, 0.97)), and frailty (OR 0.23 (0.07, 0.59)). Females were significantly more likely to be rejected for SAVR on the basis of frailty (OR 0.66 (0.46, 0.94)). Females also had significantly higher rates of 1-year mortality, hospitalization, and heart failure hospitalization compared to males (p-values < 0.05). Conclusions: Our data suggest significant sex-based discrepancies in the management of AS. Females with severe AS are diagnosed later in life and are less likely to be evaluated for valve intervention. They are less likely to receive intervention due to older age, frailty, and multimorbid conditions. Further research is warranted for a more effective identification and follow up of aortic stenosis, as well as timely referral for AVR, where appropriate, especially for females. Full article

Sutureless aortic valve replacement (SuAVR) has emerged as a potential alternative to conventional surgical aortic valve replacement (SAVR), particularly in minimally invasive settings. However, its global adoption remains limited, with a notable concentration of use and scientific production in select European countries. This bibliographic meta-analysis systematically reviewed 538 studies to assess the evidence landscape surrounding SuAVR, highlighting a predominance of observational data, sparse randomized controlled trials (1.3%), and significant geographical imbalances in research output. Europe accounted for 80% of publications, while North America contributed less than 10%. Key structural factors—including reimbursement policies, earlier regulatory approvals, and population characteristics—appear to influence SuAVR adoption. Despite procedural advantages such as reduced cross-clamp times, concerns over cost, pacemaker implantation rates, and uncertain long-term durability persist. Importantly, SuAVR may offer its greatest clinical value by facilitating minimally invasive surgery, a niche still underutilized worldwide. The limited randomized data and industrial focus on transcatheter approaches have further hindered widespread acceptance. Our findings underscore the need for high-quality comparative trials and standardized guidelines to define the role of SuAVR in modern valve therapy. Full article

Background: The aim of this study was to compare costs and clinical outcomes associated with transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR). A secondary analysis was performed in patients with coronary artery disease, and patients with TAVI and percutaneous coronary intervention (PCI) were compared with SAVR and coronary artery bypass grafting (CABG). Methods: All patients who underwent the TAVI or SAVR procedure for severe degenerative aortic stenosis between August 2013 and February 2025 at a tertiary cardiovascular center were selected for inclusion in the present study. Patients were excluded if there was no available follow-up or if there was a crossover between treatments (especially CABG undergoing TAVI or SAVR undergoing PCI within a 6-month timeframe). Results: A total of 2452 patients (1925 undergoing SAVR and 527 undergoing TAVI) were included. Of those, 400 underwent SAVR + CABG and 75 underwent TAVI + PCI. During a median follow-up of 2.88 (1.12–6.43) years, a total of 404 all-cause events occurred, corresponding to 4.18 deaths per 100 patient-years. TAVI was associated with higher hospitalization costs and fewer in-hospital deaths than SAVR. However, long-term survival was similar between TAVI and SAVR and between TAVI + PCI and SAVR + CABG. Interventional treatment was more cost-effective in patients with EuroSCORE > 10%, while surgical treatment was more cost-effective in patients with EuroSCORE < 10%. Conclusions: In patients who are at high surgical risk, TAVI is more cost-effective than SAVR, and TAVI + PCI is more cost-effective than SAVR + CABG. In patients who are not at high surgical risk, SAVR is more cost-effective than TAVI, and SAVR + CABG is more cost-effective than TAVI + PCI. Full article

Background: Transcatheter aortic valve implantation (TAVI) is becoming the most important treatment strategy for aortic valve disease. With its dramatic increase, the rate of major complications and the impact of TAVI on long term outcomes is becoming a pressing issue, especially in terms of comparison with surgical aortic valve replacement (SAVR). PVE is a severe complication that can arise post-procedure, leading to significant morbidity and mortality. The aim of this meta-analysis is to compare the incidence of PVE and 30-day mortality rates between TAVI and SAVR. Methods: A comprehensive literature review was conducted, identifying studies that reported the incidence and outcomes of PVE in patients undergoing TAVI and SAVR. The selected studies were assessed for heterogeneity using the χ² test and I² statistic. A random effect model was applied to account for variability among studies. The Odds Ratios (ORs) for 30-day mortality and the incidence of PVE were calculated. Funnel plots were utilized to assess the reliability of the data and potential publication bias. Results: The analysis showed no significant difference in 30-day mortality of PVE in TAVI and SAVR, with an OR of 1.29 (CI 0.98–1.69). However, there was a significant difference in the incidence of PVE (HR 0.76, CI 0.61–0.96), with TAVI demonstrating a protective effect attributed to its lesser invasiveness and shorter procedural times. The funnel plots indicated high reliability of the data, with low standard errors and minimal publication bias. Conclusions: TAVI and SAVR carry similar 30-day mortality rates for patients with PVE; on the other hand, TAVI shows a lower incidence of PVE due to its minimally invasive nature. These findings suggest that TAVI might be a preferable option for certain patient populations, though further randomized clinical trials are needed to confirm these results and address the limitations of the current study. Full article

Background: Aortic valve stenosis remains the most prevalent valvular pathology in Western countries. Rapid deployment bioprosthesis (RD) has emerged as a promising alternative to conventional valves for surgical aortic valve replacement (SAVR), particularly in elderly and high-risk patients. This study reports the short- and long-term outcomes of RD in patients with isolated aortic stenosis. Methods: A retrospective single-center analysis was conducted on 382 patients who underwent RD-AVR between 2014 and 2020. Data were collected from clinical files and national electronic databases. Primary outcomes included cardiopulmonary bypass (CPB) and cross-clamping (XC) times, postoperative complications, and long-term survival. Results: The mean age was 75.6 ± 5.9 years, with 29.8% of patients over 80 years old and a mean EuroSCORE II of 2.3 ± 1.5%. CPB and XC times were 36.7 ± 10.8 and 27.4 ± 8.1 min, respectively. Postoperative complications included acute kidney injury (AKI, 53.4%), de novo atrial fibrillation (31.9%), and high-grade/complete atrioventricular block with permanent pacemaker implantation (9.8%). In-hospital and 30-day mortality was 1.02% and 2.3%, respectively. The 5-year survival rate was 77%. At 6 months postoperatively, the mean transvalvular gradient was 11.1 ± 4.7 mmHg. At a median follow-up of 6.7 years, no cases of structural valve deterioration and only one case of endocarditis were reported. Conclusion: In this single-center study, RD in isolated AVR demonstrated favorable short- and long-term outcomes, including no structural valve deterioration at mid-term follow-up. These devices offer a safe and effective alternative to conventional SAVR, particularly in high-risk populations. Full article

Bicuspid aortic valve (BAV) is the most common congenital heart disease, affecting 0.5–2% of the population and often leading to early aortic valve degeneration. While surgical aortic valve replacement (SAVR) remains the gold standard for treating severe bicuspid aortic stenosis (AS), transcatheter aortic valve implantation (TAVI) is emerging as a viable alternative in selected BAV anatomies. Initial experiences with first-generation transcatheter heart valves (THVs) showed the feasibility of this technique, but were associated with lower device success rates and higher complications, such as paravalvular leak (PVL) and pacemaker implantation. Advancements in second- and third- generation THVs, together with better pre-procedural imaging assessment and growing operator experience, have significantly enhanced TAVI outcomes in BAV patients, with results now comparable to those seen in tricuspid aortic valves (TAVs). Proper patient selection, pre-procedural sizing, and device implantation are key to improving TAVI success in BAV. Recent registry data on contemporary THV platforms demonstrate improved procedural success, hemodynamic performance, and the safety of TAVI in BAV. However, higher rates of PVL, pacemaker implantation, and strokes remain concerns. Ongoing advancements in THV design and procedural techniques will further enhance outcomes for this challenging population. Up to the present, there are no dedicated THVs for BAV, but the latest-generation THVs offer promising results. Full article

Background and Objectives: Prosthesis–patient mismatch (PPM) after surgical aortic valve replacement (SAVR) is associated with worse clinical outcomes and worse valve durability. The aim of this retrospective single-center study was to evaluate the consistency between predicted PPM (PPMp) and measured PPM (PPMm) after SAVR with three different bioprostheses. Materials and Methods: We analyzed data of all consecutive patients who underwent surgical aortic valve replacement with Magna Ease, Intuity, and Inspiris Resilia bioprostheses (Edwards Lifesciences, Irvine, CA, USA) at our institution. PPM was defined if EOAi ≤ 0.85 cm²/m². PPMm was determined by institutional echo lab-measured EOAi on discharge-day echocardiogram. PPMp was assessed using reference values for each valve model and size indexed to BSA based on height, weight, prosthesis type, and size. For the overall population and for the three valve types we evaluated the sensitivity, specificity, positive predicted value, negative predicted value, and accuracy of PPMp. Furthermore, the consistency between PPMm and PPMp were evaluated according to prosthesis type, size, stent internal diameter (ID), and true ID. Results: A total of 1323 patients underwent SAVR; complete hemodynamic data were available for 872 patients, who represent the population of our study. Magna Ease, Intuity, and Inspiris Resilia were implanted in 446 (51.1%), 341 (39.1%), and 85 (9.7%) patients, respectively. In 635 out of 872 cases (72.8%), PPMp was consistent with PPMm (Magna Ease: 321/446, 72%; Inspiris Resilia: 58/85, 68.2%; Intuity: 256/341, 75%). Overall, the sensitivity, specificity, positive predicted value, negative predicted value, and accuracy of PPMp were 0.26, 0.83, 0.24, 0.84, and 0.73, respectively (Magna Ease: 0.21, 0.82, 0.3, 0.8, and 0.72; Inspiris Resilia: 0.11, 0.82, 0.14, 0.79, and 0.68; Intuity: 0.45, 0.78, 0.19, 0.93, and 0.75). Conclusions: The consistency between PPMp and PPMm was suboptimal. We did not observe differences between PPMp and PPMm among different valve types. Discordance between PPMp and PPMm was more evident in smaller valve sizes. When implanting small valves, the evaluation of PPMp should be used with caution to avoid unexpected PPMm. Full article

Transcatheter aortic valve implantation (TAVI) has emerged as a revolutionary therapeutic modality for the management of severe aortic stenosis (AS), particularly in patients who are at high or prohibitive risk for surgical aortic valve replacement (SAVR). Over the past decade, extensive clinical evidence has expanded the indications for TAVI to include intermediate- and low-risk populations, which usually represent a population of younger age, in which the most common complications of TAVI, including paravalvular leak (PVL) and pacemaker implantation, should be avoided. This review focuses on the incidence and predictors of PVL in various types of TAVI implantation, its clinical implication, and the prevention strategies to tackle this complication. Full article

While surgical aortic valve replacement (SAVR) has traditionally been regarded as the gold standard for severe symptomatic aortic stenosis (AS), transcatheter aortic valve implantation (TAVI) has emerged as a compelling less invasive alternative for patients with severe AS across the entire surgical risk spectrum. Despite TAVI’s increasing utilization and promising outcomes, SAVR continues to be an essential treatment modality for certain patient populations, including individuals with complex aortic anatomies unsuitable for TAVI, patients presenting with significant aortic regurgitation, individuals requiring concomitant surgical procedures, and cases involving infective endocarditis. Furthermore, concerns regarding the long-term durability and complication profile of transcatheter valves underscore the importance of individualized patient assessment, especially for younger patients requiring optimal lifetime management strategies. This review examines the evolving role of SAVR amidst the growing adoption of TAVI and highlights key considerations for selecting the most appropriate treatment strategy for patients with aortic valve disease, incorporating insights from recent advancements in transcatheter technologies and the latest clinical trial evidence. Full article

Abstract: Background: Transcatheter aortic valve implantation (TAVI) is the treatment of choice for symptomatic aortic stenosis in patients with moderate to high surgical risk. When transfemoral access is unsuitable, alternative routes such as transapical (TAP) or transaxillary (TAX) routes must be considered. This study compares the in-hospital mortality and clinical outcomes of TAP vs. TAX TAVI. Methods: We conducted a retrospective analysis of 76 patients who underwent TAP or TAX TAVI between 2018 and 2021 at our department. Inverse probability of treatment weighting (IPTW) was used to account for baseline differences. Results: Among 1901 TAVI procedures, a total of 76 was selected of which TAP was performed in 34.2% (n = 26), and TAX in 65.8% (n = 50) of cases. Self-expanding CoreValve Evolut R valve prostheses were used in 96% of TAX cases, while balloon-expandable Edwards SAPIEN 3 valve prostheses were exclusively implanted in TAP cases. After IPTW adjustment, baseline characteristics, including EuroSCORE II, LVEF, and NYHA class, were comparable. TAX was associated with a higher pacemaker implantation rate (22.6% vs. 0%; p = 0.032), while TAP had a higher incidence of late bacteremia (13.4% vs. 1.6%; p = 0.027) and longer hospitalization (19 [13, 28] vs. 10 [8, 21] days; p = 0.016). In-hospital (0% vs. 2.1%; p = 0.388), 30-day (3.4% vs. 3.5%; p = 0.957), and 3-year mortality (6.7% vs. 4.8%; p = 0.709) were similar. Device implantation success was 100% in both groups. Major bleeding and vascular complications were rare. Balloon predilatation was more frequent in TAX (57.6% vs. 13.3%; p = 0.002). Rates of mild and moderate aortic regurgitation did not differ. Conclusions: In patients unsuitable for transfemoral TAVI, TAP was associated with lower pacemaker rates but longer hospitalization and increased late bacteremia compared to TAX. Both approaches showed comparable safety and efficacy, emphasizing the need for individualized access selection. Full article

Surgical aortic valve replacement (SAVR) remains an essential treatment option for patients with aortic stenosis (AS). Open-heart surgery requires the use of cardiopulmonary bypass (CPB), which triggers an inflammatory response that can lead to end-organ dysfunction and severe complications. Dexmedetomidine, a highly selective α2-adrenergic agonist, is widely used in anesthesia and intensive care medicine for its sedative, analgesic, and sympatholytic properties. This study aimed to investigate whether dexmedetomidine exerts a clinically relevant anti-inflammatory effect in patients undergoing open-heart surgery and to determine the optimal dose. A prospective, double-blind, placebo-controlled study was conducted, including 60 patients randomized into three groups according to dexmedetomidine dose. Inflammatory markers (IL-6, TNF-α), renal function, and other clinical parameters were analyzed at multiple time points. Statistical analyses were performed to assess differences between the groups. Dexmedetomidine administration significantly affected TNF-α levels 12 h after CPB (p = 0.033), while previously reported suppression of IL-6 was not observed. Dexmedetomidine was associated with lower opioid consumption before extubation and showed a tendency to reduce postoperative delirium. Diuresis was significantly increased on the first postoperative day in dexmedetomidine-treated patients (p = 0.003), with no significant changes in other renal parameters. The incidence of atrial fibrillation was highest in the control group and lowest in the high-dose dexmedetomidine group, though this difference was not statistically significant. These results suggest that dexmedetomidine influences inflammatory and clinical outcomes; however, further research is needed to confirm its long-term benefits and optimal dosing strategies. Full article