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Future Perspective for Transcatheter Aortic Valve Replacement

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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 (31 March 2022) | Viewed by 10218

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Special Issue Editors

Dr. Thomas G. Nührenberg

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Guest Editor

Division of Cardiology & Angiology II, University Heart Center Freiburg • Bad Krozingen, University Hospital Freiburg, 79106 Freiburg, Germany
Interests: platelet biology; platelet pharmacotherapy; structural heart diseases; interventional cardiology; coronary artery disease

Dr. Philipp Breitbart

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Guest Editor

Division of Cardiology & Angiology II, University Heart Center Freiburg • Bad Krozingen, University Hospital Freiburg, 79106 Freiburg, Germany
Interests: cardiac imaging; structural heart diseases; interventional cardiology; coronary artery disease

Special Issue Information

Dear Colleagues,

Very recently, transcatheter aortic valve implantation (TAVR) has been reported to be superior to traditional surgical aortic valve replacement (SAVR), even in younger patients with low perioperative risk. In light of these findings, we expect a further expansion of the worldwide TAVR procedures. However, this also means that possible TAVR complications and their avoidance are becoming increasingly important. Additional knowledge about the underlying mechanisms of complications or factors leading to valve deterioration are crucial for any specific valve design or for optimization of the implantation procedure. New imaging techniques can help in the development and improvement of both. The further expansion of the TAVR procedure can only be successful if these gaps of knowledge can be filled with scientific evidence. In summary, the further expansion of TAVR indication worldwide is both an opportunity and a responsibility.

The present Special Issue aims to discuss and present future perspectives for transcatheter aortic valve replacement to accelerate the further development.

Dr. Thomas G. Nührenberg
Dr. Philipp Breitbart
Guest Editors

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Keywords

TAVI
aortic valve stenosis
structural heart disease
interventional cardiology
cardiac imaging
computed tomography angiography

Published Papers (5 papers)

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Research

8 pages, 722 KiB

Open AccessArticle

Impact of On-Clopidogrel Platelet Reactivity on Incidence of Peri-Interventional Bleeding in Patients Undergoing Transcatheter Aortic Valve Implantation

by Alexander Kille, Kilian Franke, Noé Corpataux, Julia Hromek, Christian M. Valina, Franz-Josef Neumann, Dietmar Trenk, Thomas G. Nührenberg and Willibald Hochholzer

J. Clin. Med. 2022, 11(10), 2871; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11102871 - 19 May 2022

Cited by 2 | Viewed by 1457

Abstract

Dual anti-platelet therapy (DAPT) with clopidogrel and acetylsalicylic acid (ASA) has previously been recommended after transcatheter aortic valve implantation (TAVI) and is still the standard of care in patients who underwent coronary stent placement within 3 months prior to TAVI. This study sought to evaluate whether on-treatment platelet reactivity is a predictor for the occurrence of bleeding events after TAVI. This study enrolled 484 patients undergoing TAVI from November 2013 until April 2018. Patients were either on long-term DAPT with clopidogrel and ASA or received loading doses of both drugs before TAVI, reflecting the standard of care at the time of the patient’s enrollment. Platelet reactivity was determined by multi-electrode impedance aggregometry before TAVI, at days 1 and 5 thereafter. Peri-interventional bleeding was assessed up to 5 days following TAVI and coded according to BARC-classification. Bleeding events were seen in 199 (41.1%) patients. The most frequent were BARC 2 bleeding cases (24.2%), followed by BARC 1 (6.0%), BARC 3b (5.2%), and BARC 3a (4.5%) cases. Low on-clopidogrel platelet reactivity before TAVI was present in 243 patients, of which 44.4% had a bleeding event. In contrast, the incidence of bleeding was 30.5% in the 95 patients with high on-clopidogrel platelet reactivity. Multivariate logistic regression analysis identified low/normal/high on-clopidogrel platelet reactivity (OR: 0.533; CI: 0.309–0.917; p = 0.023) and use of oral anticoagulation (OR: 1.766; CI: 1.209–2.581; p = 0.003) as strongest predictors for peri-interventional bleeding events. These findings support current recommendations advocating against the routine use of dual antiplatelet therapy following TAVI. Full article

(This article belongs to the Special Issue Future Perspective for Transcatheter Aortic Valve Replacement)

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10 pages, 4455 KiB

Open AccessArticle

Impact of the Aortic Geometry on TAVI Prosthesis Positioning Using Self-Expanding Valves

by Philipp Breitbart, Martin Czerny, Jan Minners, Holger Schröfel, Franz-Josef Neumann and Philipp Ruile

J. Clin. Med. 2022, 11(8), 2259; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11082259 - 18 Apr 2022

Viewed by 1604

Abstract

Background: The impact of transcatheter heart valve (THV) position on the occurrence of paravalvular leakage and permanent pacemaker implantation caused by new-onset conduction disturbances is well described. The purpose of this study was to investigate the influence of the geometry of the thoracic aorta on the implantation depth after TAVI (transcatheter heart valve implantation) using self-expanding valve (SEV) types. Methods: We evaluated three-dimensional geometry of the thoracic aorta based on computed tomography angiography (CTA) in 104 subsequently patients receiving TAVI with SEV devices (Evolut R). Prosthesis position was determined using the fusion imaging method of pre- and post-procedural CTA. An implantation depth of ≥4 mm was defined as the cut-off value for low prosthesis position. Results: The mean implantation depth of the THV in the whole cohort was 4.3 ± 3.0 mm below annulus plane. THV position was low in 66 (63.5%) patients and high in 38 (36.5%) patients. After multivariate adjustment none of the aortic geometry characteristics showed an independent influence on the prosthesis position—neither the Sinus of Valsalva area (p = 0.335) nor the proximal aortic arch diameter (p = 0.754) or the distance from annulus to descending aorta (p = 0.309). Conclusion: The geometry of the thoracic aorta showed no influence on the positioning of self-expanding TAVI valve types. Full article

(This article belongs to the Special Issue Future Perspective for Transcatheter Aortic Valve Replacement)

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Graphical abstract

9 pages, 1081 KiB

Open AccessArticle

Performance of Computed Tomography Angiography (CTA) for the Diagnosis of Hypo-Attenuated Leaflet Thickening (HALT)

by Manuel Hein, Philipp Breitbart, Jan Minners, Philipp Blanke, Simon Schoechlin, Christopher Schlett, Tobias Krauss, Martin Soschynski, Franz-Josef Neumann and Philipp Ruile

J. Clin. Med. 2022, 11(7), 1817; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11071817 - 25 Mar 2022

Cited by 3 | Viewed by 1902

Abstract

(1) Background: Early hypo-attenuated leaflet thickening (HALT) is diagnosed by computed tomography angiography (CTA) in approximately 15% of patients undergoing transcatheter aortic valve replacement (TAVR). We sought to investigate the diagnostic performance of CTA for the diagnosis of HALT, focusing on timing data assessment within the cardiac cycle. (2) Methods: The study enrolled 50 patients with and 50 without HALT with available post-TAVR-CTA. The primary objective was to compare the diagnostic performance of CTA readings at specific intervals and time points during the cardiac cycle (entire systole, entire diastole, end-systole, and mid-diastole) versus gold standard (consensus reading by two observers based on multiphase full cardiac cycle data sets). (3) Results: 100 CTAs were independently analysed by two observers blinded to clinical characteristics of the study population and the results from the gold standard reading. Sensitivity and specificity for the diagnosis of HALT were 84%/94% in systole, 87%/92% in diastole, 78%/95% at end-systole, and 80%/94% at mid-diastole. End-systole had the highest positive predictive value (0.88) and positive likelihood ratio (36). Cohen’s kappa for interobserver reliability was 0.715 in systole, 0.578 in diastole, 0.650 at end-systole, and 0.517 at mid-diastole. (4) Conclusion: Limiting CTA reading to distinct intervals or time points during the cardiac cycle has good specificity but lowers sensitivity. For a reliable diagnosis of HALT, data sets from a multiphase CTA covering the entire cardiac cycle should be analysed. A double reader approach would be desirable in further studies investigating HALT. Full article

(This article belongs to the Special Issue Future Perspective for Transcatheter Aortic Valve Replacement)

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10 pages, 2751 KiB

Open AccessArticle

Non-Invasive Myocardial Work in Patients with Severe Aortic Stenosis

by Salvatore De Rosa, Jolanda Sabatino, Antonio Strangio, Isabella Leo, Letizia Rosa Romano, Carmen Anna Spaccarotella, Annalisa Mongiardo, Alberto Polimeni, Sabato Sorrentino and Ciro Indolfi

J. Clin. Med. 2022, 11(3), 747; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11030747 - 29 Jan 2022

Cited by 11 | Viewed by 2057

Abstract

Changes in cardiac mechanics after correction of severe Aortic Stenosis (AS) are under-investigated. Myocardial Work (MW) is emerging as a useful non-invasive correlate of invasively measured myocardial performance and oxygen consumption. The aim of this study was to assess the usefulness of MW in the clinical management of patients with AS undergoing transcatheter aortic valve implantation (TAVI). Consecutive patients referred for TAVI were included in this observational study. Echocardiograms were performed before and after TAVI to measure Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), and Global Work Efficiency (GWE). Mean transvalvular gradient was significantly improved (p < 0.05), without significant changes in left ventricular ejection fraction, nor in global longitudinal strain (GLS). GWI (p < 0.001) and GCW (p < 0.001), but not GWW (p = 0.241) nor GWE (p = 0.854) were significantly reduced after TAVI. Patients with a low flow low gradient (LF-LG) AS had lower left ventricular ejection fraction (LVEF) (p < 0.001), worse global longitudinal strain (GLS) (p < 0.001), and lower baseline GWI (p < 0.001), GCW (p < 0.001) and GWE (p = 0.003). The improvement in GWI and GCW observed after TAVI in the general study population were abolished among LF-LG patients. In conclusion, non-invasive MW might be useful to further classify patients with AS and to predict non responders. Full article

(This article belongs to the Special Issue Future Perspective for Transcatheter Aortic Valve Replacement)

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10 pages, 1533 KiB

Open AccessArticle

Prosthesis Position after TAVI with Balloon-Expandable SAPIEN 3 in Bicuspid Aortic Valves

by Philipp Breitbart, Jan Minners, Martin Czerny, Manuel Hein, Franz-Josef Neumann and Philipp Ruile

J. Clin. Med. 2021, 10(12), 2561; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10122561 - 09 Jun 2021

Cited by 2 | Viewed by 2311

Abstract

Background: Prior data suggest a correlation between the position of transcatheter heart valves (THV) and the occurrence of complications after transcatheter aortic valve implantation (TAVI) in patients with tricuspid aortic valves (TAV). However, data including a detailed analysis of prosthesis positioning in bicuspid aortic valves (BAV) are limited. Therefore, the purpose of this study was to investigate THV position after TAVI in BAV. Methods: We evaluated the THV position in 50 BAV and 50 TAV patients (all received the balloon-expandable Sapien 3 prosthesis) using fusion imaging of pre- and post-procedural computed tomography angiography. According to the manufacturers’ recommendations, a low implantation position was defined as >30% of the prosthesis below the annulus. Results: THV position was appropriate in the majority of the patients within both groups (90.0% for BAV vs. 96.0% for TAV, p = 0.240). In BAV, we observed a more pronounced THV waist (7.4 ± 4.5% vs. 5.8 ± 3.0%, p = 0.043) and a lower average THV expansion (91.9 ± 12.2% vs. 95.5 ± 2.7% of nominal expansion, p = 0.044). Conclusions: Accurate positioning in relation to the aortic annulus of the TAVI Sapien 3 prosthesis is possible in patients with BAV with results comparable to TAV. However, there is a more pronounced prosthesis waist and a lower average THV expansion in BAV. Full article

(This article belongs to the Special Issue Future Perspective for Transcatheter Aortic Valve Replacement)

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