Transaortic Valve Replacement Research Articles

Determining risk factors for vascular and bleeding complications after TAVR using CT angiography

Abstract Funding Acknowledgements None. Introduction The use of pre-procedural computed tomography angiography (CTA) of the iliofemoral sector in the planning of transaortic valve replacement (TAVR) has demonstrated a reduction in the risk of vascular complications in patients undergoing TAVR. In this study, we aimed to characterise the clinical and radiological factors associated with bleeding and vascular complications after TAVR. Methods Patients undergoing transfemoral TAVR in a tertiary centre between 2017 and 2019 were included in this analysis. All patients underwent iliofemoral CTA before the procedure and classical CTA-derived data as well as iliofemoral calcium volume were collected. Clinical data and outcomes regarding bleeding events, as well as vascular complications according to Valve Academic Research Consortium 2 (VARC-2) criteria, were also collected. 207 patients were included in this analysis, of whom 53% were women. The median age was 82 years (IQR 76-86) and the median STS mortality risk score was 3.9% (IQR 2.59-5.99). In this population, vascular complications according to the VARC-2 criteria occurred in 33% of patients (19% with major complications). Patients with lower body mass index (BMI) were more likely to suffer vascular complications. Vascular access with fluoroscopy was associated with a higher prevalence of complications compared to ultrasound-guided vascular access (62% vs. 38%, p=0.037). When considering radiological criteria, smaller minimum luminal diameter and area of the common femoral and external iliac arteries were associated with a greater risk of vascular complications, as were increased sheath to external iliac artery ratios and luminal attenuation values (p<0.05 for all). Bleeding complications occurred in 20 patients, with a greater prevalence of bleeding events in female patients (77% vs. 23%, p=0.001). Patients with a lower BMI, a history of obstructive pulmonary disease or coronary artery disease, aortic insufficiency and fluoroscopic valvular access were more likely to have bleeding complications. Regarding radiological criteria, decreased maximal luminal diameter of the common femoral artery and smaller minimal luminal diameters and areas of the external iliac artery were associated with bleeding complications. Increased sheath-to-femoral artery ratios and luminal attenuation values were associated with an increased risk of vascular complications (p<0.05 for all). Conclusion Our study underscores the importance of pre-procedural CTA in TAVR planning and identifies separate risk factors for vascular and bleeding complications.

Abstract 16826: A Rare Case of an Emergent Third Valve in Valve Intervention

Introduction: Bioprosthetic valves are prone to structural degeneration due to an average lifetime of 10-15 years. Valve in Valve (VIV) TAVR has become an alternative to the high-risk surgical patients as the growing number of successful bioprosthetic valve placements and the deteriorations over time. Emergent VIV intervention effectiveness with prior multiple artificial valves is less studied. Hypothesis: We report a case of a 54-year-old male presenting with obstructive shock with history of substance abuse and bicuspid aortic valve status post bioprosthetic aortic valve with aortic root repair at age of 15(1983), aortic stenosis requiring repeat surgical bioprosthetic Aortic Valve Replacement (SAVR) (25 mm) at age 42(2011). Recalcitrant cardiogenic shock despite vasopressor. Emergent Heart catheterization showed mild coronary artery disease (CAD) and severe cardiomyopathy, Left Ventricle ejection Fraction 15-20%. Aortic valve Gradient was 80 mmHg. Transesophageal Echocardiography (TEE) ruled out endocarditis. Impella CP and Swan-Ganz catheter were placed for hemodynamic support and monitoring. Methods: The Heart Team approach was followed. Patient was at high risk of mortality and operative complications with redo sternotomy. He subsequently underwent valve in valve TAVR with self-expanding 26 mm valve. Prior surgical valve did not require fracturing post implantation. Results: Post Trans Aortic Valve Replacement (TAVR) the mean gradient on echocardiogram decreased to 10 mmHg and LVEF recovered to 55-60%. The patient was successfully weaned off Vaso-pressors and eventually discharged home. Conclusion: Most common cause of transcatheter bioprosthetic valve failure is stenosis from calcification and thrombosis. VIV TAVR in recent studies has proven to be safe with favorable outcomes. Our patient had already undergone two surgical valve interventions, presented with critical bioprosthetic valve stenosis requiring salvage TAVR for cardiogenic shock. After the Heart team approach, TAVR was opted as a more favorable option for the patient. Although, the life of a bioprosthetic valve results in multiple interventions but overall valve in Valve technique has been proven to provide expected results in emergent high-risk patients.

Valve In Valve Transaortic Valve Replacement (ViV-TAVR) in a Patient with Recurrent Pulmonary Edema: A Novel Procedure That Could Be Effective and Life-Saving in High-Risk Patients

Background: Bio-prosthesis is the method of choice in managing aortic valve stenosis due to THE lesser probability of coagulation, even though higher valve replacement rates are undeniable. Valve-in-Valve Surgical Valve Replacement (ViV-SAVR) is shown to have lower rates of mortality than reoperation. We have reported a patient undergoing a ViV-SAVR procedure with exceptionally better results than in the literature. Case presentation: A 73-year-old Caucasian female was admitted with dyspnea and pulmonary edema with a bioprosthetic Mitroflow valve stented 10 years before admission. The echocardiography showed ejection fraction = 30%, left ventricular end-diastolic volume = 135 mL, LVEDV index = 72.9 mi∕m2, degenerated aortic valve with severe transvalvular aortic regurgitation, and mild aortic stenosis (mean gradient = 19 mmHg, peak gradient = 36 mmHg). The prosthetic valve was positioned on the previous Mitroflow bioprosthetic valve strut, followed by aortography. The patient was followed up for one month using transesophageal echocardiography, with no paravalvular leakage. Aortic transvalvular mean gradient of 16 mmHg and EOA of 1.3 cm2. Conclusion: ViV-SAVR is a method of treating aortic valve stenosis, which, if performed correctly, can enhance the survival and quality of life of the patients.

Antithrombotic therapy with Transcatheter aortic valve replacement.

Aortic valve replacement is a necessary management strategy for patients with severe aortic stenosis. The use of transaortic valve replacement (TAVR) has increased significantly over the last decade and now exceeds traditional surgical aortic valve replacement. Since the valve systems used in TAVR consist of bioprosthetic valve tissue encased in a metal stent frame, antithrombotic therapy recommendations cannot be extrapolated from prior data with differently constructed surgical bioprosthetic or mechanical valves. Data on the use of antithrombotic therapy with TAVR are a rapidly developing area of medicine. Choice of agents depends on several patient factors. Patients undergoing TAVR also have a relatively high incidence of subclinical valve thrombosis. The clinical impact of this phenomenon and the implications for antithrombotic therapy continue to evolve. It is critical for clinicians who treat patients undergoing TAVR to have a firm understanding of practice guidelines, the evolving evidence, and its implications for the use of antithrombotic therapy in these patients.

C-36 | In-hospital Outcomes Post-TAVR in Patients with Amyloidosis – A Perspective from National Inpatient Sample

As many as 15% of patients with aortic stenosis (AS) have underlying amyloidosis. However, there is scarce data on the outcome of patients with AS and amyloidosis after transaortic valve replacement (TAVR), and studies suggest that this population may have a higher risk for procedural complications due to the fragility of amyloid infiltrated tissue.

Trans-aortic Mitral Valve Repair and Aortic Valve Replacement with Rapid Deployment Prostheses in High Risk Patients

Objective: To report a case of trans-aortic mitral valve repair and aortic valve replacement with rapid deployment prosthesis in a high risk patient. Methods: A 79 year-old female underwent trans-aortic mitral valve repair and aortic valve replacement with rapid deployment prosthesis. Her past medical history revealed hypertension, COPD and diabetes. She was referred to our center for the worsening of dyspnea on exertion. Trans-thoracic echocardiogram showed a severe aortic regurgitation and moderate mitral regurgitation. The mechanism of mitral insufficiency was the chordal rupture of the scallop A2 while aortic valve was calcified. Ejection fraction was 45%. She was a very fragile patient with a intermediate surgical risk profile (Euroscore II: 6.6%). Results: After removing the calcified aortic valve, we carried out a trans-aortic mitral valve repair by cutting the two ruptured chords on A2 and performing an edge-to-edge plasty between A2 and P2. Afterwards, we implanted a rapid deployment aortic prosthesis. This approach allowed us to reduce the CPB and aortic cross clamp times. Post-operative TTE showed trivial mitral regurgitation and no aortic paravalvular leaks. The patient was in-hospital discharged by a week. Conclusions: In high risk patients suffering from mitro-aortic disease our approach could be safe and easy.

Rapid deployment versus trans-catheter aortic valve replacement in intermediate-risk patients: A propensity score analysis.

There are insufficient studies comparing rapid deployment aortic valve replacement (RDAVR) and trans-aortic valve replacement (TAVR) in intermediate-risk patients with severe aortic stenosis (AS). We compared 2-year outcomes between RDAVR with INTUITY and TAVR with SAPIEN 3 in intermediate-risk patients with AS. Inclusion criteria were patients with severe AS at a EuroSCORE II ≥ 4%, who received RDAVR or TAVR implantation and clinical evaluation by the Heart Team. Regression adjustment for the propensity score was used to compare RDAVR and TAVR. Primary outcome was the composite criterion of death, disabling stroke, or rehospitalization. major bleeding complications postoperation, paravalvular regurgitation ≥ 2, patient-prosthesis mismatch, and pacemaker implantation. A total of 152 patients were included from 2012 to 2018: 48 in the RDAVR group and 104 in the TAVR group. The mean age was 82.7 ± 6.0,51.3% patients were female, the mean EuroSCORE II was 6.03 ± 1.6%, mean baseline LVEF was 56 ± 13%, mean indexed effective orifice area was 0.41 ± 0.1 cm/m2 , and the mean gradient was 51.7 ± 14.7 mmHg. RDAVR patients were younger (79.5 ± 6 years vs. 82.6 ± 6 years;p = .01), and at higher risk (EuroSCORE II, 6.61 ± 1.8% vs. 5.63 ± 1.5%;p = .005), Twenty-two patients (45.99%) in the RDAVR group and 32 (66.67%) in the TAVR group met the composite criterion. Through the 1:1 propensity score matching analysis, there was a significant difference between the groups, favoring RDAVR (HR = 0.58[95% CI: 0.34-1.00];p = .04). No differences were observed in terms of patient-prosthesis mismatch (0.83 [0.35-1.94];p = .67), major bleeding events (1.33 [0.47-3.93];p = .59), paravalvular regurgitation ≥ 2 (0.33[0-6.28];p = .46), or pacemaker implantation (0.84 [0.25-2.84];p = .77) CONCLUSION: RDAVR was associated with better 2-year outcomes than TAVR in intermediate-risk patients with severe symptomatic AS.

Original Experience of Transaortic Approach in Bivalve Replacement

Background. Combined valve lesions affect more than one valve, which may hamper a correct estimation of the individual valve severity. The study aimed to assess the outcome of transaortic mitral valve replacement (TAMVR) in a bivalve replacement procedure. Materials and methods . A retrospective study was conducted with 19 patients having TAMVR during bivalve replacement. The mean patient age was 58 ± 8.6 years, including 10 male patients. Diabetes mellitus was diagnosed in 3 patients, atrial fibrillation — in 14, coronary heart disease — in 2, chronic obstructive pulmonary disease — in 2, stroke in history — in 1, chronic heart failure stage 3–4 (NYHA) — in 19 patients. Infectious endocarditis as the disease aetiology was found in 4 patients. Two patients had previous heart surgery. Echocardiography: mean left ventricular ejection fraction 55 ± 7.3 %, mean pulmonary artery pressure 47 ± 13.7 mm Hg, median aortic valve fibrous ring diameter 23 (21–25) mm. Results and discussion. Mechanical replacement was performed in 12 cases. Median surgery time was 160 (150–185) min, median myocardial ischaemia (MI) time — 67 ± 9.7 min and artificial circulation (AC) time — 87 ± 12.5 min. Resternotomy for bleeding was performed in 2 patients, with median postoperative blood loss 300 (212–587) mL. Early postoperative delirium developed in 4 patients, acute renal failure requiring haemodialysis — in 1 patient. Stroke, perioperative myocardial damage and conduction disorder requiring pacemaker implantation not observed in postoperative period. Median artificial lung ventilation time (ALV) was 9.5 (6–15) h, ≥24 h — in two cases. One lethal early postoperative case was registered. Conclusion. TAMVR in a bivalve replacement setting is a safe technique with short AC, MI and surgery times and can be recommended in patients with a wide aortic valve fibrous ring.

Prognostic evaluation of patients benefiting from a trans aortic valve replacement according to the type of aortic stenosis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Aortic Stenosis (AS) is a common condition in patients over 75 years. Latest ESC recommendations differentiate 4 types of AS according to: Indexed Stroke Volume (SVi), mean gradient and left ventricular ejection fraction (LVEF). The aim of our study is to evaluate prognosis of patients who have had a transcatheter aortic valve replacement (TAVR), in terms of mortality, according to the 4 types of AS. Methods This study compares prognosis of 620 patients who had TAVR between January 1, 2015 and December 31, 2018. Patients were classified into 4 groups according to AS type: high gradient; low gradient, low flow, low LVEF; low gradient, low flow, normal LVEF; low gradient, normal flow. Results 69 patients (11.1%) died within 12 months of the procedure: 49 in the high gradient group (9.4%); 13 in the low gradient, low flow, low LVEF group (47.1%); 1 in the low gradient, low flow, normal LVEF group (5%); 6 in the low gradient, normal flow, normal LVEF group (18.2%). All-cause mortality at one year follow-up is higher in low-gradient, low-flow, altered LVEF group (p = 0.0004) than in other groups. Patients in this group were significantly more often admitted for heart failure than patients in high-gradient group (p = 0.009). Conclusion A complete echocardiography evaluation is needed to evaluate AS, its severity and type. Patients in the low gradient, low flow, low LVEF group have an independent risk of mortality at 12 months higher than other groups and are more hospitalized than patients in the high gradient group.

Is transaortic valve replacement the modality of choice in patients with chronic lung disease?

Journal of Cardiac SurgeryVolume 36, Issue 2 p. 678-679 INVITED COMMENTARY Is transaortic valve replacement the modality of choice in patients with chronic lung disease? Cesar E. Mendoza MD, Corresponding Author Cesar E. Mendoza MD cesar.mendoza2@jhsmiami.org orcid.org/0000-0002-5209-6388 Division of Cardiovascular Disease, Jackson Memorial Hospital, Miami, Florida, USA Correspondence Cesar E. Mendoza, MD, 1611 NW 12th Ave, East Tower 3019, Miami, Florida 33136, USA. Email: cesar.mendoza2@jhsmiami.orgSearch for more papers by this authorDiego Celli MD, Diego Celli MD orcid.org/0000-0002-8545-8664 Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida, USASearch for more papers by this author Cesar E. Mendoza MD, Corresponding Author Cesar E. Mendoza MD cesar.mendoza2@jhsmiami.org orcid.org/0000-0002-5209-6388 Division of Cardiovascular Disease, Jackson Memorial Hospital, Miami, Florida, USA Correspondence Cesar E. Mendoza, MD, 1611 NW 12th Ave, East Tower 3019, Miami, Florida 33136, USA. Email: cesar.mendoza2@jhsmiami.orgSearch for more papers by this authorDiego Celli MD, Diego Celli MD orcid.org/0000-0002-8545-8664 Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida, USASearch for more papers by this author First published: 05 January 2021 https://doi.org/10.1111/jocs.15243Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume36, Issue2February 2021Pages 678-679 RelatedInformation

Determining prosthesis‐patient mismatch after TAVR: Which is the best method?

Determining prosthesis‐patient mismatch after TAVR: Which is the best method?

Abstract 17133: The Use of Novel Hematological Markers in Predicting Stroke After TAVR Using a Machine Learning Algorithm

Introduction: Aortic Stenosis is the most common valvular disorder with a predominance in the elderly. Trans-Aortic Valve Replacement (TAVR) has been an effective procedure with marked improvement in quality of life for patients. The procedure carries a small, yet clinically significant risk of stroke. The use of Neutrophil-Lymphocyte Ratios (NLR) and Platelet-Lymphocyte Ratios (PLR) have been growing as novel markers of systemic inflammation. We investigated the ability of a machine learning algorithm (Light GBM) to predict and weigh these ratios along with other clinical parameters for prediction of stroke after TAVR. Objective: To demonstrate the efficacy of the Supervised Machine Learning algorithm, Light GBM, in identifying important variables to predict stroke after TAVR. Methods: We performed a retrospective analysis of 291 patients who underwent TAVR from 2015-2019 at Montefiore Medical Center. Age (80±8), 50.2% Female, BMI (28.7 ±6.3). Clinical data was collected through our Hospital EMR. NLR and PLR averages were obtained using the mean of baseline (prior to surgery), Immediate Post-operative, and Post-operative Day 1 values. A supervised machine learning algorithm, Light GBM, used decision tree algorithms with both level-wise growth and leaf-wise growth. The algorithm was trained on 80% of the data and internally validated on the other 20%. Results: We identified NLR and PLR as the second and third most important feature of importance (Table 1) Clinical and demographic features of importance included BMI, Age, and Sex. Our model when internally validated yield a Sensitivity of 75.0%, Specificity of 91.5%, Accuracy of 91.5%, and F1 of 0.75. The AUC for the model was 0.84. Conclusions: Using Novel hematological parameters in conjunction with machine learning algorithms have highlighted important variables in predicting stroke after TAVR. Extrapolated, average NLR and PLR can be an inexpensive tool in stratifying patients those patients most at risk.

Cardiovascular outcomes of concurrent TAVR and PCI compared to TAVR alone using the U.S. national inpatient sample: 2011–2014

Abstract Introduction The high concurrent prevalence of coronary artery disease (CAD) in patients with severe aortic stenosis (AS) inevitably forces experts to face a pressing decision whether to revascularize and replace the aortic valve at the same time. While current recommendations support combined transaortic valve replacement (TAVR) and percutaneous coronary intervention (PCI) for treatment of ostial/proximal lesions, or in unstable patients, less clear indications exist for patients not fulfilling this pattern. The population undergoing concomitant TAVR and PCI can be clinically challenging and thus it is important to further characterize prognosis and major cardiovascular outcomes in this cohort. Purpose To assess the likelihood of major cardiovascular events in patients undergoing TAVR with PCI during the same hospital admission compared to those with TAVR only. As well as to have a better understanding of the risks and possible benefits of a combined procedure and thus aid in clinical decision-making. Methods This study used the National Inpatient Sample (NIS) of patients undergoing a TAVR from 2011 to 2014. The NIS is a stratified systematic random sample of 20% hospital admissions in the United States. Internal Classification of Diseases Ninth Revision-Clinical Modification procedure codes were used to identify all patients that underwent a PCI and/or TAVR during the same admission. Patients aged greater than 50 years were included. Outcomes of interest included all-cause in-hospital mortality, new TIA/ischemic stroke, cardiogenic shock, cardiac arrest, hemopericardium, and length of stay. Multivariate logistic regression was used to adjust for patient and procedural confounders. Results Among the 33,652 patients who underwent TAVR between 2011 and 2014, 1,179 underwent a PCI during the same hospital admission. The adjusted odds of all-cause in-hospital mortality was 3.05 (95% CI 1.95–4.75) in those with a TAVR+PCI compared to TAVR only. The adjusted odds of cardiac arrest and cardiogenic shock was 2.50 (95% CI: 1.48–4.22) and 4.85 (95% CI 3.05–7.7), respectively. Furthermore, the odds of a new TIA/ischemic stroke during the same admission was 0.86 (95% CI 0.35–2.07) and odds of hemopericardium was 3.13 (95% CI: 0.71–13.70). Conclusion Concomitant PCI and TAVR during the same hospitalization was associated with higher all-cause in-hospital mortality, increased length of stay, cardiogenic shock, and cardiac arrest but does not appear to increase the likelihood of stroke/TIA. While this suggest worse outcomes in the cohort undergoing both procedures, the initial indications for these patients to receive a PCI might predispose them to these outcomes. Funding Acknowledgement Type of funding source: None

Conduction defect rates in high risk surgical patients undergoing TAVR with or without PCI during a single hospitalization: a nationwide study

Abstract Introduction Since the first documented transaortic valve replacement (TAVR) by Cribier et. al. in 2002 as a less invasive treatment approach for severe aortic stenosis (AS) and following the landmark PARTNER 1 trial, the Food and Drug Administration (FDA) approved TAVR in 2012 for patients deemed to be at high surgical risk. In recent years, there has been an expansion of indications to include low surgical risk candidates. Risk factors associated with aortic stenosis overlap with those for coronary artery disease, and up to 40–70% of patients referred for replacement have incidental obstructive coronary lesions. The best timing of intervention for concurrent pathology has been a subject of debate; recommendations support combined TAVR and percutaneous coronary intervention (PCI) for treatment of ostial/proximal lesions or in unstable patients. TAVR is not free of complications and a concern has been on post-deployment alterations of the heart's electrical system that may result in need for permanent pacemaker (PPM) implantation. Purpose To secure the aortic valve in place during a TAVR, there is a known risk of inducing a conduction disturbance. This study examined conduction abnormalities in patients undergoing a concurrent TAVR and PCI during the same hospitalization. Methods The patient population was obtained from the Nation Inpatient Sample database, which is a stratified systematic random sample of 20% hospital admissions in the USA. ICD-9 Revision-Clinical Modification procedure codes were used to identify all patients undergoing PCI and TAVR during the same admission between 2011 and 2014. Patients 50 years and older were included. Those with a history of a PPM were excluded. Outcomes of interest included new PPM, left bundle branch block (LBBB), first degree/second degree/complete AV bock, all-cause in-hospital mortality, and length of stay. Multivariate logistic regression analysis was used while adjusting for patient and procedural confounders. Results Between 2011 and 2014, 29,998 patients underwent TAVR, of which 1070 had a concurrent PCI during the same hospital admission. There was no noted increase in odds of PPM (OR 0.42 95% CI: 0.010–1.72), LBBB (OR 1.89 95% CI 0.65–5.49), second degree AV block (OR 1.49 95% CI: 0.21–10.50), complete AV block (OR: 1.44, 95% CI: 0.57–3.63), atrial fibrillation (OR 0.95 95% CI: 0.46–1.94), or atrial flutter (OR 1.75 95% 0.38–7.94) in those undergoing PCI+TAVR compared to TAVR alone. The odds of all cause, in-hospital mortality was 4.44 (95% CI: 1.25–15.8) times greater in those with a PCI+TAVR during the same admission compared to TAVR alone. Length of stay was 7.5 days (95% CI: 7.25–7.75) in those undergoing a TAVR compared to 12.4 days (95% CI: 10.67–14.15) in those with a TAVR+PCI, p<0.0001. Conclusion Periprocedural PCI and TAVR during the same hospitalization does not further increase risk of major conduction defects or rates of pacemaker implantation. Funding Acknowledgement Type of funding source: None

Predictors of pacemaker dependency in patients implanted with a pacemaker after Transaortic valve replacement.

Introduction and objectivesThe development of complete AV block and the need for pacemaker implantation (PM) is the most frequent complication after Transaortic valve replacement (TAVR). In other PM clinical contexts, a higher percentage of ventricular stimulation has been associated with worse prognosis. The objective was to study the existence of predictors of PM dependence.MethodsWe identified 96 consecutive patients who had received a PM post-TAVR (all Core-Valve). We retrospectively analyzed this cohort with the aim of identifying predictors of a high and very high percentage of ventricular pacing (VP), PM dependency and survival.ResultsThe mean age was 82.3 years, with a mean logistic EuroSCORE of 17.1, 53% were women and 12% of patients had LVEF < 50%. The indication was complete AV block in 40.5%, and LBBB in 59.5%. Mean survival was 62.7 months, IQR [54.4–71]. The only independent predictor of mortality was the pre-TAVR logistic Euro-SCORE (RR = 1,026, p = 0.033), but not LVEF < 50%, VP > 50%, VP > 85% or PM dependence. In 73 patients PM rhythm was documented at the end of follow-up. Of these, 14 (19.2%) were considered dependent, and 37 (50.7%) presented VP > 50%. The post-TAVR complete AV block recovery rate was 67.8%. In multivariate analysis, female sex (HR = 5.6, p = 0.005), and indication of complete AV block vs. LBBB (HR = 15.7, p = 0.017) were independently associated with PM dependency.ConclusionsFemale sex and indication due to complete AV block were independent predictors of PM dependency during follow up. In our series of patients with mostly normal LVEF, a high percentage of stimulation does not influence prognosis.

Method for cost-effective trans aortic valve replacement device prototyping

&lt;p&gt;&lt;span&gt;Trans Aortic Valve Replacement (TAVR) has offered the cardiology sector of health a new alternative to open heart surgeries which treat aortic stenosis. The technologies used by TAVR manufacturers are kept private. Our research goal was to develop a process that allows college level laboratories to fabricate their own TAVR stents in order to research new designs and methods of fabrication which may improve current TAVR practices. By creating a solid model of a stent cell design in SolidWorks, we were able to export a cutting pattern we used with a waterjet. The stent frame was then hand polished to prepare for fabric skirting and leaflet attachment. Synthetic ripstop fabric was cut using a commercial fabric cutting machine and attached to the frame using a waterproof glue. Future research entails welding techniques, improved polishing methods, and implantation into a mechanical system. This prototype could be used for TAVR related research and surgical training simulations.&lt;/span&gt;&lt;/p&gt;

PERICARDITIS: A RARE COMPLICATION OF TRANSCATHETER AORTIC VALVE REPLACEMENT

Transaortic valve replacement (TAVR) is a treatment for severe aortic stenosis. Current TAVR complications are related to vascular access, valve deployment, valve function, organ injury, and arrhythmia. We present a rare scenario where a patient developed acute pericarditis shortly after TAVR. 77

IN-HOSPITAL STROKE AFTER TAVR AND SAVR IN RENAL TRANSPLANT PATIENTS

Renal transplant recipients undergoing aortic valve replacement (SAVR) have high operative risk, whereas transaortic valve replacement (TAVR) can be a potentially safer option. We aim at assessing outcomes of TAVR and SAVR among renal transplant patients. Renal transplant patients who were

Von Willebrand factor (VWF) as a determinant of silent cerebral microbleeds during TAVR in a prospective MRI cohort

Cerebral microbleeds have been observed in “asymptomatic” elderly patients undergoing systematic MRIs and might be related with cognitive decline. A defect in Von Willebrand factor (VWF) after Trans Aortic-valve Replacement (TAVR) enhanced bleeding risk and possibly contributes to vascular malformations. To define the occurrence of “acute” microbleeds during TAVR and the clinical and procedural factors associated with this occurrence including a post-procedural defect in VWF. A prospective cohort of patients with aortic stenosis referred for TAVR was included. A standardized neurological assessment, a cerebral magnetic resonance imaging (MRI) and a biological analysis including quantification of VWF multimers and PFA-CADP were performed before and after TAVR. Eighty-four patients completed the imaging protocol. On pre-procedural MRI, 22 patients (26%, 95%CI = 17–37%) had at least one microbleeds. After TAVR, new microbleeds were observed in 19 (23%, 95%CI = 14–33%) patients. The occurrence of new microbleeds was independent of the presence microbleeds at baseline. A lower HMW-multimer-ratio as measured immediately at the end of the procedure was associated with the occurrence of new microbleed detected on the MRI performed 3 days after the procedure (0.90 ± 0.14 vs. 1.06 ± 0.27, P = 0.009). The same observation was made with a higher CT-ADP (165 ± 72 vs. 127 ± 57, P = 0.02). A prolonged procedure (RR = 1.21 [1.01–1.170] for every 5 min of fluoroscopy time, P = 0.04) and post-procedural acquired-VWF-defect (RR = 1.42 [1.08–1.89] for every lower “0.1 unit” of HMW-multimer-ratio, P = 0.004) were the only factors associated with the occurrence of new post-procedural microbleed(s). We report for the first time a high incidence (23%, 95%CI = 14–33%) of new post-procedural cerebral microbleeds occurring during TAVR. Procedural management and persistence of acquired-VWF defect could play a major role in the occurrence of those new microbleeds.

1644 Unusual management of dislodged TAVR prosthesis, Nightmare in Cath lab

Abstract Introduction The Trans aortic valve replacement( TAVR) is well established technique that is basically designed for patient with sever aortic stenosis with high surgical risk. We describe a TAVR procedure was complicated with valve dislodgment and treated without surgical intervention Case report 75 year old Female Patient hypertensive, diabetic, Hypothyroidism and Atrial Fibrillation on oral anticoagulation. Her transthoracic echocardiography(TTE) showed sever critical aortic valve stenosis and calculated aortic valve are was 0.6 cm² and Peak gradient is 68mmhg and mean 46 mmHg , sever Left ventricular dysfunction and estimated EF 25 % . The CT Aortogram showed The aortic annulus maximum transverse diameter measures was 30 mm and the anteroposterior diameter was 25 mm. The sinus of Valsalva measures 37 mm was Sino tubular junction measures 24 mm and the proximal ascending aorta measures 39 mm. There is no evidence of coronary artery disease by the CT coronary angiogram. Because of depressed LV function, it was decided to do the TAVR with ECMO (Extra Corporeal Membrane Oxygenation) support. Based on CT measurements, CoreValve29 was selected The native valve is pre dilated then CoreValve29 was advanced. Unfortunately valve was larger than the aortic annulus and during trial to valve deployment ( Fig A) ,valve jumped into proximal ascending aorta in opining position just few centimeters from coronary ostium ( Fig B). We advance balloon for maximum dilatation of core valve 29 to ensure fixation of valve in ascending aorta and complete opening of valve leaflets. A second smaller valve (coreValve26) was advanced through the dislodged valve and crossing through its leaflet of first core valve (which settled in aorta) and successfully reaches the aortic annulus and confirming proper positioning of the coreValve26 and then deployed safely The coreValve26 was deployed in acceptable position and coreValve29 was hooked and well-fixed to 26 valves in proximal ascending aorta (Fig C). Coronary flow was secured and confirmed by aortic root injection (Fig F). Patient kept supported on ECMO before and during the TAVR procedure. The patient tolerated the procedure and was stable hemodynamically throughout the procedure. Successful ECMO weaning and patient hemodynamically remained stable with Total bypass time on ECMO was 142 minutes. Post procedure chest X ray showed two corValves hooked together in aortic root and ascending aorta in (Fig D). Follow up TTE showed improved EF systolic LV function (EF 39 %). Normal functioning aortic valve prosthesis. Conclusion Up to our knowledge, this is the first case that valve dislodgment was treated percutaneously not required urgent surgical intervention. Although it is one case report, however it could open the ideas for new approach how to manage difficult cases with dislodged valve with percutaneous approach. Abstract 1644 Figure.