Transcatheter Heart Valve Interventions Research Articles

Computed tomography imaging in preprocedural planning of transcatheter valvular heart interventions.

Cardiac Computed Tomography (CCT) has become a reliable imaging modality in cardiology providing robust information on the morphology and structure of the heart with high temporal and isotropic spatial resolution. For the past decade, there has been a paradigm shift in the management of valvular heart disease since previously unfavorable candidates for surgery are now provided with less-invasive interventions. Transcatheter heart valve interventions provide a real alternative to medical and surgical management and are often the only treatment option for valvular heart disease patients. Successful transcatheter valve interventions rely on comprehensive multimodality imaging assessment. CCT is the mainstay imaging technique for preprocedural planning of these interventions. CCT is critical in guiding patient selection, choice of procedural access, device selection, procedural guidance, as well as allowing postprocedural follow-up of complications. This article aims to review the current evidence of the role of CCT in the preprocedural planning of patients undergoing transcatheter valvular interventions.

Transcatheter heart valve interventions for patients with rheumatic heart disease.

Rheumatic heart disease [RHD] is the most prevalent cause of valvular heart disease in the world, outstripping degenerative aortic stenosis numbers fourfold. Despite this, global resources are firmly aimed at improving the management of degenerative disease. Reasons remain complex and include lack of resources, expertise, and overall access to valve interventions in developing nations, where RHD is most prevalent. Is it time to consider less invasive alternatives to conventional valve surgery? Several anatomical and pathological differences exist between degenerative and rheumatic valves, including percutaneous valve landing zones. These are poorly documented and may require dedicated solutions when considering percutaneous intervention. Percutaneous balloon mitral valvuloplasty (PBMV) is the treatment of choice for severe mitral stenosis (MS) but is reserved for patients with suitable valve anatomy without significant mitral regurgitation (MR), the commonest lesion in RHD. Valvuloplasty also rarely offers a durable solution for patients with rheumatic aortic stenosis (AS) or aortic regurgitation (AR). MR and AR pose unique challenges to successful transcatheter valve implantation as landing zone calcification, so central in docking transcatheter aortic valves in degenerative AS, is often lacking. Surgery in young RHD patients requires mechanical prostheses for durability but morbidity and mortality from both thrombotic complications and bleeding on Warfarin remains excessively high. Also, redo surgery rates are high for progression of aortic valve disease in patients with prior mitral valve replacement (MVR). Transcatheter treatments may offer a solution to anticoagulation problems and address reoperation in patients with prior MVR or failing ventricles, but would have to be tailored to the rheumatic environment. The high prevalence of MR and AR, lack of calcification and other unique anatomical challenges remain. Improvements in tissue durability, the development of novel synthetic valve leaflet materials, dedicated delivery systems and docking stations or anchoring systems to securely land the transcatheter devices, would all require attention. We review the epidemiology of RHD and discuss anatomical differences between rheumatic valves and other pathologies with a view to transcatheter solutions. The shortcomings of current RHD management, including current transcatheter treatments, will be discussed and finally we look at future developments in the field.

Transcatheter valvular therapies in patients with left ventricular assist devices.

Aortic, mitral and tricuspid valve regurgitation are commonly encountered in patients with continuous-flow left ventricular assist devices (CF-LVADs). These valvular heart conditions either develop prior to CF-LVAD implantation or are induced by the pump itself. They can all have significant detrimental effects on patients' survival and quality of life. With the improved durability of CF-LVADs and the overall rise in their volume of implants, an increasing number of patients will likely require a valvular heart intervention at some point during CF-LVAD therapy. However, these patients are often considered poor reoperative candidates. In this context, percutaneous approaches have emerged as an attractive "off-label" option for this patient population. Recent data show promising results, with high device success rates and rapid symptomatic improvements. However, the occurrence of distinct complications such as device migration, valve thrombosis or hemolysis remain of concern. In this review, we will present the pathophysiology of valvular heart disease in the setting of CF-LVAD support to help us understand the underlying rationale of these potential complications. We will then outline the current recommendations for the management of valvular heart disease in patients with CF-LVAD and discuss their limitations. Lastly, we will summarize the evidence related to transcatheter heart valve interventions in this patient population.

On the Modeling of Transcatheter Therapies for the Aortic and Mitral Valves: A Review

Transcatheter aortic valve replacement (TAVR) has become a milestone for the management of aortic stenosis in a growing number of patients who are unfavorable candidates for surgery. With the new generation of transcatheter heart valves (THV), the feasibility of transcatheter mitral valve replacement (TMVR) for degenerated mitral bioprostheses and failed annuloplasty rings has been demonstrated. In this setting, computational simulations are modernizing the preoperative planning of transcatheter heart valve interventions by predicting the outcome of the bioprosthesis interaction with the human host in a patient-specific fashion. However, computational modeling needs to carry out increasingly challenging levels including the verification and validation to obtain accurate and realistic predictions. This review aims to provide an overall assessment of the recent advances in computational modeling for TAVR and TMVR as well as gaps in the knowledge limiting model credibility and reliability.

A first dedicated heart valve unit: safe and streamlined patient care for the rapidly growing field of transcatheter heart valve interventions

Abstract Background A dedicated Heart Valve Unit was launched in 2018 to meet the demands of the growing transcatheter heart valve program by optimizing patient care in a single dedicated unit. Purpose To assess the performance of the heart valve unit (all steps of patient care in a single unit with intermediate care facilities) over a conventional approach (preparation on a normal ward, postprocedural intensive care unit (ICU) monitoring and transfer to an additional monitoring ward before discharge) in a high volume center. Methods Retrospective analysis including patients undergoing transcatheter mitral or tricuspid valve repair who were admitted to the Heart Valve Unit (02/2018–01/2020) compared to a conventional patient care approach (02/2016–01/2018). Patients who were already preprocedurally admitted to the ICU or in whom ICU monitoring postprocedurally was mandatory (direct annuloplasty, valve replacement) were excluded. The Heart Valve Unit patient care algorithm is presented in figure 1. We assessed procedural numbers, length of hospital stay, length and need for ICU monitoring, patient transfers between wards and periprocedural safety including in-hospital mortality. Results We observed a 164% increase in procedures (521 vs. 316 in total, 369 vs 282 with mitral valve procedures and 152 vs 34 tricuspid valve procedures) with the launch of the Heart Valve Unit over the 2-year-interval compared to the earlier time period. Length of in-hospital stay was significantly decreased compared to a conventional approach (9±7 vs. 12±11 days, p<0.001). In particular, postprocedural stay could be shortened from 7±7 to 5±6 days (p<0.001). Patients were less transferred between different wards in the Heart Valve Unit setting (p<0.001). Whereas all patients were postprocedurally transferred to the ICU in the conventional setting, only 16% of patients required an ICU bed immediately after the procedure due to complex interventions, intraprocedural events or high-risk comorbidities. The length of stay on ICU declined from 1.4±1.4 to 0.5±2.2 days. Among the patients re-transferred to the Heart Valve Unit directly after the procedure, 2% (10 patients) required an ICU bed in the further course due to hemodynamic instability (2), severe bleeding (4), seizures (1), ventricular fibrillation (1), anaesthetic overhang (1) or after urgent surgery due to a atrioventricular fistula (1). After stabilization, all patients were re-transferred to the Heart Valve Unit and discharged hereinafter. There was no intra-hospital death among these patients. Conclusions A dedicated Heart Valve Unit allows a safe and optimized patient care structure for transcatheter valvular interventions by combining all pre- and postprocedural steps in a single unit, thereby decreasing length of in-hospital stay to meet increasing economic demands. ICU capacity can be specifically used for complex procedures aftercare and complication monitoring. Funding Acknowledgement Type of funding sources: None.

Percutaneous Valve Interventions in Heart Failure

Heart failure remains a major cause of morbidity and mortality despite advances in guideline directed medical and electrophysiologic device therapies. Valvular heart disease (VHD) is common in heart failure patients and independently associated with poor outcomes. This review provides an update in the rapidly evolving field of transcatheter heart valve interventions (THVI) in the management of heart failure. Aortic stenosis (AS) may cause or worsen heart failure. Functional mitral regurgitation (FMR) and functional tricuspid regurgitation (FTR) occur secondary to heart failure and contribute to ongoing adverse remodeling. Each of these valvular lesions is independently associated with worse clinical outcomes including mortality. Transcatheter aortic valve replacement (TAVR) has revolutionized the management of AS. Challenges unique to the mitral and tricuspid valves are being answered by a multitude of different device designs with promising early data, most notably for edge-to-edge leaflet repair. Unbridled innovation in THVI technologies stand to dramatically alter the management of VHD in heart failure patients. Here we will review the complex interactions between VHD and heart failure, appraise the data surrounding THVI devices, and discuss opportunities for future research.

Treatment decision for transcatheter aortic valve implantation: the role of the heart team : Position statement paper of the Dutch Working Group of Transcatheter Heart Interventions.

The current paper presents a position statement of the Dutch Working Group of Transcatheter Heart Valve Interventions that describes which patients with aortic stenosis should be considered for transcatheter aortic valve implantation and how this treatment proposal/decision should be made. Given the complexity of the disease and the assessment of its severity, in particular in combination with the continuous emergence of new clinical insights and evidence from physiological and randomised clinical studies plus the introduction of novel innovative treatment modalities, the gatekeeper of the treatment proposal/decision and, thus, of qualification for cost reimbursement is the heart team, which consists of dedicated professionals working in specialised centres.

Current status and future perspective of transcatheter heart valve interventions in China

随着人口老龄化，心脏瓣膜病的发病率逐年上升，严重威胁着我国人民的生命健康。近年来随着心脏瓣膜病介入治疗技术的蓬勃发展，心脏瓣膜病的治疗取得了重大突破。本文对我国心脏瓣膜病介入治疗的现状进行了系统的阐述并对其未来进行了展望。.

Transcatheter heart valve interventions: where are we? Where are we going?

Transcatheter heart valve interventions have transformed the outcomes of patients with valvular heart disease (VHD) who are unfavourable candidates for surgery. Technological advances have allowed extension of these interventions to younger or lower risk patients and those with other forms of VHD and may in the future permit earlier treatment of VHD in less symptomatic patients or those with moderate disease. The balance of risks and benefits is likely to differ between lower and higher risk patients, and more evidence is needed to evaluate the net benefit of transcatheter technology in these groups. As academic researchers, clinicians, industry, and patient stakeholders collaborate to research these broader indications for transcatheter valve interventions, it is essential to address (i) device durability and deliverability, (ii) specific anatomical needs (e.g. bicuspid aortic valves, aortic regurgitation, mitral and tricuspid valve disease), (iii) operator training, and (iv) the reinforced importance of the multidisciplinary Heart Team.

Highlights from EuroEcho-Imaging 2016 Congress of the European Society of Cardiology, Leipzig, Germany.

Highlights from EuroEcho-Imaging 2016 Congress of the European Society of Cardiology, Leipzig, Germany.

Expanding Indications of Transcatheter Heart Valve Interventions.

Transcatheter aortic valve replacement (TAVR) has been established as a less invasive alternative to open-heart surgery in inoperable or high-risk patients presenting with symptomatic severe aortic valve stenosis. The feasibility and efficacy of valve-in-valve implantation in degenerated surgical aortic bioprostheses have also been described and can currently be considered a valuable treatment option in patients deemed unsuitable for repeat cardiac surgery. However, the clinical use of TAVR devices is not limited to the treatment of the tricuspid stenotic aortic valve. Several additional indications including treatment of the bicuspid stenotic aortic valve, aortic regurgitation, and valve-in-valve or valve-in-ring implantation in the mitral or tricuspid position as well as treatment of pure mitral, tricuspid, or pulmonary regurgitation have been described. The purpose of the present review is to summarize the available evidence concerning the emerging off-label use of TAVR devices in current clinical practice. Case examples have been selected to highlight the main procedural steps of each particular intervention.

The Year in Cardiology 2013: valvular heart disease (focus on catheter-based interventions)

2013 was the year of transcatheter heart valve interventions. Not least because of the 2012 European guidelines on the management of valvular heart disease (VHD), the multidisciplinary heart team approach became an established concept. Decision-making, when a patient is too 'sick' for surgery and too 'healthy' for catheter-based interventions, is complex, since VHD is often seen at an older age and, as a consequence, there is a higher frequency of co-morbidity and frailty. However, before TAVI and other transcatheter heart valve interventions can be expanded to intermediate-risk patients, evidence in favour of this less invasive treatment has to be provided by upcoming randomized clinical trials.

Transcatheter aortic valve implantation and closure of the left atrial appendage under cerebral protection

An 80-year-old male patient with symptomatic, severe aortic stenosis, coronary artery disease and permanent atrial fibrillation was referred for transcatheter aortic valve implantation (TAVI). After staged percutaneous coronary intervention of the LAD with drugeluting stents, he suffered from recurrent lower gastro-intestinal bleeding under triple anticoagulation (acetylsalicylic acid, clopidogrel, and phenprocoumon). Due to high surgical risk (STS score 11.8%) and high risk for stroke (CHA2DS2-VASC score 6) and recurrent bleeding (HASBLED score 4), he underwent transfemoral TAVI (CoreValve 29 mm bioprosthesis; Medtronic, Minneapolis, MN, USA) and closure of the left atrial appendage (Watchman 27 mm device; Boston Scientific, Natick, MA, USA) with periprocedural use of a novel cerebral protection device (CE Pro; Claret Medical Inc., Santa Rosa, CA, USA) via right-sided transbrachial access. The proximal and distal filters were deployed within the innominate artery and the left common carotid artery, respectively (Figure 1A and Figure 1B). TAVI and LAA closure under TEE guidance were then successfully performed (Figure 1C Figure 1E). After retrieval of the cerebral protection device, debris and embolic material were found to be captured within the filters (Figure 1F). The patient was discharged uneventfully on day six. Not only transcatheter heart valve interventions but also other structural heart procedures with transseptal puncture and introduction of a sheath into the left atrium for closure of the LAA or mitral valve interventions bear the potential risk of periprocedural cerebral embolism and stroke that may be reduced by use of a dedicated cerebral protection device.

Terms of agreement between the Austrian Society of Cardiology and the Austrian Society of Thoracic and Cardiovascular Surgery on transcatheter heart valve interventions*

BACKGROUND: Due to the increasing volume of transcatheter heart valve interventions, we place on record the terms of the agreement reached between the Austrian Society of Cardiology (OKG) and the Austrian Society of Thoracic and Cardiovascular Surgery (OGTHC) regarding these procedures as follows. METHODS: The paper is based on the guidelines of the European societies, a review of the PubMed literature, as well as information from the medical industry. RESULTS: Currently, transcatheter-based aortic and pulmonary implantation are performed as well as transcatheter-based procedures for mitral valve insufficiency. In all cases the indication should be decided jointly by the cardiologist and the cardiac surgeon. Furthermore, these procedures should only be performed in centres where both specialists are available on site. Only patients with either congenital or acquired heart valve disease who are at very high risk of morbidity and mortality with medical or standard surgical therapy should undergo transcatheter heart valve intervention. CONCLUSIONS: According to current literature, recommendations for transcatheter heart valve interventions are only based on level of Evidence C (Consensus of Expert Opinion).