Residual aortic regurgitation (AR) complicates a not negligible number of transcatheter aortic valve replacement (TAVR) procedures, and its entity is not always clear at intraprocedural angiographic ...and echocardiographic control. We applied a minimally invasive hemodynamic monitoring system (Pressure Recording Analytical Method, PRAM) in the setting of TAVR, with the aim of identifying parameters that may help in detection and quantification of residual AR.
We performed hemodynamic monitoring with PRAM in 43 patients undergoing trans-femoral TAVR. Investigated parameters were systolic (Psys, mm Hg), diastolic (Pdia, mm Hg), mean (MAP, mm Hg) and dicrotic pressure (Pdic, mm Hg), cardiac output (CO, L/min), stroke volume (SV, mL), cardiac cycle efficiency (CCE, Units), dP/dtmax_rad (mm Hg/ms), MAP-Pdic (mm Hg).
Procedural success was achieved in 86% of the patients; vascular complications occurred in 3 (6.9%), death in 2 (4.7%). Twenty (46.5%) patients had at least mild residual AR. CO, SV, CCE and dP/dtmax_rad changed significantly (p < 0.001) between baseline and end of procedure in the overall population, with more evident modifications in the subgroup without residual AR. MAP-Pdic variations were statistically significant only in the subgroup without AR (p = 0.05).
TAVR determined an improvement in hemodynamic parameters such as CO, SV, CCE, dP/dtmax_rad. MAP-Pdic was able to discriminate patients with significant residual AR. Hemodynamic monitoring with PRAM system during TAVR is easy and fast to obtain and may help in clinical decision-making in controversial cases.
•Residual aortic regurgitation is still an important issue after TAVI•Available diagnostic tools as echocardiography and angiography are not accurate in the evaluation of residual AR during TAVI•A minimally invasive hemodynamic monitoring system may provide intraprocedural quantification of residual AR
The DESolve (Elixir Medical Corporation, Sunnyvale, California, USA) is a poly-L lactide-based polymer scaffold coated with the antiproliferative and anti-inflammatory drug novolimus. The scaffold ...biodegrades within one year with a complete resorption in two years and
bench test have shown the ability to supply the necessary radial strength to support the vessel for the critical 3- to 4-month period after implant. The DESolve showed the unique self-correction property, which may reduce the incidence of minor malapposition after deployment. Overexpansion with DESolve is safe since a high capability resistance to fracture has been demonstrated with this scaffold. The aim of this review is to provide a comprehensive overview of the available preclinical and clinical data regarding the DESolve.
Abstract
Aims
The presence of severe calcific atherosclerosis at the iliofemoral axis may preclude transcatheter aortic valve implantation (TAVI) by transfemoral (TF) approach. Intravascular ...lithotripsy (IVL) is a novel technology that fractures intimal/medial calcium and increases vessel compliance allowing TF-TAVI in selected patients with peripheral artery disease (PAD). To report on the safety and efficacy of IVL-assisted TF-TAVI in an all-comers population.
Methods and results
Clinical, imaging and procedural data on all consecutive patients treated by IVL-assisted TF-TAVI in six high-volume European centres (2018–2020) were collected in this prospective, real-world, multicentre registry. IVL-assisted TF-TAVI was performed in 108 patients, increasing from 2.4% to 6.5% of all TAVI in 2018 to 2020, respectively. The target lesion was most often localized at the common and/or external iliac artery (93.5% of cases; average TL-MLD 4.6 ± 0.9 mm with 318 degrees of calcium arc). Transfemoral aortic valve delivery was successful in 100% of cases; final procedural success in 98.2% (two conversion to cardiac open surgery for annular rupture and valve migration). Complications of the IVL-treated segments consisted of one perforation and three major dissections requiring stent implantation (two covered stents and two BMS). Access site related complication included three major bleedings. Three in-hospital deaths were recorded (2.8%, one failed surgical conversion after annular rupture, one cardiac arrest after initial valvuloplasty, one late hyperkalaemia in renal dysfunction).
Conclusions
IVL-assisted TF-TAVI proved to be a safe and effective approach, which helps expanding the indications for TF-TAVI in patients with severe calcific PAD. Still, these patients maintain a higher than average incidence of peri-procedural complication.
Abstract Objective The aim of this study was to investigate interactions among pre-procedural aortic regurgitation (AR), post-procedural paravalvular leak (PVL) and long-term clinical outcomes. ...Methods and results We analyzed data prospectively collected in the Italian Transcatheter balloon-Expandable Registry (ITER) on aortic stenosis (AS) patients. The degree of pre-procedural AR and post-procedural PVL was stratified as: absent/trivial, mild, and moderate/severe. VARC definitions were applied to outcomes. Of 1708 patients, preoperatively, AR was absent/trivial in 40% of the patients, mild in 42%, and moderate in 18%. Postoperatively, PVL was moderate–severe in 5%, mild in 32% of patients, and absent/trivial in 63%. Clinical follow-up, median 821 days (IQR 585.75), was performed in 99.7% of patients. PVL, but not preoperative AR, was a major predictor of adverse outcome (HR 1.33, CI 95% 0.9–2.05, p = 0.012 for mild PVL, HR 1.36, CI 95% 0.9–2.05, p < 0.001 for PVL ≥ moderate and OR 1.04, p = 0.97 respectively). Patients with moderate–severe PVL and preoperative left ventricle (LV) dilatation (LVEDVi > 75 ml/m2 ) showed better survival than those without dilatation (HR 8.63, p = 0.001). Conclusions In patients with severe AS treated with balloon-expandable TAVI, the presence of PVL, but not pre-procedural AR, was a major predictor of adverse outcome. Preoperative LV dilatation seemed to offer some clinical advantages.
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