Transcatheter Aortic Valve Replacement in Left Ventricular Assist Device Patients with Aortic Regurgitation
Mark N. BelkinTeruhiko ImamuraTakeo FujinoAnthony J. KanelidisLuise HolzhauserImo EbongNikhil NarangJohn E. BlairSandeep NathanJonathan PaulAtman P. ShahBen ChungAnn NguyenB. SmithSara KalantariJ. RaikhelkarTakeyoshi OtaValluvan JeevanandamGene KimDaniel BurkhoffGabriel SayerNir Uriel
0
Citation
0
Reference
10
Related Paper
Abstract:
Background: Development of aortic regurgitation (AR) following left ventricular assist device (LVAD) implantation is common, and it is associated with a poor prognosis. Transcatheter aortic valve replacement (TAVR) has become a mainstay therapy for patients with severe aortic stenosis, with an off-label use for severe AR. The aim of this study was to assess the feasibility and durability of TAVR in LVAD patients with significant AR. Methods: We evaluated all LVAD patients within our database that underwent TAVR for AR. Clinical and echocardiographic data were collected before and after TAVR procedure. Aortic regurgitant fraction (RF) was calculated using outflow graft Doppler echocardiography. Results: Seven patients underwent nine attempted TAVR procedures. Median age was 69 (IQR 63–73) and 43% were female. Median time from LVAD to TAVR was 23 (IQR 17–52) months. One procedure was aborted due to vascular complications, and one patient underwent two separate procedures 22 months apart. Five patients (71%) survived over median follow-up of 9 (IQR 6–23) months. Two patients died of paravalvular complications following device deployment. Procedural success was achieved in 67% of attempts, with significant improvement in RF from 44.8% (IQR 37.6–63.6) pre-procedurally to 28.1% (IQR 0.30–29.6) at six-month follow-up. Qualitatively, mild or moderate paravalvular leak was noted on all surviving patients at one- and six-month follow-up. There was significant improvement in right ventricular function at 6-month follow-up. Conclusion: TAVR is a reasonable option for treating LVAD-induced AR. Longer follow-up and larger cohorts are needed to assess the durability and long-term efficacy of this procedure. Abbreviations: AR: Aortic regurgitation; AV: Aortic valve; LV: Left ventricle; LVAD: Left ventricular assist device; LVIDd: Left ventricular internal dimension at end-diastole; LVIDs: Left ventricular internal dimension at end-systole; PAPi: Pulmonary artery pulsatility index; RA: Right atrial; RF: Regurgitant fraction; RV: Right ventricle; RVEDA: Right ventricular end-diastolic area; RVFAC: Right ventricular fractional area change; RVSP: Right ventricular systolic pressure; TAPSE: tricuspid annular plane systolic excursion; TAVR: Transcatheter aortic valve replacement; TV: Tricuspid valveKeywords:
Aortic valve regurgitation
Commissure
Aortic Valve Insufficiency
Cite
Citations (8)
Quadricuspid aortic valve (QAV) is a rare congenital heart defect usually accompanied with different hemodynamic abnormalities. Due to the rarity of QAV, treatment and prognosis of QAV patients with aortic regurgitation still remain challenging. We here present the first case of a patient with severe QAV regurgitation who underwent successful treatment and performed favorable prognosis with transapical aortic valve implantation (TAVI) using J-Valve system.A 62-year-old man experienced intermittent palpitation, shortness of breath and chest pain. Echocardiography revealed congenital QAV with massive aortic regurgitation and mild aortic stenosis, left ventricular enlargement. Aortic valve replacement was successfully performed with TAVI using J-Valve system. The postoperation and follow-up was uneventful.TAVI using J-Valve system has emerged as a new high success rate method for treatment of patients with simple non-calcified aortic valve insufficiency.
Cardiothoracic surgery
Aortic Valve Insufficiency
Cite
Citations (4)
To review the surgical outcome of doubly committed subarterial (DCSA) ventricular septal defect repair.Data of 51 patients of doubly committed sub arterial Ventricular septal defect from January 2012 to June 2017 that were referred to Chaudhary Pervaiz Elahi institute of Cardiology Multan was retrospectively reviewed using electronic database. All patients were operated by first author. In our study, we segregated patients into four main groups depending on presence or absence of aortic structural defect and degree of aortic valve regurgitation. Group-A comprised of nineteen (37%) patients who neither had aortic structural nor functional abnormality while Group-B had six (11.7%) patients, having aortic valve cusp prolapse without aortic regurgitation. Group-C and Group-D consists of seventeen (33.3%) and nine (17.6%) patients respectively depending upon degree of aortic regurgitation. Furthermore, six (11.7%) patients among these 51 had associated defects as well.Group-A patients had no aortic valve regurgitation post operatively and at follow up of 22.6 months (1.8 years) as well. In Group-B, aortic valve was not addressed and aortic regurgitation was also not present post operatively or on follow up of 33.6 months (2.8 years). Similarly, in Group-C aortic valve was not addressed, these patients also did not show progression of disease on regular follow up of 18 months (1.5 year). While, in Group-D, eight patients underwent aortic valve repair and one patient had aortic valve replacement. Aortic regurgitation improved significantly in all patients of this group and remained unchanged on follow up of 22.7 months (1.8 years).Early closure of doubly committed subarterial ventricular septal defect with appropriate management of aortic valve disease can halt the process of disease progression.
Aortic valve regurgitation
Cite
Citations (3)
After follow up for seven years a 10 year old boy with congenital aortic regurgitation was found to have a tricuspid non-stenotic aortic valve at operation. The right coronary cusp was dysplastic, thickened, and contracted; the gap between its free margin and aortic wall was bridged with two fibrous bands; and the left coronary and non-coronary cusps were almost normal. The aortic valve was replaced with a prosthesis (St Jude Medical No 23), and the postoperative course was uneventful.
Aortic Valve Insufficiency
Aortic valve regurgitation
Cite
Citations (11)
Abstract Background: Quadricuspid aortic valve (QAV) is a rare congenital heart defect usually accompanied with different hemodynamic abnormalities. Due to the rarity of QAV, treatment and prognosis of QAV patients with aortic regurgitation still remain challenging. We here present the first case of a patient with severe QAV regurgitation who underwent successful treatment and performed favorable prognosis with transapical aortic valve implantation (TAVI) using J-Valve system. Case presentation: A 62-year-old man experienced intermittent palpitation, shortness of breath and chest pain. Echocardiography revealed congenital QAV with massive aortic regurgitation and mild aortic stenosis, left ventricular enlargement. Aortic valve replacement was successfully performed with TAVI using J-Valve system. The postoperation and follow-up was uneventful. Conclusion: Transapical aortic valve implantation (TAVI) using J-Valve system has emerged as a new high success rate method for treatment of high-risk patients with simple non-calcified aortic valve insufficiency.
Cite
Citations (0)
A 58-year-old male presented with a diastolic heart murmur was found to have a severe aortic regurgitation on cardiac evaluation. He was transferred to our department, and underwent an aortic valve replacement. During the operation, the aortic valve was recognized quadricuspid, including three equal cusps and one smaller accessory cusp. The finding was consistent with Hurwitz type b quadricuspid aortic valve. It was etiologically thought that the relatively small cusp decreased in size with the aging to produce some space, causing aortic regurgitation. Aortic valve was replaced with Carbomedics 23mm prosthetic valve uneventfully. Thirty-five reported cases are reviewed in terms of clinical features and surgical therapy.
Aortic valve regurgitation
Cite
Citations (0)
The accuracy in diagnosing aortic regurgitation was studied in 170 consecutive cineaortograms. In 85 patients (group A) cineaortograms were undertaken with Sones or Gensini catheters, which producea jet of contrast material directed towards the aortic valve. The other 85 patients (group B) underwent cineaortography with pigtail catheters, which may cause more equal distribution of contrast material in the aortic root. In group A, 31 of 71 patients (44%) without clinically known aortic valve disease showed angiographic grade I–III/IV aortic regurgitation. In group B only 8 of 61 patients (13%) without clinical evidence of aortic valve disease had grade I–II/IV aortic regurgitation on cineaortography. This difference is statistically significant (P<0.001). We conclude that catheters which produce a jet of contrast medium directed straight at the aortic valve can cause artificial trivial to moderate aortic regurgitation. Angiographic evaluation of aortic regurgitation should be performed with a catheter such as a pigtail or closed-end multiple sidehole catheter in which the contrast medium is not directed straight at the aortic valve.
Aortic valve regurgitation
Cite
Citations (4)
Objective To evaluate the application value of transthoracic echocardiography(TTE) in diagnosis the congenial aortic valve disease.Methods A total of 43 patients with congenial aortic valve diseases were enrdled,male 25,female 18,aged 4-46 years old,mean age 23.4 years old.Among these cases there were 7 homozygous familial hypercholesterolemia(HoFH),35 bicuspid aortic valve(BAV) malformation and 1 aortic valve downward displacement malformation.The results of transthoracic echocardiography were retrospective analyzed,and compared with color Doppler.Results Seven HoFH were characterized essentially with supravalvular aortic stenosis,calcified plaque involved aortic valve and aortic root,all patients had aortic regurgitation.Fourteen patients had aortic regurgitation(8 with moderate regurgitation and 6 with mild regurgitation) in 35 BAV patients,9 cases only showed aortic stenosis,12 patients had aortic stenosis and regurgitation together.Other 5 patients were accompanied by dilatation of ascending aorta.One patient of rare aortic valve downward displacement malformation only showed aortic valve regurgitation.Conclusion It is demonstrated that TTE could noninvasive diagnose congenial aortic valve diseases,and precise evaluation of the secondary changes.
Supravalvular aortic stenosis
Cite
Citations (0)
Cite
Citations (0)