Last Build Date: Tue, 22 Mar 2016 08:28:42 +0100
Tue, 22 Mar 2016 05:43:04 +0100The introduction of transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis, especially in high-risk patients and in the elderly. These patients would be considered either high risk or not eligible for surgical aortic valve replacement. The pivotal PARTNER-B (Placement of Aortic Transcatheter Valves) trial, which evaluated TAVR in high-risk U.S. patients, enrolled 358 patients (mean age 83 years) with aortic stenosis not considered to be suitable candidates for surgery and randomized them to TAVR versus continuing medical therapy (1). At 1 year, the death rate was 31% with TAVR versus 51% with medical therapy (p < 0.001). At 1 year, New York Heart Association functional class III or IV symptoms occurred in 25% of TAVR patients versus 58% of medi...
Tue, 22 Mar 2016 05:43:04 +0100This study sought to prove that microvascular dysfunction is responsible for chest pain in patients with severe AS and normal epicardial coronary arteries using adenosine-stress cardiac magnetic resonance (CMR) imaging.MethodsBetween June 2012 and April 2015, 117 patients with severe AS without obstructive CAD and 20 normal controls were enrolled prospectively. After exclusions, study patients were divided into 2 groups according to presence of exertional chest pain: an angina group (n = 43) and an asymptomatic group (n = 41), and the semiquantitative myocardial perfusion reserve index (MPRI) was calculated.ResultsMPRI values were significantly lower in severe AS patients than in normal controls (0.90 ± 0.31 vs. 1.25 ± 0.21; p < 0.001), and were much lower in the angina group than the...
Tue, 22 Mar 2016 05:43:04 +0100In this issue of the Journal, Ahn et al. (1) correlate an index of relative myocardial perfusion reserve (MPRI) by magnetic resonance imaging (MRI) in patients with aortic stenosis (AS) and angina pectoris, those with AS without angina, and control patients without aortic stenosis. The results confirm previously established inverse relationships of coronary flow reserve (CFR), severity of AS, and left ventricular (LV) hypertrophy (LVH) or mass. They sorted data into 3 groups in Figure 4 (1): patients with the most severe AS with angina, those with less severe AS without angina, and control subjects with no AS, LVH, or angina for the expected continuum of clinical AS in Figure 5. On the basis of the reduced mean MPRI in the AS-angina group, the authors conclude that microvascular dysfunc...
Tue, 22 Mar 2016 05:43:04 +0100Transcatheter aortic valve replacement (TAVR) has become a safe and effective therapy for patients with severe aortic stenosis (AS). In recent trials, the hemodynamic performance and clinical outcomes of the latest generation of TAVR devices demonstrated at least parity with surgical outcomes in patients of similar risk. Many initial obstacles with TAVR have largely been overcome, including frequent access site complications and concerns about strokes and paravalvular leaks. Using a multidisciplinary heart team approach, patient selection, procedural planning, and device implantation have been refined and optimized such that clinical outcomes are generally predictable and reproducible. Future research will focus on the durability of TAVR devices, further enhancements in clinical outcomes, ...
Mon, 21 Mar 2016 00:00:00 +0100CONCLUSIONS BAV patients with aortic valve dysfunction and normal-sized ascending aorta are at considerably low risk of late adverse aortic events after isolated AVR. (Source: Interactive CardioVascular and Thoracic Surgery)
Mon, 21 Mar 2016 00:00:00 +0100A best evidence topic was written according to a structured protocol. The question addressed was: is cardiac magnetic resonance (CMR) imaging as accurate as echocardiography in the assessment of aortic valve stenosis? Altogether 239 papers were found using the reported search. Only 12 demonstrated the best evidence to answer the clinical question. Nine of these 12 papers found CMR to correlate well with transthoracic echocardiography (TTE) or transoesophageal echocardiography (TOE) in the evaluation of aortic valve stenosis. When aortic valve areas were measured with cardiac tomography (CT) or cardiac catheterization (CC), four papers found CMR to be more accurate than TTE. Eight of 12 papers found CMR to have excellent reliability and reproducibility, as demonstrated by the low inter- and...
Sat, 19 Mar 2016 00:00:00 +0100In patients with symptomatic severe aortic stenosis, advanced age is often a reason for a transcatheter rather than surgical aortic valve replacement. In this pre-transcathter cohort we had the unique oportuni... (Source: Journal of Cardiothoracic Surgery)
Fri, 18 Mar 2016 00:00:00 +0100Authors: Vahl TP, Hahn RT, Moses JW Abstract Over the past decade, transcatheter aortic valve replacement (TAVR) has established itself as an important alternative to surgical AVR for patients with symptomatic severe aortic stenosis who have a high or prohibitive surgical risk. The success of this breakthrough technology was propelled by data from several randomized controlled trials and large registries.(1, 2) Over this period the technology has been serially refined to overcome many key limitations. Procedural planning and execution have been largely standardized, making TAVR a mature method with reproducible outcomes across a growing spectrum of patients. The general simplicity of the TAVR procedure, compared with traditional surgery, combined with excellent outcomes of this min...
Thu, 17 Mar 2016 15:01:05 +0100CONCLUSIONS: Sutureless AVR can be used safely in elderly high risk patients with relatively low morbidity and mortality. The device can be safely implanted via a minimally invasive incision. Mid-term hemodynamic results are satisfactory, demonstrating significant clinical improvement. PMID: 26979006 [PubMed - in process] (Source: The Israel Medical Association Journal)
Thu, 17 Mar 2016 00:00:00 +0100CONCLUSIONS: Native T1 relaxation time and ECV at 10 min after contrast administration are accurate markers of DMF. PMID: 26984717 [PubMed - as supplied by publisher] (Source: Circulation Journal)
Wed, 16 Mar 2016 13:26:03 +0100CONCLUSION: We found a significant relationship between PLR and AS. PMID: 26974393 [PubMed - as supplied by publisher] (Source: Future Medicine: Biomarkers in Medicine)
Wed, 16 Mar 2016 13:07:07 +0100We report the case of a TTTS recipient with moderate cardiomyopathy at diagnosis who developed progressive calcification of the pulmonary arteries and aorta after successful in utero laser therapy. Postnatally, both twins were diagnosed with a heterozygous ABCC6 gene mutation associated with GACI. The recipient had progressive supravalvular pulmonary and aortic stenosis, was treated with bisphosphonate therapy, and successfully underwent cardiac surgery at 4 months of age. The donor twin with the same mutation remained phenotypically normal at 15 months of age. This case illustrates monozygotic fetuses with discordant in utero hemodynamics, with subsequent development of phenotypic differences. TTTS recipients with arterial calcifications should undergo genetic testing for GACI.Fetal Diagn...
Wed, 16 Mar 2016 00:00:00 +0100(Source: European Journal of Echocardiography)
Wed, 16 Mar 2016 00:00:00 +0100Conclusion The employed non-contrast 3D-FLASH MRA protocol allows for reliable assessment of aortic annulus dimensions and calcifications even in the presence of arrhythmias in an all-comers pre-TAVR population. Implementation of this technique appears legitimate in patients at an increased risk for contrast-induced nephropathy. (Source: European Journal of Echocardiography)
Wed, 16 Mar 2016 00:00:00 +0100CONCLUSIONS Since the introduction of TAVI, there has been an increase in both TAVI and AVR activity. TAVIs now represent over 10% of all aortic valve implants. There are distinct differences between procedural groups with respect to patient risk factors. Outcomes for all procedural groups have improved, but long-term TAVI results are required before its role in the treatment of aortic stenosis can be fully defined. (Source: European Journal of Cardio-Thoracic Surgery)
Wed, 16 Mar 2016 00:00:00 +0100CONCLUSION: Aortic valve replacement improves survival of cancer patients with symptomatic aortic stenosis. Transcatheter aortic valve replacement (TAVI) is a treatment option in inoperable patients and patients at high surgical risk. Symptoms should not be confused for the progression of the malignant disease. In patient selection emphasis should be made on their frailty and futility. Eligible patients must have a life expectancy of at least 1 year. Final decision has to be made by a multidisciplinary heart team. TAVI can reduce treatment risk and facilitate the oncologic treatment. PMID: 26983954 [PubMed - as supplied by publisher] (Source: Wiener Klinische Wochenschrift)
Tue, 15 Mar 2016 16:19:04 +0100We read with interest the results of the OBSERVANT (Italian Observational Multicenter Registry) study by Tamburino et al. in a recent issue of the Journal(1). The idea of extending transcatheter aortic valve implantation (TAVI) to lower risk patients, although defined by the authors as “a worrying trend,” might actually represent an intriguing revolution in aortic stenosis management considering the benefit in terms of length of stay in hospital demonstrated by the study (1) and the relative consequences on perioperative costs. Is this just a “worrying extreme” or could something be done to make it happen? We believe that besides resolving the still-known daunting issues affecting TAVI outcomes (2), there are some hidden players. First, keep in mind that the concept of transcat...
Tue, 15 Mar 2016 16:19:04 +0100We read with interest the comments by Dr. Spadaccio and colleagues regarding the results of the OBSERVANT (Italian Observational Multicenter Registry) study, and we thank them for giving us the opportunity to clarify some of the issues raised in their letter. First, we would like to emphasize that OBSERVANT is a prospective observational study that enrolled consecutive patients with severe aortic stenosis treated with either surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) at 93 Italian centers between December 2010 and June 2012 (1). Therefore, it represents a “screen shot” depicting the adoption rates of SAVR and TAVI in Italy during the study period. After having acknowledged that most of patients treated with TAVI were at low or intermedi...
Tue, 15 Mar 2016 13:37:02 +0100We report a case of aortic stenosis (AS) associated with SS in an elderly patient. The diagnosis of primary SS had been made based on clinical features, positive ocular signs, and positive serologic findings. Echocardiography showed severe calcification, elevated mean pressure gradient (57 mmHg), and a small orifice area (0.45 cm(2)) of the aortic valve. At surgery, severe calcification of the aortic cusps and the annulus was the mechanism of AS, and the aortic valve was replaced with a bioprosthetic valve. Valve pathology showed nodular calcification and hyaline degeneration, but lymphocyte infiltration was not evident. The etiologic relation of SS to the valve lesions is not clear pathologically in this case, however, chronic inflammation related to immunologic reactions in SS could have...
Tue, 15 Mar 2016 00:00:00 +0100Key Points Patients with paradoxical low flow low gradient (PLFLG) aortic stenosis (AS) have favorable mid‐term outcomes after transcatheter aortic valve replacement (TAVR). These outcomes were comparable to those patients with high gradient AS (HGAS). Clinicians should avoid delaying referral of patients with PLFLG AS for valve replacement for either surgical aortic valve replacement (SAVR) or TAVR. Further studies are need to understand the increased early mortality after TAVR in PLFLG AS compared to HGAS, and to determine whether improvements of TAVR procedural techniques can result in better outcomes. (Source: Catheterization and Cardiovascular Interventions)
Mon, 14 Mar 2016 00:00:00 +0100CONCLUSIONS: Patients with RHD hospitalized in sub-Saharan Africa are young, socially disadvantaged, with a high mortality rate and extremely low access to surgery. Poverty, as quantified by GDP and educational level, affects RHD-related severity, NYHA class and left ventricular dysfunction. PMID: 26988837 [PubMed - as supplied by publisher] (Source: Archives of Cardiovascular Diseases)
Sat, 12 Mar 2016 23:19:41 +0100This article discusses the rationale, patient selection, technical aspects, and outcomes of percutaneous, ultrasound-guided fetal cardiac intervention (FCI) for structural congenital heart disease. Recent findings: FCI is most commonly performed for three forms of congenital heart disease: severe aortic stenosis with evolving hypoplastic left heart syndrome (HLHS), pulmonary atresia with intact ventricular septum and evolving hypoplastic right heart syndrome, and HLHS with intact or highly restrictive atrial septum. For severe aortic stenosis and pulmonary atresia with intact ventricular septum, the goal of intervention is to alter the natural history such that a biventricular circulation may be achieved postnatally. A growing number of patients have achieved a biventricular circulation; ...
Sat, 12 Mar 2016 00:00:00 +0100We thank Drs Chhabra and Flynn for their discussion about the topics of hemodynamic characterization of severe aortic stenosis (AS) . First of all, we agree that secondary valve diseases might influence distinct parameters of the severity of aortic stenosis. Although not mentioned in the text we excluded moderate or severe aortic or mitral valve regurgitation as well as previous aortic valve replacement . (Source: International Journal of Cardiology)
Fri, 11 Mar 2016 00:32:02 +0100CONCLUSION: This case example demonstrates how a tailored step-by-step strategy including PCI, BAV, peripheral angioplasty, percutaneous ventricular assistance, and transcatheter aortic valve implantation (TAVI) allowed the successful treatment of a critical patient with CS. Impella CP could be considered an effective bridge to TAVI in patients developing aortic regurgitation after BAV, since maintaining arterial access can be achieved using the pump-rewiring technique. PMID: 26716594 [PubMed - in process] (Source: The Journal of Invasive Cardiology)
Fri, 11 Mar 2016 00:32:02 +0100CONCLUSION: Transradial retrograde crossing of severely stenosed aortic valve is feasible using ordinary equipment, with reduced access-site related complications. PMID: 26630647 [PubMed - in process] (Source: The Journal of Invasive Cardiology)
Fri, 11 Mar 2016 00:32:02 +0100Authors: Shah AP, Retzer EM PMID: 26630645 [PubMed - in process] (Source: The Journal of Invasive Cardiology)
Fri, 11 Mar 2016 00:32:02 +0100CONCLUSION: In the TAVI era, BAV may represent a reasonable option for patients with severe aortic stenosis and temporary contraindications to definite therapy. Given the mortality rates at 30 days, patients should be carefully selected, while events at follow-up are deeply influenced by the decision of whether or not subsequent interventions are performed. PMID: 26630642 [PubMed - in process] (Source: The Journal of Invasive Cardiology)
Fri, 11 Mar 2016 00:32:02 +0100TAVR Through Heavily Calcified Aorta Following Atheroma Retrieval With the "Elevator" Technique. J Invasive Cardiol. 2015 Oct;27(10):E216-9 Authors: Senguttuvan NB, Ellozy S, Tejani F, Kovacic J, Kini AS, Sharma SK, Dangas GD Abstract An 86-year-old Caucasian female with severe symptomatic, inoperable aortic stenosis was accepted for high-risk transfemoral transcatheter aortic valve replacement (TAVR) approach due to severe calcification of the aorta. During initial passage of a 22 Fr sheath, there was dislodgment with proximal migration of a circumferential tunnel of calcium from the infrarenal aorta. A novel "elevator" technique was used to secure and retrieve the dislodged aorta en bloc back to its original infrarenal aortic position and allow in situ fixation with ...
Fri, 11 Mar 2016 00:32:02 +0100CONCLUSION: BAV is associated with poor long-term clinical outcome. However, when no other therapeutic options are feasible, a strategy of repeated palliative BAV appears to be safe and is potentially associated with improved clinical outcomes. PMID: 26378413 [PubMed - in process] (Source: The Journal of Invasive Cardiology)
Fri, 11 Mar 2016 00:00:00 +0100Conclusions In this series of patients with LF-LG AS and low LVEF, reduced RVLS was independently associated with increased risk of mortality. Furthermore, stress RVLS provided incremental prognostic value beyond that obtained from rest RVLS. Thus, RVLS measurement at rest and at DSE may be helpful to enhance risk stratification in this high-risk population. Trial registration number NCT01835028; Results. (Source: Heart)
Thu, 10 Mar 2016 05:16:52 +0100Nagre SW, Bendre S. New four Patch Repair [Modified Brom’s ] Technique for Supravalvular Aortic Stenosis. Journal of Cardiovascular Disease Research. 2016;7(1):45-8. (Source: Journal of Cardiovascular Disease Research)
Thu, 10 Mar 2016 00:00:00 +0100Conclusions PPM is associated in the long term with moderate but significant impairment of functional capacity, despite optimal LV reverse remodeling and normalization of LV systolic and diastolic function. Teaser Patients with prosthesis-patient mismatch (PPM) after mechanical aortic valve replacement face a moderate decrease in functional capacity in the long term compared with those without PPM, despite normalization of left ventricular mass and systolic and diastolic functions. For young patients with symptomatic significant aortic stenosis undergoing mechanical aortic valve replacement, PPM should be prevented as far as possible at the time of the surgery in order to confer high post-operative exercise capacity. (Source: Canadian Journal of Cardiology)
Thu, 10 Mar 2016 00:00:00 +0100Publication date: Available online 10 March 2016 Source:Journal of Cardiology Cases Author(s): Hidenori Matsusaka, Yusuke Akiyama, Toshihiko Kubo An 86-year-old man was admitted to our hospital for treatment of congestive heart failure with severe aortic stenosis and advanced atrioventricular (AV) block. Despite pharmacological therapy, he developed complete AV block and resultant acute pulmonary edema requiring temporary pacing and tracheal intubation. We urgently performed retrograde balloon aortic valvuloplasty (BAV) with a sheathless technique. The AV block disappeared soon after the procedure; this was probably attributable to the correction of relative myocardial ischemia, obtained by BAV. Thus, he successfully recovered from a critical condition.
Thu, 10 Mar 2016 00:00:00 +0100CONCLUSIONS: In the majority of AS patients, an aortic valve procedure leads to reduction in coexistent MR. A significant decrease in the severity of MR in our study was observed regardless of etiology and preoperative grade of MR. Persistence of higher degrees of MR was associated with increased patient morbidity. PMID: 26972342 [PubMed - as supplied by publisher] (Source: Journal of Cardiology)
Wed, 09 Mar 2016 12:34:25 +0100Conclusions: Mean and peak baseline AVGs are directly associated with improved outcomes after TAVI; AVG can be used to select the patients most likely to benefit from TAVI.Cardiology 2016;134:128-135 (Source: Cardiology)
Wed, 09 Mar 2016 00:00:00 +0100Abstract Aortic stenosis (AS) is the most common primary valve disorder in the elderly with an increasing prevalence; transcatheter aortic valve implantation (TAVI) has become an accepted alternative to surgical aortic valve replacement (AVR) in the high risk or inoperable patient. Appropriate selection of patients for TAVI is crucial and requires a multidisciplinary approach including cardiothoracic surgeons, interventional cardiologists, anaesthetists, imaging experts and specialist nurses. Multimodality imaging including echocardiography, CT and MRI plays a pivotal role in the selection and planning process; however, echocardiography remains the primary imaging modality used for patient selection, intra-procedural guidance, post-procedural assessment and long-term follow-up. T...
Tue, 08 Mar 2016 00:00:00 +0100Conclusions— A laboratory practice pattern that was amenable to reform was identified, and a multistep modification was designed and implemented that produced clinically valuable performance improvements. The new protocol improved aortic stenosis mean gradient agreement between echocardiography and catheterization and was associated with a measurable decrease in referrals of patients for invasive studies. (Source: Circulation: Cardiovascular Imaging)
Tue, 08 Mar 2016 00:00:00 +0100(Source: Circulation: Cardiovascular Imaging)
Mon, 07 Mar 2016 00:00:00 +0100Since the introduction of transcatheter aortic valve implantation (TAVI) into clinical practice, the treatment of aortic stenosis has changed dramatically. In the past, medical therapy with or without balloon aortic valvuloplasty was the only option for inoperable patients. More recently, TAVI has become the treatment of choice for these patients and the preferred alternative for high-risk operable patients. Surgical aortic valve replacement (SAVR) currently remains the gold standard for patients at low or intermediate operative risk. As randomized trials have demonstrated comparable results between TAVI and SAVR in the high-risk population, there is now a clear trend towards performing TAVI even in intermediate-risk patients while awaiting the results of randomized trials in that populati...
Mon, 07 Mar 2016 00:00:00 +0100In this study, we use lineage and genetic analysis, pharmacological inhibition, explant cultures, and induced pluripotent stem cells (iPSCs) to investigate supravalvular aortic stenosis (SVAS) patients and/or elastin mutant mice that model SVAS. These experiments demonstrate that multiple preexisting SMCs give rise to excess aortic SMCs in elastin mutants, and these SMCs are hyperproliferative and dedifferentiated. In addition, SVAS iPSC-derived SMCs and the aortic media of elastin mutant mice and SVAS patients have enhanced integrin β3 levels, activation, and downstream signaling, resulting in SMC misalignment and hyperproliferation. Reduced β3 gene dosage in elastin-null mice mitigates pathological aortic muscularization, SMC misorientation, and lumen loss and extends survival,...
Sun, 06 Mar 2016 14:13:01 +0100Authors: Tamburino C, IMMé S, Barbanti M, Capranzano P, Sgroi C, Scalia M, Riccobene F, Condorelli A, Gulino S, Capodanno D, Tamburino C Abstract Transcatheter aortic valve implantation (TAVI) is the treatment of choice among patients with symptomatic severe aortic stenosis (AS) deemed inoperable and a valuable alternative to surgical aortic valve replacement for high-risk surgical patients. Over the years, this procedure proved to be relatively safe, but despite this complications may occur . When performing TAVI, the most frequent complications are represented by peripheral vascular complications and bleeding involving the access site. Trans-femoral (TF) route is the preferred access site and device evolution has made it possible to reduce in size sheaths and delivery systems...
Sun, 06 Mar 2016 00:00:00 +0100ConclusionsBPD with the V8 hourglass‐shaped balloon was feasible in reducing PVL from self‐expanding TAVR prostheses. © 2016 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)
Sat, 05 Mar 2016 07:34:19 +0100Conclusions The real-time sequence is accurate compared to conventional segmented PC-MRI. Its applicability in Afib was shown. Real-time PC-MRI might become a valuable tool in arrhythmia. Key Points • Assessment of haemodynamics is crucial in many cardiac diseases. • Arrhythmias are a major limitation of conventional techniques in cardiac magnetic resonance. • A real-time technique, which allows application in arrhythmia, was validated. • This real-time technique might become a valuable tool in arrhythmic patients. (Source: European Radiology)
Sat, 05 Mar 2016 00:00:00 +0100Conclusions The presence of a bicuspid aortic valve and an aortic valve annular z-score of −3.0 or less before primary repair are risk factors for LVOTO, and stenotic bicuspid valves and discrete subvalvular LVOTO are the main causes of LVOTO after primary repair of CoA/IAA with ventricular septal defect. The bicuspid patients more frequently required reoperation than the tricuspid patients. (Source: The Annals of Thoracic Surgery)
Fri, 04 Mar 2016 00:00:00 +0100ConclusionsPatients with ESRD who undergo TAVR are at high risk for mortality and complications. TAVR outcomes are comparable to but not substantially better than those with SAVR. Transfemoral TAVR seems to be at least as safe and effective as the current standard SAVR in patients undergoing aortic valve replacement. © 2016 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)
Fri, 04 Mar 2016 00:00:00 +0100We present a patient with critical degenerative aortic stenosis, mitral annular and aortomitral continuity calcification, and senile sigmoid septal hypertrophy who underwent transcatheter aortic valve replacement using the CoreValve bioprosthesis. Immediately after predilation of the aortic valve (18‐mm balloon), the patient developed severe hypotension and dynamic left ventricular outflow tract (LVOT) obstruction with systolic anterior motion of the anterior mitral leaflet, causing severe mitral regurgitation. After deployment of a 26‐mm bioprosthesis, a transesophageal echocardiogram and left ventriculogram showed that the frame of the bioprosthesis appeared distorted and underexpanded. On the mitral side of the aorta (side of the aortomitral curtain between 12:00 and 3:00, echo shor...
Fri, 04 Mar 2016 00:00:00 +0100ConclusionsThe transfemoral implantation of the balloon‐expandable SAPIEN 3 prosthesis without pre‐dilatation is feasible in the majority of cases. In the presence of severe aortic valve calcification and critical aortic stenosis, however, predilatation may still be necessary. Furthermore, the significance of increased post‐procedural gradients requires further verification. © 2016 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)
Fri, 04 Mar 2016 00:00:00 +0100ConclusionsIn this meta‐analysis we found that TAVR may be an acceptable alternative to SAVR in patients with intermediate risk for surgery. However, we must await evidence from the current large randomized trials before widespread adoption of this procedure is undertaken. © 2016 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)
Fri, 04 Mar 2016 00:00:00 +0100CONCLUSIONS: The presence of a bicuspid aortic valve and an aortic valve annular z-score of -3.0 or less before primary repair are risk factors for LVOTO, and stenotic bicuspid valves and discrete subvalvular LVOTO are the main causes of LVOTO after primary repair of CoA/IAA with ventricular septal defect. The bicuspid patients more frequently required reoperation than the tricuspid patients. PMID: 26952292 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)
Tue, 01 Mar 2016 06:00:00 +0100Abstract: Invasive coronary angiography (ICA) is the recommended assessment for coronary artery disease in patients undergoing elective aortic valve replacement (AVR). Noncontrast computed tomography (CT) is useful for evaluating lung lesions and calcifications at the cannulation site of the ascending aorta. The purpose of this study was to evaluate the role of noncontrast CT in the visual assessment of coronary artery calcification (CAC) in patients undergoing AVR. We retrospectively identified patients with significant aortic stenosis (AS) who were referred for AVR between January 2006 and December 2013. Among these, we included 386 patients (53.6% males, 69.2 ± 8.4 years) who underwent both noncontrast CT and ICA. Significant coronary artery stenosis (CAS) in the ICA was defined a...
Tue, 01 Mar 2016 00:00:00 +0100Epidemiological, genetic association, and Mendelian randomization studies have provided strong evidence that lipoprotein (a) [Lp(a)] is an independent causal risk factor for CVD, including myocardial infarction, stroke, peripheral arterial disease, and calcific aortic valve stenosis. Lp(a) levels >50 mg/dl are highly prevalent (20% of the general population) and are overrepresented in patients with CVD and aortic stenosis. These data support the notion that Lp(a) should be a target of therapy for CVD event reduction and to reduce progression of aortic stenosis. However, effective therapies to specifically reduce plasma Lp(a) levels are lacking. Recent animal and human studies have shown that Lp(a) can be specifically targeted with second generation antisense oligonucleotides (ASOs) that...
Tue, 01 Mar 2016 00:00:00 +0100Authors: PMID: 26926983 [PubMed - in process] (Source: American Family Physician)
Tue, 01 Mar 2016 00:00:00 +0100Authors: Grimard BH, Safford RE, Burns EL Abstract Aortic stenosis affects 3% of persons older than 65 years. Although survival in asymptomatic patients is comparable to that in age- and sex-matched control patients, it decreases rapidly after symptoms appear. During the asymptomatic latent period, left ventricular hypertrophy and atrial augmentation of preload compensate for the increase in afterload caused by aortic stenosis. As the disease worsens, these compensatory mechanisms become inadequate, leading to symptoms of heart failure, angina, or syncope. Aortic valve replacement is recommended for most symptomatic patients with evidence of significant aortic stenosis on echocardiography. Watchful waiting is recommended for most asymptomatic patients. However, select patients may ...
Tue, 01 Mar 2016 00:00:00 +0100Introduction: Transcatheter aortic valve implantation (TAVI) is an established treatment for symptomatic aortic stenosis among elderly patients whose surgical complication risk seems to be high. Till now about 150.000 or more TAVI procedures have been performed worldwide but little is known of the occurrence of valve thrombosis following TAVI and its therapy. (Source: Journal of Cardiovascular Computed Tomography)
Tue, 01 Mar 2016 00:00:00 +0100Introduction: Familial hypercholesterolemia (FH) is an autosomal dominant disorder that causes severe elevations in total cholesterol and low-density lipoprotein cholesterol (LDLc). FH is associated with a high risk for premature coronary artery disease (CAD), peripheral vascular disease, cerebrovascular disease, or aortic stenosis. (Source: Journal of Cardiovascular Computed Tomography)
Tue, 01 Mar 2016 00:00:00 +0100Background and aim: Trans-catheter aortic valve implantation (TAVI) is a new treatment option for patients with severe aortic stenosis. Pre-TAVI procedure work-up includes computed tomography angiography (CTA) of the heart and aorta from aortic annulus to the iliofemoral arteries. Frequently, there are number of incidental noncardiac findings (INCF) in pre-TAVI CTA, However, the frequency and clinical significance of these INCF unknown. The aim of our study is to investigate the prevalence of INCF and their clinical significant. (Source: Journal of Cardiovascular Computed Tomography)
Tue, 01 Mar 2016 00:00:00 +0100This article describes its assessment and clinical interpretation using echocardiography and also shows how magnetic resonance, cardiac computed tomography and stress testing may be useful. PMID: 26961441 [PubMed - in process] (Source: British Journal of Hospital Medicine)
Mon, 29 Feb 2016 00:00:00 +0100CONCLUSIONS: Isolated AVR in patients aged ≥85 years can be performed with acceptable risk. Survivors improve in NYHA class and, when compared to age- and gender-matched individuals, show a similar life expectancy and a no lower QoL. PMID: 26953896 [PubMed - as supplied by publisher] (Source: The International Journal of Artificial Organs)
Sat, 27 Feb 2016 00:00:00 +0100CONCLUSION: This retrospective study demonstrated the current associations between the types of AS symptoms and prognosis in Japanese patients with severe AS. PMID: 26936469 [PubMed - as supplied by publisher] (Source: Journal of Cardiology)
Fri, 26 Feb 2016 15:26:01 +0100CONCLUSIONS: High hsCRP1 or an increase in hsCRP during the first year of follow-up predicted later AVR independently of AVA, age, gender and other risk factors, although no significant improvement in C-statistics was observed. PMID: 26911132 [PubMed - as supplied by publisher] (Source: Scandinavian Cardiovascular Journal)
Fri, 26 Feb 2016 01:36:27 +0100Until recently, the only treatment for severe, symptomatic aortic stenosis was open heart surgery. With the advancement of medical devices and minimally invasive surgical techniques, the transcatheter aortic valve replacement (TAVR) procedure has emerged as a potential option for patients previously denied surgical treatment. However, recent sub-group analysis of the PARTNER I trial and similar cohorts has demonstrated that 25-30% of patients are dead at one year. Properly counseling patients and families on the risks associated with this “new” technology is an important consideration in the post-acute and long-term care environment. (Source: Journal of the American Medical Directors Association)
Fri, 26 Feb 2016 00:00:00 +0100Key Points Recent real world comparisons of echo and invasive assessment of transaortic pressure gradients in aortic stenosis often show a poor correlation. The guideline recommended use of Doppler echo without hemodynamic assessments may not reflect the variability of echo measurements in practice, particularly in unselected patients. An approach using both echo and invasive data is often used in practice today. The guideline recommended use of echo assessments alone should be critically revisited. (Source: Catheterization and Cardiovascular Interventions)
Fri, 26 Feb 2016 00:00:00 +0100CONCLUSIONS: -Gait speed is independently associated with 30-day mortality following TAVR. Identification of frail patients with the slowest gait speeds facilitates pre-procedural evaluation and anticipation of a higher level of post-procedural care. Clinical Trial Registration Information-ClinicalTrials.gov. Identifier: NCT01737528. PMID: 26920495 [PubMed - as supplied by publisher] (Source: Circulation)
Fri, 26 Feb 2016 00:00:00 +0100Conclusions: In stable outpatients with AI, KCCQ scores correlate with the presence of shortness of breath and heart failure symptoms, but are not affected by the degree of AI or history of aortic valve surgery. Symptoms rather than diagnosis drives patient perceived health status. (Source: Circulation: Cardiovascular Quality and Outcomes)
Fri, 26 Feb 2016 00:00:00 +0100CONCLUSION: Age and kidney function determine the degree of anemia. The anisocytosis of red blood cells in anemic patients supplements prognostic information in addition to that derived from the WHO-based definition of anemia. PMID: 26981217 [PubMed] (Source: World Journal of Cardiology)
Fri, 26 Feb 2016 00:00:00 +0100Authors: Katayama M, Chaliki HP Abstract Aortic stenosis (AS) is a disease that progresses slowly for years without symptoms, so patients need to be carefully managed with appropriate follow up and referred for aortic valve replacement in a timely manner. Development of symptoms is a clear indication for aortic valve intervention in patients with severe AS. The decision for early surgery in patients with asymptomatic severe AS is more complex. In this review, we discuss how to identify high-risk patients with asymptomatic severe AS who may benefit from early surgery. PMID: 26981214 [PubMed] (Source: World Journal of Cardiology)
Thu, 25 Feb 2016 22:59:31 +0100Chinese device firm JC Medical said today that the 1st implantation of its J-Valve bioprosthesis transcatheter aortic valve implant was performed outside China in Vancouver, Canada. The patient in the operation suffered from heart failure due to severe aortic regurgitation and was considered high risk for open-heart aortic valve replacement surgery due to the condition. “The J-Valve is a unique valve designed for both aortic regurgitation and aortic stenosis. Most TAVI devices are designed for aortic stenosis. Up to date, there are no transcatheter valves approved for the treatment of pure aortic regurgitation in North America. The J-Valve is relatively easier to implant compared with other valves, and provides true anatomical positioning. Furthermore, no rapid ventricular pacing is...
Thu, 25 Feb 2016 20:41:02 +0100Authors: Marchi F, Cerillo AG, Rizza A, Mariani M, De Caterina AR, Palmieri C, Maffei S, Berti S Abstract A 78-year-old man was referred for surgical treatment of a 55 x 59 mm abdominal aortic aneurysm (AAA). However, clinical and instrumental data revealed a more complex case than was initially thought, the patient having a large AAA in the setting of severe symptomatic aortic stenosis with multiple comorbidities. Following multidisciplinary discussion, a combined transcatheter aortic valve implantation and endovascular aneurysm repair was performed. The present case represents a good example of the importance of the heart team in the project of tailored operative strategies, and in the optimization of the interventional therapy for the individual patient. PMID: 26901901 [PubM...
Thu, 25 Feb 2016 20:41:02 +0100CONCLUSION: LVM regression at six to months post-TAVI was variable, with about one-third of patients not showing a significant regression. Only baseline LVM predicted LVM regression; patients with a higher baseline LVM demonstrated a greater regression. PMID: 26901894 [PubMed - in process] (Source: Journal of Heart Valve Disease)
Thu, 25 Feb 2016 20:41:02 +0100Authors: Alnasser SM, Benhomeid O, Peterson MD, Buller CE, Latter D, Deva DP, Cheema AN Abstract Transcatheter aortic valve replacement (TAVR) with balloon-expandable (BE) or self-expanding (SE) transcatheter heart valves (THVs) is indicated for the treatment of high-risk patients with severe aortic stenosis. Limited data are available comparing the two THV designs, and evidence suggests that each may offer unique advantages. Herein are described two patients who underwent TAVR with BE-THV and SE-THV, and who each developed a device-related complication that was successfully treated by using the alternate THV design. PMID: 26897845 [PubMed - in process] (Source: Journal of Heart Valve Disease)
Thu, 25 Feb 2016 20:41:02 +0100CONCLUSION: The ascending aorta assessed using Mimics 3D reconstruction software was frequently asymmetrically dilated in stenotic BAV, and the expansion progressed to the aortic arch. It is believed that calculating the ellipticity of the vertical section against the centerline offers an innovative means of quantifying aortic symmetry in three dimensions. PMID: 26897833 [PubMed - in process] (Source: Journal of Heart Valve Disease)
Thu, 25 Feb 2016 20:41:02 +0100In conclusion, the target population for TAVI must be more accurately specified, with further research helping to define whether AVR or TAVI is the best treatment option for 'intermediate-risk' patients. PMID: 26897827 [PubMed - in process] (Source: Journal of Heart Valve Disease)
Thu, 25 Feb 2016 20:41:02 +0100CONCLUSION: Besides SWL and female gender, the EF after dobutamine as well as highest exercise stress intensity reached are helpful in determining the prognosis of asymptomatic patients with moderate-severe AS. PMID: 26897816 [PubMed - in process] (Source: Journal of Heart Valve Disease)
Thu, 25 Feb 2016 20:41:02 +0100CONCLUSION: The study results showed that the activity of GSH-Px, a marker of oxidative stress, is increased in patients with degenerative AS. The increase in GSH-Px activity may be a protective response to remove reactive oxygen derivatives (RODs) from the body. PMID: 26897814 [PubMed - in process] (Source: Journal of Heart Valve Disease)
Thu, 25 Feb 2016 20:41:02 +0100CONCLUSION: Among the present cohort of patients undergoing TAVI, those with MR at baseline showed an improvement in the severity of their MR. Patients with moderate MR regurgitation or above demonstrated the greatest improvement. PMID: 26897813 [PubMed - in process] (Source: Journal of Heart Valve Disease)
Thu, 25 Feb 2016 20:41:02 +0100Authors: Huang D, Lam PH, Shea PC, Yiu KH, Tse HF, Siu CW Abstract Patients with severe aortic stenosis (AS) and left ventricular systolic dysfunction pose a significant challenge to the managing physician. Conventional pharmacological therapy for systolic heart failure has not been proven beneficial in this setting. Ivabradine, a selective current inhibitor, decreases the spontaneous firing rate of sinoatrial nodal cells, thereby reducing the heart rate, and has been shown to reduce a composite end-point of heart failure hospitalization and mortality in patients with impaired left ventricular function. Herein are reported details of the hemodynamic effects and clinical outcome of ivabradine treatment in an 86-year-old man with severe AS and severe left ventricular systolic functio...
Thu, 25 Feb 2016 20:41:02 +0100CONCLUSION: In-hospital mortality is higher for octogenarians undergoing CABG+AVR compared to those undergoing isolated CABG. In the present study, a 'prophylactic' AVR was justified in patients with moderate AS, and their increased mortality (versus isolated CABG) was congruent with a higher preoperative co-morbid risk profile. Excellent long- term symptom-free survival further justifies 'prophylactic' AVR in octogenarians undergoing CABG with coexistent moderate AS. PMID: 26897807 [PubMed - in process] (Source: Journal of Heart Valve Disease)
Thu, 25 Feb 2016 14:34:03 +0100Authors: Chin CW, Djohan AH, Lang CC Abstract Calcified aortic stenosis is one of the most common causes of heart failure in the elderly. Current guidelines recommend aortic valve replacement in patients with severe disease and evidence of decompensation based on either symptoms or impaired systolic ejection fraction. However, symptoms are often subjective whilst impaired ejection fraction is not a sensitive marker of ventricular decompensation. Interest has surrounded the use of cardiac biochemical markers as objective measures of left ventricular decompensation in aortic stenosis. We will first examine mechanisms of release of biochemical markers associated with myocardial wall stress (BNP/NT-proBNP), myocardial fibrosis (markers of collagen metabolism, galectin-3, soluble ST2) a...
Thu, 25 Feb 2016 00:00:00 +0100Abstract Transcatheter Aortic Valve Implantation (TAVI) is increasingly being used in patients with severe aortic stenosis who are not candidates for surgery. ECG-gated CT angiography (CTA) plays an important role in the preoperative planning for these devices. As the number of patients undergoing these procedures increases, a subset of patients is being recognized who have contraindications to iodinated contrast medium, either due to a prior severe allergic type reaction or poor renal function. Another subgroup of patients with low flow and low gradient aortic stenosis is being recognized that are usually assessed for severity of aortic stenosis by stress echocardiography. There are contraindications to stress echocardiography and some of these patients may not be able to undergo...
Thu, 25 Feb 2016 00:00:00 +0100Conclusions— In this pilot study, AS leads to abnormal blood flow pattern and peak systolic wall shear stress in the ascending aorta. In addition to aortic orifice area, normalized flow displacement was significantly associated with LV remodeling. (Source: Circulation: Cardiovascular Imaging)
Thu, 25 Feb 2016 00:00:00 +0100(Source: Circulation: Cardiovascular Imaging)
Wed, 24 Feb 2016 22:20:02 +0100CONCLUSIONS: Pre-TAVI CTA detected non-valvular extravascular pathologies leading to procedure cancellation/postponement or procedure modification in 8% and 16%, respectively. Comprehensive CTA evaluation that acknowledges the importance of such findings is of major importance since it might alter the TAVI procedure or even render it inappropriate. PMID: 26897979 [PubMed - in process] (Source: The Israel Medical Association Journal)
Wed, 24 Feb 2016 00:00:00 +0100Conclusions There are significant differences in the way that male and female hearts adapt to AS. 6m following aortic valve replacement, there are no sex-related differences in reverse remodeling, but superior reverse remodeling in men as a result of their more adverse remodeling profile at baseline. (Source: American Heart Journal)
Tue, 23 Feb 2016 22:07:08 +0100ConclusionsDespite the anatomic proximity of the aortic annulus to the LM, TAVR plus LM PCI is safe and technically feasible, with short- and intermediate-term clinical outcomes comparable with those in patients undergoing TAVR alone. These results suggest that TAVR plus LM PCI is a reasonable option for patients who are at high risk for surgery. (Source: Journal of the American College of Cardiology)
Tue, 23 Feb 2016 22:07:08 +0100Coronary artery disease is commonly found in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) (1–3). Although there is little evidence from published reports supporting a specific management approach to severe coronary artery disease in the setting of TAVR, today staged or combined percutaneous coronary intervention (PCI) is generally contemplated for severely stenotic lesions in proximal coronary arteries that subtend a large area of myocardium at risk (3). (Source: Journal of the American College of Cardiology)
Mon, 22 Feb 2016 22:00:00 +0100Women undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis have lower 1-year mortality than men, even though their 30-day rates of vascular complications and major... (Source: Hospitalist News)
Mon, 22 Feb 2016 14:07:18 +0100This study is an important next step in developing robust clinical evidence to help heart teams understand the potential benefits of TAVR in a broader patient population.” Earlier this month, the FDA granted an expanded indication for the CoreValve devices for patients with end-stage renal disease and low-grade, low-flow aortic stenosis. The post FDA approves trial for low-risk patients with MDT’s CoreValve Evolut R appeared first on MassDevice. (Source: Mass Device)
Sun, 21 Feb 2016 00:00:00 +0100Conclusions Despite the same degree of AS severity, women have less AVC and lower AVW compared with men, irrespective of valve morphology. Aortic valve calcium is correlated to excised AVW. Hypertension, diabetes, and current cigarette smoking were independently associated with AVW. (Source: European Heart Journal)
Sun, 21 Feb 2016 00:00:00 +0100(Source: European Heart Journal)
Sun, 21 Feb 2016 00:00:00 +0100Conclusion We propose a clinical score that predicts adverse outcomes in asymptomatic AS patients and potentially identifies high-risk patients who may benefit from early valve replacement. (Source: European Heart Journal)
Sun, 21 Feb 2016 00:00:00 +0100(Source: European Heart Journal)
Sat, 20 Feb 2016 00:00:00 +0100An anterior aortoventriculoplasty, known as the Konno-Rastan procedure, is a useful tool for the cardiac surgeon. Originally described for congenital aortic stenosis secondary to small annular size 1, it relieves sub-valvar, valvar, and supra-valvar stenosis. There is usually some intrepidation about the procedure, as it involves opening the right ventricular outflow tract and then cutting through the aortic annulus and ventriculo infundibular fold into the ventricular septum. Although this is unusual anatomy outside the congenital arena, it is a relatively safe and straight forward procedure. (Source: Operative Techniques in Cardiac and Thoracic Surgery)
Fri, 19 Feb 2016 16:19:02 +0100Conclusions. This study demonstrates that echocardiogram was not helpful in establishing a diagnosis of syncope in patients with normal ECG and normal physical examination. PMID: 26881172 [PubMed] (Source: Cardiology Research and Practice)
Fri, 19 Feb 2016 00:00:00 +0100Conclusions The present study demonstrated no significant differences in regards to mortality or stroke between the two therapeutic procedures. However, the cost-effectiveness and long-term efficacy of TAVI may require further investigation. Technological improvement and increased experience may broaden the clinical indication for TAVI for low-intermediate risk patients in the future. PMID: 26891807 [PubMed - as supplied by publisher] (Source: Current Pharmaceutical Design)
Fri, 19 Feb 2016 00:00:00 +0100Conclusions VARC-2–defined cTnT elevation emerged as a strong, independent predictor of 30-day mortality and remained a modest, but significant, predictor throughout 2 years post-TAVI. The prognostic value of cTnT elevation was modified by the presence and complexity of underlying CAD with highest mortality risk observed in patients combining SYNTAX score >22 and evidence of myocardial injury. (Source: JAHA:Journal of the American Heart Association)
Thu, 18 Feb 2016 00:00:00 +0100This article is part of a Special Issue entitled:Cardiomyocyte Biology: Integration of Develomental and Environmental Cues in the Heart edited by Marcus Schaub and Hughes Abriel. (Source: Biochimica et Biophysica Acta (BBA) Molecular Cell Research)
Thu, 18 Feb 2016 00:00:00 +0100To compare incidence of aortic regurgitation (AR), paravalvular AR and valvular performance with Doppler hemodynamic parameters following transcatheter aortic valve replacement (TAVR) with Edwards valve (EV) versus CoreValve (CV). Currently, there are scarce data on post-TAVR echocardiographic outcomes comparing EV and CV. (Source: Cardiovascular Revascularization Medicine)
Thu, 18 Feb 2016 00:00:00 +0100We report the first case of trans-catheter aortic valve implantation in a 90-year-old man with a severely stenotic bioprosthetic aortic valve in the context of an autoimmune hemolytic anemia and immune thrombocytopenia (Evans syndrome) using the trans-femoral approach. The patient was supported in the peri-procedural period with high-dose steroids, intravenous immunoglobulins, platelet transfusions, and thrombopoietin receptor agonist (romiplostim). The post-procedural period was unremarkable with no bleeding complications.
Wed, 17 Feb 2016 16:17:02 +0100Authors: Htun NM, Webb JG Abstract Transcatheter aortic valve replacement is a viable alternative to surgical aortic valve replacement in patients with severe aortic stenosis. The SAPIEN 3 is the latest generation of balloon-expandable transcatheter heart valve, designed to address some of the shortcomings of earlier versions of transcatheter heart valves. It has a lower device profile to reduce access-related vascular injury, an improved delivery catheter to facilitate accurate implantation, and incorporates an additional outer sealing cuff to minimise paravalvular leakage. The latest European and North American trials using SAPIEN 3 have documented very low rates of vascular complications and paravalvular regurgitation with rates of stroke and mortality rates lower than anticipat...
Wed, 17 Feb 2016 15:49:03 +0100Authors: Clark BC, Berul CI Abstract Arrhythmias, covering bradycardia and tachycardia, occur in association with congenital heart disease (CHD) and as a consequence of surgical repair. Symptomatic bradycardia can occur due to sinus node dysfunction or atrioventricular block secondary to either unrepaired CHD or surgical repair in the area of the conduction system. Tachyarrhythmias are common in repaired CHD due to scar formation, chamber distension or increased chamber pressure, all potentially leading to abnormal automaticity and heterogeneous conduction properties as a substrate for re-entry. Atrial arrhythmias occur more frequently, but ventricular tachyarrhythmias may be associated with an increased risk of sudden cardiac death, notably in patients with repaired tetralogy of F...