Academic literature on the topic 'Transcatheter aortic valve implantation (TAVI)'
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Journal articles on the topic "Transcatheter aortic valve implantation (TAVI)"
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Esposito, Giovanni, and Anna Franzone. "The TAVI: Transcatheter Aortic Valve Implantation." Cardiologia Ambulatoriale, no. 1 (January 30, 2020): 49–57. http://dx.doi.org/10.17473/1971-6818-2020-1-4.
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L’impianto transcatetere di valvola aortica (Transcatheter Aortic Valve Replacement, TAVI) è una procedura di cardiologia interventistica, introdotta nel 2002, che prevede il posizionamento e l’impianto di una protesi biologica a livello dell’annulus aortico mediante accesso percutaneo, prevalentemente transfemorale. Dopo le prime esperienze cliniche, riservate a pazienti senza altre opzioni terapeutiche, la TAVI si è affermata come alternativa all’intervento chirurgico tradizionale di sostituzione valvolare grazie ad una serie di studi randomizzati che ne hanno dimostrato l’efficacia e la sicurezza in pazienti appartenenti a tutto lo spettro del rischio operatorio (da estremo a basso). L’utilizzo della TAVI è in continua crescita, a livello mondiale, e si assiste ad una progressiva espansione delle sue indicazioni cliniche (stenosi di valvola bicuspide, insufficienza aortica severa). Il presente articolo ha lo scopo di riassumere i recenti progressi nell’ambito del trattamento transcatetere della stenosi valvolare aortica, descrivere le caratteristiche della procedura e analizzare i risultati degli studi che ne hanno favorito la diffusione nella pratica clinica.
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Kleiman, Neal, and Michael J. Reardon. "TAVI: Transcatheter Aortic Valve Implantation." Methodist DeBakey Cardiovascular Journal 7, no. 1 (January 2011): 49–52. http://dx.doi.org/10.14797/mdcj-7-1-49.
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Kleiman, Neal, and Michael J. Reardon. "TAVI: Transcatheter Aortic Valve Implantation." Methodist DeBakey Cardiovascular Journal 7, no. 1 (January 1, 2011): 49. http://dx.doi.org/10.14797/mdcvj.252.
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ALUR, İhsan, Bekir Serhat YILDIZ, and Yusuf İzzettin ALİHANOĞLU. "Complications of Transcatheter Aortic Valve Implantatiton (TAVI): Letter to the Editor." Turkiye Klinikleri Cardiovascular Sciences 27, no. 3 (2015): 119–20. http://dx.doi.org/10.5336/cardiosci.2016-50396.
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Byczkowska, Katarzyna. "Katz Frailty Syndrom has no Predictive Value in Low-Risk Patients Undergoing Transcatheter Aortic Valve Implantation." Clinical Cardiology and Cardiovascular Interventions 04, no. 16 (October 12, 2021): 01–08. http://dx.doi.org/10.31579/2641-0419/227.
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Background: Aortic stenosis is a disease of the elderly people, with multiple comorbidities and often with the frailty syndrome. Therefore, we decided that frailty as a clinical factor requires precise characterization as it is a valuable supplement to the risk stratification in transcatheter aortic Valve implantation (TAVI). Objective: The aim of our study was to evaluate the prognostic value of the Katz frailty scale in patients undergoing TAVI in relation to the risk of mortality assessed with the STS scale. Material and methods: The study included 105 patients with severe aortic stenosis (AS) treated with TAVI at the Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior. In our group, the Katz frailty syndrome confirmed in all patients, and 48% in the advanced stage. Results: Statistical analysis showed a significant difference between survival and Katz frailty score before TAVI. Analysis using Cox's model confirmed a significant prognostic value for the Katz frailty syndrome before TAVI. Patients with moderate to severe frailty on the Katz score (values ≤ 4) had a 13,68 times higher risk of death per year compared to the group with Katz frailty syndrome ≥ 5. Multivariate regression analysis indicated that Katz frailty score and STS score were prognostically significant factors of cardiovascular death in patients undergoing TAVI. Conclusion: The Katz frailty score had a significant prognostic value in the high- and intermediate risk patients. Katz frailty score and STS risk score significantly correlated with the risk of death from cardiovascular causes in frailty patients undergoing TAVI.
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Siontis, George C. M., Pavel Overtchouk, Thomas J. Cahill, Thomas Modine, Bernard Prendergast, Fabien Praz, Thomas Pilgrim, et al. "Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: an updated meta-analysis." European Heart Journal 40, no. 38 (April 23, 2019): 3143–53. http://dx.doi.org/10.1093/eurheartj/ehz275.
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Abstract Aims Owing to new evidence from randomized controlled trials (RCTs) in low-risk patients with severe aortic stenosis, we compared the collective safety and efficacy of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) across the entire spectrum of surgical risk patients. Methods and results The meta-analysis is registered with PROSPERO (CRD42016037273). We identified RCTs comparing TAVI with SAVR in patients with severe aortic stenosis reporting at different follow-up periods. We extracted trial, patient, intervention, and outcome characteristics following predefined criteria. The primary outcome was all-cause mortality up to 2 years for the main analysis. Seven trials that randomly assigned 8020 participants to TAVI (4014 patients) and SAVR (4006 patients) were included. The combined mean STS score in the TAVI arm was 9.4%, 5.1%, and 2.0% for high-, intermediate-, and low surgical risk trials, respectively. Transcatheter aortic valve implantation was associated with a significant reduction of all-cause mortality compared to SAVR {hazard ratio [HR] 0.88 [95% confidence interval (CI) 0.78–0.99], P = 0.030}; an effect that was consistent across the entire spectrum of surgical risk (P-for-interaction = 0.410) and irrespective of type of transcatheter heart valve (THV) system (P-for-interaction = 0.674). Transcatheter aortic valve implantation resulted in lower risk of strokes [HR 0.81 (95% CI 0.68–0.98), P = 0.028]. Surgical aortic valve replacement was associated with a lower risk of major vascular complications [HR 1.99 (95% CI 1.34–2.93), P = 0.001] and permanent pacemaker implantations [HR 2.27 (95% CI 1.47–3.64), P < 0.001] compared to TAVI. Conclusion Compared with SAVR, TAVI is associated with reduction in all-cause mortality and stroke up to 2 years irrespective of baseline surgical risk and type of THV system.
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Penkalla, Adam, Joerg Kempfert, Axel Unbehaun, Semih Buz, Thorsten Drews, Miralem Pasic, and Volkmar Falk. "Transcatheter Aortic Valve Implantation in Nonagenarians." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 11, no. 6 (November 2016): 390–95. http://dx.doi.org/10.1097/imi.0000000000000315.
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Objective In this report, we assess the outcome of transcatheter aortic valve implantation (TAVI) in nonagenarians at our institution during a 6-year period. Methods Between April 2008 and July 2014, 40 patients with a mean ± SD age of 91.8 ± 2.3 years (range, 90–98 years) underwent TAVI. Thirty-three patients (82.5%) received transapical TAVI, and seven patients (17.5%) received transfemoral TAVI. Baseline characteristics were as follows: mean ± SD EuroSCORE II, 23.9 ± 14.21; mean ± SD Society of Thoracic Surgeons mortality score, 24.2 ± 11.4; mean ± SD SYNTAX score, 7.6 ± 9.3; mean ± SD NYHA class, 3.5 ± 0.5; mean ± SD transvalvular gradient, 46.8 ± 17.8 mm Hg; mean ± SD aortic valve area, 0.7 ± 0.2 cm2. Results Intraoperative mortality was 2.5% and 30-day all-cause mortality was 10%. The actuarial survival rates at 1 and 5 years were 58.6% and 30.4%, respectively. Seven patients (17.5%) underwent simultaneous elective TAVI and percutaneous coronary intervention. Three patients (7.5%) were operated on with the use of cardiopulmonary bypass. No conversion to open surgery occurred. In transesophageal echocardiography assessment, no moderate or severe prosthetic aortic valve regurgitation was observed. Four patients (10%) had postoperative acute renal failure stage 3 and needed new dialysis (P = 0.125). Three patients (7.5%) had a disabling stroke. Periprocedural myocardial infarction occurred in one patient (2.5%). Seven patients (17.5%) needed postoperative pacemaker implantation. Male sex and renal insufficiency were found to be predictors of mortality in univariable analysis. Conclusions Transcatheter aortic valve implantation can be performed in nonagenarians despite very high preoperative risk scores and substantial multimorbidity, with acceptable outcomes.
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Vanhaverbeke, Maarten, Ole De Backer, and Christophe Dubois. "Practical Approach to Transcatheter Aortic Valve Implantation and Bioprosthetic Valve Fracture in a Failed Bioprosthetic Surgical Valve." Journal of Interventional Cardiology 2022 (February 15, 2022): 1–9. http://dx.doi.org/10.1155/2022/9899235.
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Bioprosthetic surgical aortic valve failure requiring reintervention is a frequent clinical problem with event rates up to 20% at 10 years after surgery. Transcatheter aortic valve-in-valve implantation (ViV-TAVI) has become a valuable treatment option for these patients, although it requires careful procedural planning. We here describe and illustrate a stepwise approach to plan and perform ViV-TAVI and discuss preprocedural computerized tomography planning, transcatheter heart valve selection, and implantation techniques. Particular attention is paid to coronary artery protection and the possible need for bioprosthetic valve fracture since patients with small surgical aortic bioprostheses are at a risk of high residual gradients after ViV-TAVI. Considering updated clinical data on long-term outcomes following ViV-TAVI, this approach may become the default treatment strategy for patients with a failing surgical aortic bioprosthesis.
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Hayashida, Kentaro. "1. Aortic Valve, 2) Transcatheter Aortic Valve Implantation." Nihon Naika Gakkai Zasshi 105, no. 2 (2016): 215–21. http://dx.doi.org/10.2169/naika.105.215.
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Harding, Daniel, Thomas J. Cahill, Simon R. Redwood, and Bernard D. Prendergast. "Infective endocarditis complicating transcatheter aortic valve implantation." Heart 106, no. 7 (January 13, 2020): 493–98. http://dx.doi.org/10.1136/heartjnl-2019-315338.
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Infective endocarditis complicating transcatheter aortic valve implantation (TAVI-IE) is a relatively rare condition with an incidence of 0.2%–3.1% at 1 year post implant. It is frequently caused by Enterococci, Staphylococcus aureus and coagulase negative staphylococci. While the incidence currently appears to be falling, the absolute number of cases is likely to rise substantially as TAVI expands into low risk populations following the publication of the PARTNER 3 and Evolut Low Risk trials. Important risk factors for the development of TAVI-IE include a younger age at implant and significant residual aortic regurgitation. The echocardiographic diagnosis of TAVI-IE can be challenging, and the role of supplementary imaging techniques including multislice computed tomography (MSCT) and positron emission tomography (18FDG PET) is still emerging. Treatment largely parallels that of conventional prosthetic valve endocarditis (PVE), with prolonged intravenous antibiotic therapy and consideration of surgical intervention forming the cornerstones of management. The precise role and timing of cardiac surgery in TAVI-IE is yet to be defined, with a lack of clear evidence to help identify which patients should be offered surgical intervention. Minimising unnecessary healthcare interventions (both during and after TAVI) and utilising appropriate antibiotic prophylaxis may have a role in preventing TAVI-IE, but robust evidence for specific preventative strategies is lacking. Further research is required to better select patients for advanced hybrid imaging, to guide surgical management and to inform prevention in this challenging patient cohort.
Dissertations / Theses on the topic "Transcatheter aortic valve implantation (TAVI)"
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Leung, Wing-ki Vikki, and 梁頴琪. "The implications of transcatheter aortic valve implantation (TAVI) adoption." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48424031.
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Aortic stenosis is a life-threatening valvular heart disease. At the onset of symptoms, a patient’s prognosis becomes poor and the risk of death rapidly increases. Aortic valve replacement surgery remains the gold standard in treatment for aortic stenosis. However, in the total population of patients with severe aortic stenosis, about one third are deemed inoperable due to their high surgical risk. In recent years, the development of transcatheter aortic valve implantation (TAVI), a non-invasive heart valve replacement procedure brought hope for the elderly, high-risk and inoperable aortic stenosis patient population pool. A literature review was performed to examine the safety, efficacy and effectiveness evidence for transcatheter aortic valve treatment option. The results showed that TAVI is a safe treatment option, however the effectiveness for the whole patient population is unknown. The adoption of this alternative treatment option is certainly coupled with multiple dimension of impact from a public health perspective. It remains inconclusive whether TAVI is an effective treatment option to be adopted.published_or_final_version
Public Health
Master
Master of Public Health
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Kemp, Iain Henry. "Development,testing and fluid interaction simulation of a bioprosthetic valve for transcatheter aortic valve implantation." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71710.
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Thesis (MScEng)--Stellenbosch University, 2012.ENGLISH ABSTRACT: Bioprosthetic heart valves (BHVs) for transcatheter aortic valve implantation (TAVI) have been rapidly developing over the last decade since the first valve replacement using the TAVI technique. TAVI is a minimally invasive valve replacement procedure offering lifesaving treatment to patients who are denied open heart surgery. The biomedical engineering research group at Stellenbosch University designed a 19 mm balloon expandable BHV for TAVI in 2007/8 for testing in animal trials. In the current study the valve was enlarged to 23 mm and 26 mm diameters. A finite element analysis was performed to aid in the design of the stents. New stencils were designed and manufactured for the leaflets using Thubrikar‟s equations as a guide. The 23 mm valve was manufactured and successfully implanted into two sheep. Fluid structure interaction (FSI) simulations constitute a large portion of this thesis and are being recognized as an important tool in the design of BHVs. Furthermore, they provide insight into the interaction of the blood with the valve, the leaflet dynamics and valve hemodynamic performance. The complex material properties, pulsating flow, large deformations and coupling of the fluid and the physical structure make this one of the most complicated and difficult research areas within the body. The FSI simulations, of the current valve design, were performed using a commercial programme called MSC.Dytran. A validation study was performed using data collected from a cardiac pulse duplicator. The FSI model was validated using leaflet dynamics visualisation and transvalvular pressure gradient comparison. Further comparison studies were performed to determine the material model to be used and the effect of leaflet free edge length and valve diameter on valve performance. The results from the validation study correlated well, considering the limitations that were experienced. However, further research is required to achieve a thorough validation. The comparative studies indicated that the linear isotropic material model was the most stable material model which could be used to simulate the leaflet behaviour. The free edge length of the leaflet affects the leaflet dynamics but does not greatly hinder its performance. The hemodynamic performance of the valve improves with an increase in diameter and the leaflet dynamics perform well considering the increased surface area and length. Many limitations in the software prevented more accurate material models and flow initiation to be implemented. These limitations significantly restricted the research and confidence in the results. Further investigation regarding the implementation of FSI simulations of a heart valve using the commercial software is recommended.
AFRIKAANSE OPSOMMING: Bio-prostetiese hartkleppe (Bioprosthetic Heart Valves - BHVs) wat gebruik word vir transkateter aortaklep-inplantings (Transcatheter Aortic Valve Implantation - TAVI) het geweldig vinnige ontwikkeling getoon in die afgelope tien jaar sedert die eerste klepvervanging wat van die TAVI prosedure gebruik gemaak het. TAVI is ʼn minimaal indringende klepvervangingsprosedure wat lewensreddende behandeling bied aan pasiënte wat ope-hart sjirurgie geweier word. Die Biomediese Ingenieurswese Navorsingsgroep (BERG) by Stellenbosch Universiteit het in 2007/8 ʼn 19 mm ballon-uitsetbare BHV vir TAVI ontwerp vir eksperimente met diere, en hierdie tesis volg op die vorige projekte. In die huidige studie is die klep vergroot na 23 mm en 26 mm in deursnee. ʼn Eindige element analise is gedoen om by te dra tot die ontwerp van die rekspalke vir die klep. Nuwe stensils is ontwerp en vervaardig vir die klepsuile, deur gebruik te maak van Thubrikar se vergelykings. Die 23 mm klep is vervaardig en suksesvol in twee skape ingeplant. Vloeistruktuur interaksie (Fluid Structure Interaction (FSI)) simulasies vorm ‟n groot deel van die tesis en word gesien as ʼn noodsaaklike hulpmiddel in die ontwerp van BHVs. Die simulasies verskaf ook insig in die interaksie van die bloed met die klep, die klepsuil-dinamika en die klep se hemodinamiese werkverrigting. Die komplekse materiaal eienskappe, polsende vloei, grootskaalse vervorming, die verbinding van die vloeistof en die fisiese struktuur maak van hierdie een van die mees gekompliseerde voorwerpe om te simuleer. Die FSI simulasies van die huidige ontwerp, is uitgevoer deur van kommersiële sagteware, MSC.Dytran, gebruik te maak. ʼn Geldigheidstudie wat data gebruik het vanaf die hartklop-nabootser, is uitgevoer. Die FSI model word geverifieer deur klepsuil dinamika visualisering en ʼn vergelyking van die drukgradiënt gebruik te maak. Verdere vergelykende studies is uitgevoer om te bepaal watter materiaal model om te gebruik, asook die uitwerking van die klepsuil-vrye rand en klepdeursnee op die klep se werkverrigting. Die resultate van die studie korreleer goed, in ag genome die beperkings wat ervaar is. Verdere navorsing is egter nodig vir ʼn volledige geldigheidstudie. Vergelykende studies het getoon dat die liniêre isotropiese materiaalmodel die meer stabiele materiaalmodel is wat kan gebruik word om klepsuilgedrag te simuleer. Die vrye-rand lengte van die klepsuil affekteer die dinamika van die klepsuil, maar belemmer nie die werkverrigting grootliks nie. Die hemodinamiese werkverrigting van die klep verbeter met die toename in deursnee en die klepsuil-dinamika vertoon goed in ag genome die verhoogde oppervlak area en lengte. Die vele beperkings in die sagteware het die implementering van meer akkurate materiaalmodelle verhoed. Hierdie beperkings het ʼn verminderde vertroue in die resultate tot gevolg gehad. Verdere ondersoek rakende die implementering van die FSI simulasies van ʼn hartklep deur kommersieel beskikbare sagteware te gebruik, word aanbevel.
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Shirzadi, Mohammad Mehdi. "Development of a patient-specific finite element model of the transcatheter aortic valve implantation (TAVI) procedure." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22893.
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Transcatheter Aortic Valve Implantation (TAVI) is a procedure developed for replacing the defective aortic valve of a patient as an alternative to open heart Surgical Aortic Valve Replacement (SAVR). In the TAVI procedure a prosthetic valve, which is assembled on to a stent, is crimped and delivered to the patient's aortic root site through several available percutaneous means. The percutaneous nature of TAVI, which is its core advantage in comparison to other SAVR procedures, can however also be its main disadvantage. This is due to lack of direct access to the calcified leaflets, and hence reliance on the host tissue for the proper positioning and anchorage of the deployed prosthetic valve. Therefore, it is desired to have a preoperative quantitative understanding of patient-specific biomechanical interaction of the stent and the native valve to be able to maximise the chance of success of the procedure. The aim of this study was to develop a patient-specific Finite Element (FE) model of the Transcatheter Aortic Valve Implantation (TAVI) procedure for two patients, using a model of the 23 mm percutaneous prosthetic aortic valve developed by Strait Access Technologies (SAT), for the purpose of its post-operative performance. In this regard, the image processing software ScanIP was used to extract the 3D models of the patient-specific aortic roots and leaflets from the provided Multi-Slice Computer Tomography (MSCT) images of the patients. An anisotropic hyperelastic material model was implemented for the roots and leaflets, using two and one families of collagen fibres for their tissues respectively. The stent is made of a cobalt-chromium alloy and its mechanical response was modelled as an isotropic elastoplastic material, with a linear elastic initial response, followed by plastic behaviour with isotropic hardening. The prosthetic leaflets are made of polymer and were modelled as an isotropic hyperelastic material, using the provided experimental test data. The results for the first patient showed that the stent maintained its structural integrity after deployment, and successfully pushed the native leaflets back to keep the aortic root clear of all impediments. No obstruction of the coronary ostia was observed, and prosthetic leaflets were seen to function normally. The stent radial recoil was calculated to be between 2 to 4.28 % after deployments. Its foreshortening was calculated to be approximately 20%. The stent was observed to move back and forth by approximately 3 mm in the last simulation step in which cardiac cycle pressure were applied to the aortic root and prosthetic leaflets. Also, two openings were observed between the stent and aortic root wall during this simulation step, which indicates the possibility of paravalvular leakage. From the second patient simulation, it was observed that the 23 mm stent was not a good choice for this patient, and will cause severe damage or tissue tearing. The maximum principal stress in the aortic root and valve tissues were observed to follow approximately the defined collagen fibre directions.
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Schneider, Stephan [Verfasser], and Christian [Akademischer Betreuer] Thilo. "Transcatheter Aortic Valve Implantation (TAVI) - Durchführung des minimalistischen Ansatzes ("The minimalist approach") / Stephan Schneider ; Betreuer: Christian Thilo." München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2021. http://d-nb.info/1229350306/34.
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Abdulghafor, Marwan [Verfasser], and Daniel [Akademischer Betreuer] Wendt. "Long- term clinical outcomes after Transcatheter Aortic Valve Implantation (TAVI) in Patients with chronic renal failure / Marwan Abdulghafor ; Betreuer: Daniel Wendt." Duisburg, 2019. http://d-nb.info/1191691896/34.
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Hartmann, Lisa [Verfasser]. "Evaluation der Aortenklappe in der CT und Korrelation mit paravalvulären Insuffizienzen in Patienten nach Transcatheter Aortic Valve Implantation (TAVI) / Lisa Hartmann." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2015. http://d-nb.info/1076038743/34.
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Grünwald, Felix. "Einfluss des Crimping auf Haltbarkeit und Gewebeintegrität bei kathetertechnischen Aortenklappenprothesen: eine experimentelle Analyse." Doctoral thesis, Universitätsbibliothek Leipzig, 2015. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-175443.
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Eine Verengung der Aortenklappe, die während der Systole zu einem Druckunterschied zwischen dem linkem Auswurftrakt und der Aorta führt, wird als Aortenstenose bezeichnet. Sie stellt nach der KHK die häufigste Indikation für eine herzchirurgische Intervention dar. Die Entstehung der Aortenstenose ist bisher nicht völlig aufgeklärt. Die Verengung ist meist durch Verkalkung der Klappensegel bedingt. Der derzeitige Stand der Forschung gibt Grund zur Annahme, dass dieser Entstehungsprozess der Ätiologie der Arteriosklerose sehr ähnlich ist.
Die Aortenstenose kann anhand der Aortenklappen-Öffnungsfläche in leicht-, mittel- und hochgradig eingeteilt werden. Zurzeit ist die Echokardiographie die wichtigste Methode zur Evaluation der Aortenstenose, weil damit die Öffnungsfläche und die Druckgradienten bestimmt werden können. Für die Entscheidung zur Operation ist insbesondere auch das Einsetzen der Symptomatik mitbestimmend.
Der konventionelle Aortenklappenersatz mit einer biologischen oder mechanischen Aortenklappenprothese ist der Goldstandard in der heutigen Therapie der Aortenstenose. Patienten höheren Alters erhalten heutzutage eine biologische Aortenklappenprothese, da keine dauerhafte Antikoagulation notwendig ist. Bei älteren Patienten (über 70 Jahre) steigt die postoperative Mortalität auf 5-15% an. In Deutschland waren 2010 über 50% der herzchirurgischen Patienten älter als 70 Jahre und 12,4% sogar über 80 Jahre. Laut einer Studie werden 33% der über 75-Jährigen nicht zur Operation zugelassen, da diese als zu risikoreich eingestuft wird.
Um dieses Patientenkollektiv besser zu versorgen, wurde ein Verfahren zur kathetergestützten Implantation einer Aortenklappenprothese entwickelt. Die neue Prothese wird auf einen Ballonkatheter gepresst und anschließend in Aortenposition dilatiert. Die Implantation kann durch die Herzspitze antegrad, also transapikal, oder über die femoralen Gefäße retrograd, also transfemoral, erfolgen. Eine Sternotomie oder die Verwendung einer Herz-Lungenmaschine mit künstlichem Herzstillstand sind dazu nicht notwendig.
Die in dieser Arbeit verwendete Sapien-Prothese besteht aus vorbehandeltem Rinderperikard und ist in einem Kobalt-Chrom-Stent aufgehängt. Bereits 2010 wurden in Deutschland schon fast ein Viertel aller isolierten Aortenklappenersätze mittels der kathetertechnischen Aortenklappenprothesen durchgeführt, 2011 ist der Anteil auf über 30% gestiegen. Der Einsatz ist im Moment auf Hochrisikopatienten über 75 Jahre beschränkt, da es noch keine Ergebnisse über die Langzeithaltbarkeit der Katheter-Herzklappen gibt. Außerdem scheint die Häufigkeit von periinterventionellen Komplikationen bei diesem Verfahren noch sehr hoch.
Ganz im Gegensatz zur schonenden Behandlung der Prothese beim konventionellen Eingriff wird die Sapien-Herzklappenprothese durch einen Crimper auf den Ballonkatheter gepresst. Der Durchmesser wird dabei von 23 bzw. 26mm auf unter 8,7mm verringert. Nur so kann die Prothese über das zum Studienzeitpunkt 26 French große Applikationssystem in Position gebracht werden. Mittlerweile beträgt der Diameter für den transfemoralen Zugang nur noch 18 French.
Bisher gibt es keine Studien darüber, ob die Krafteinwirkung des Crimping einen Einfluss auf die Langzeithaltbarkeit der Transkatheter-Herzklappen hat. Dabei ist gerade eine lange Haltbarkeit enorm wichtig, um das neue minimalinvasive System einem größeren Patientenkollektiv zugänglich zu machen. Ziel der hier vorgelegten Studie war es deshalb, den Einfluss von Crimping auf die Haltbarkeit und Gewebeintegrität der Edwards Sapien-Prothese in Abhängigkeit von der Crimping-Dauer zu untersuchen.
Dazu kam ein subkutanes Rattenmodell zur Anwendung, das zum Vergleich verschiedener Herzklappenprothesen häufig herangezogen wird. Hierbei wird vor allem das Verkalkungspotential der Prothesen untersucht, da die Verkalkung der Klappen die Funktionalität derselben limitiert. Hierfür wurden in dieser Arbeit 21 Tage alten Sprague-Dawley-Ratten (n=15) jeweils fünf Gewebeproben in separate subkutane Taschen implantiert. Nach einem Implantationszeitraum von zwölf Wochen gingen wir von der maximal möglichen Verkalkung aus. Im Menschen entspricht das einem Zeitraum von etwa zehn Jahren. Drei Gruppen á fünf Sapien-Prothesen wurden unterschiedlich lange gecrimpt: für einen Monat, einen Tag und eine Stunde. Eine vierte Gruppe wurde nicht gecrimpt. Die fünfte Gruppe bestand aus der operativ häufig verwendeten Standardklappe Perimount Magna und wurde als Kontrolle eingesetzt. Die Klappensegel wurden nach Crimping und Dilatation exzidiert (je Gruppe n=15) und unter inhalativer Anästhesie wurde jeder Ratte ein Präparat aller fünf Gruppen in subkutane separate Taschen faltenfrei implantiert. Die Taschen wurden dorsal paravertebral durch stumpfe Präparation angelegt. Die Implantation erfolgte bei allen 15 Tieren komplikationslos.
Nach zwölf Wochen erfolgte die Explantation. Ein Präparat der für einen Tag gecrimpten Prothesen und eines der Kontrollgruppe Magna konnten nicht aufgefunden werden. Ansonsten ergaben sich bei der Explantation keine Schwierigkeiten. Zur Bestimmung des Kalziumlevels im Serum wurde den Ratten eine Blutprobe abgenommen.
Die explantierten Präparate wurden dann zur Analyse in drei Teile geschnitten. Ein Teil wurde der Kalziumbestimmung durch optische Emissionsspektroskopie mit induktiv gekoppeltem Plasma (ICP-OES) zugeführt. Das Ergebnis wird in mg/g Trockengewicht angegeben. Der zweite Teil wurde für die histologische Untersuchung in Paraffin eingebettet. Es wurden Standardschnitte angefertigt und drei Färbungen pro Präparat durchgeführt. Dies waren die Hämatoxylin-Eosin-Färbung (Orientierung), die Van Kossa-Färbung (Verkalkung) und die mod. Pikrosiriusrot-Färbung (kollagene Fasern). Der Kalziumgehalt der Präparate wurde zusätzlich zur chemischen Bestimmung histologisch durch ein interaktives Bildanalyseverfahren in mm2 gemessen. Die Fragmentierung und Irregularität der Kollagenfasern wurde histologisch in vier Grade eingestuft: ohne pathologischen Befund, gering-, mittel- oder hochgradig fragmentiert bzw. irregulär. Ein weiterer Teil der Präparate wurde für die exemplarische Darstellung im Elektronenmikroskop in Epon 100 eingebettet und mit Uranylacetat und Tannin kontrastiert.
Die Kalziummessungen ergaben, dass die ungecrimpten Klappen Sapien und Perimount Magna tendenziell stärker verkalkten als die anderen Gruppen. Die Unterschiede zwischen den Gruppen waren jedoch nicht signifikant, sowohl bei der histologischen als auch bei der chemischen Quantifizierung. Die Streuung der Messwerte war sowohl intra- als auch interindividuell sehr hoch. Die Bedeutung für die Langzeithaltbarkeit bezüglich der Kalzifizierung ist unklar. Jedoch kann festgestellt werden, dass es in dieser Studie keinen signifikant messbaren Unterschied in der Verkalkung zwischen gecrimpten und ungecrimpten Prothesen gab.
In der histologischen Strukturanalyse waren die Kollagenfasern der gecrimpten Klappen signifikant stärker fragmentiert bzw. die Struktur irregulärer als die der ungecrimpten Klappen. Erstaunlich war hier auch die Tatsache, dass selbst die ungecrimpte Sapien-Prothese signifikant stärker fragmentiert war als die Perimount Magna. Dieses Ergebnis überrascht, da die Sapien-Klappe der Perimount Magna im Produktionsprozess sehr ähnlich ist. Beide bestehen aus Rinderperikard und sind mit dem Antimineralisationsverfahren ThermaFix vorbehandelt. Sie unterscheiden sich lediglich im Stent. Dieser muss für das kathetergestützte Verfahren komprimierbar und wieder dilatierbar sein. Der Produktionsprozess sollte auf Grund dieses Ergebnisses reevaluiert werden.
Wie bereits erwähnt, waren die gecrimpten Klappen signifikant stärker fragmentiert. Mit zunehmender Crimping-Dauer nahm dieser Effekt tendenziell sogar zu. Dass Crimping einen schädlichen Einfluss auf die strukturelle Integrität des Klappengewebes hat, war bis dato nicht bewiesen. Diese Tatsache allein lässt allerdings noch keine genaue Aussage über die Auswirkung von Crimping auf die Haltbarkeit im Blutstrom zu. Es ist jedoch hervorzuheben, dass die Fragmentierung der Kollagenfasern, also der Haltefasern der Aortenklappenprothese, die Erwartung einer guten Langzeitfunktionalität drastisch mindert. Dazu gibt es Hinweise aus aktuellen multizentrischen Studien wie dem Partner-Trial, in dem bereits nach 30 Tagen 1,3% und nach einem Jahr 4,2% der Patienten eine mittel- bis schwergradige transvalvuläre Aorteninsuffizienz aufwiesen. Diese Tatsache verbunden mit dem Wissen, dass Crimping die Kollagenfasern frakturiert, stellt die Langzeithaltbarkeit der Prothese in Frage.
Zu beachten ist, dass der Diameter des Systems in diesem Versuchsaufbau keine Rolle spielte. Seit Beginn der Studie hat sich der Diameter des Applikationssystems aber von 26 auf 22 French (transfemoral sogar nur 18 French) verringert. Es ist anzunehmen, dass die Krafteinwirkung beim Crimping auf 22 bzw. 18 French noch deutlich größer und damit die Fragmentierung der Fasern noch ausgeprägter wäre.
Als Limitationen des hier angewandten subkutanen Rattenmodells sind der fehlende Kontakt mit dem Blut sowie die fehlende Wirkung hämodynamischer Kräfte zu nennen. Es handelt sich hierbei um einen Tierversuch, der nicht direkt auf den Menschen übertragbar ist. Für histologische und chemische Analyse mussten jeweils unterschiedliche Teile der Präparate verwendet werden. Die histologische Beurteilung ist untersucherabhängig. In diesem Versuchsaufbau wurde lediglich ein Prothesen-Typ untersucht, so dass nicht klar ist, ob die beschriebenen Phänomene auch bei anderen kathetertechnischen Herzklappenprothesen auftreten.
Die Ergebnisse liefern neue Gesichtspunkte im Hinblick auf die Haltbarkeit der Sapien-Klappenprothese. Daraus lassen sich einige Empfehlungen ableiten.
Crimping verursacht einen irreparablen Schaden an den Kollagenfasern der Herzklappenprothesen, der tendenziell mit der Dauer des Crimpings zunimmt. Der Vorgang des Crimping sollte daher so kurz wie möglich gehalten werden. Die kathetergestützte Aortenklappenprothese sollte erst kurz vor der Implantation auf den Ballonkatheter gecrimpt werden. Crimping auf sehr kleine Diameter sollte vorerst vermieden werden.
Künftig sollte außerdem eine genauere Analyse der Auswirkungen der strukturellen Schäden auf die Haltbarkeit der Transkatheter-Herzklappen durchgeführt werden.
Vor der Ausweitung der Behandlung auf ein Patientenkollektiv mit höherer Lebenserwartung müssen noch viele Fragen hinsichtlich der Langzeithaltbarkeit dieser Herzklappen-Prothesen in weiteren Studien geklärt werden.
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Auffret, Vincent. "Aide à la décision pour le remplacement valvulaire aortique percutané." Thesis, Rennes 1, 2019. http://www.theses.fr/2019REN1B035.
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La sténose aortique serrée est la valvulopathie acquise de l’adulte la plus fréquente affectant jusqu’à 10% des octogénaires. Sa prise en charge percutanée est en plein essor et confronte les cliniciens à des problèmes nouveaux constituant un champ de recherche important. Notre travail s’inscrit dans le cadre des gestes médico-chirurgicaux assistés par ordinateur et vise à proposer des solutions d’aide à la décision basées sur l’assistance informatique. Cette Thèse est ainsi composée de 4 parties. Une première partie porte sur la problématique médicale dans laquelle s’inscrit le remplacement valvulaire aortique percutané (TAVI) ainsi que le contexte du TAVI en France et présente un article évaluant l’évolution des caractéristiques des patients et des procédures à l’échelle nationale entre 2010 et 2015 dans les registres nationaux FRANCE 2 et FRANCE TAVI. Ce premier chapitre identifie des problématiques médicales auxquelles les opérateurs sont confrontés au quotidien notamment la sélection optimale des candidats et la minimisation des complications de la procédure dans le contexte d’une réduction du profil de risque des patients traités. La seconde partie s’intéresse à l’étude de populations, par des méthodes statistiques classiques, pour établir des facteurs prédictifs de résultats du TAVI ou de survenue d’une complication donnée afin d’aider le clinicien dans sa planification de la procédure. Cette partie est articulée autour de 3 articles portant sur les facteurs prédictifs d’accidents vasculaires cérébraux, les troubles conductifs et les facteurs prédictifs de « mauvais résultats » après TAVI. Nous démontrons l’intérêt de ce type d’analyse qui resteront nécessaires à l’avenir mais abordons également leurs limites qui expliquent pourquoi d’autres pistes doivent être explorées pour stocker, trier, restituer les informations pertinentes à l’opérateur voire les augmenter pour faciliter ses décisions notamment en préopératoire.L’objet de la 3ème partie est d’aborder un système d’aide à la décision par ordinateur de type « case-based reasoning » (CBR) qui pourrait tirer bénéfice de l’identification de ces facteurs pronostiques et à terme les intégrer dans une interface globale et ergonomique d’aide à la décision. Nous avons travaillé dans le cadre du projet européen H2020 EurValve sur l’élaboration d’un CBR dont la problématique se concentre pour l’instant sur le choix optimal de la voie d’abord, du type et de la taille de prothèse. Notre travail s’est concentré sur une étape analytique de la conception de ce type de système portant sur l’étude et l’amélioration de la mesure de similarité utilisée pour rapprocher le cas à traiter (problème) de ses plus proches voisins (cas déjà traités et leur « solution » thérapeutique). Enfin, une dernière partie porte sur l’augmentation des informations disponibles pour l’aide à la décision en préopératoire par la simulation numérique spécifique patient. Après un état de l’art des méthodes utilisées dans le domaine du TAVI, nous avons travaillé à l’élaboration et au paramétrage d’un modèle de simulation de l’insertion du guide rigide dans le ventricule gauche (une étape de la procédure qui peut conditionner le positionnement de la prothèse et donc le résultat final). Afin de réaliser une première validation de cette simulation exploitant l’imagerie tomodensitométrique 3D préopératoire, l’approche proposée repose sur l’extraction de la région d’intérêt dans le volume 3D (segmentation) et sa mise en correspondance avec l’imagerie fluoroscopique 2D peropératoire par le biais d’un recalage 3D/2D. Nos travaux sur ces méthodes de traitement de l’image nécessaires à la mise en œuvre et la validation de notre stratégie de simulation sont discutés dans cette partie. Enfin nous présentons une application clinique potentielle du modèle de simulation portant sur l’influence de la forme du guide et de ses conditions d’insertion sur sa stabilité et les forces de pression s’exerçant sur le ventricule gaucheAortic stenosis represents the most frequent acquired valvular heart disease, affecting up to 10% of octogenarians. Transcatheter aortic valve implantation (TAVI) is booming and confronts clinicians with new issues that constitute a major field of research. Our work falls within the framework of computer-assisted medico-surgical interventions, and aims at proposing computer-assisted decision support systems. The present Thesis is composed of four parts. The first part focuses on the medical problematic surrounding TAVI, as well as the current French TAVI field on the basis of an article describing temporal trends in patients’ and procedural’s characteristics from 2010 to 2015 in the FRANCE 2 and FRANCE TAVI nationwide registries. This first part identifies medical issues that operators currently face, especially the optimal selection of TAVI candidates, and the reduction of procedural complications within the current trends towards treatment of patients with lower baseline surgical-risk profile. The second part deal with population-based studies, through standard statistical methods, to identify predictors of TAVI outcomes or selected procedural complications in order to facilitate procedural planning. Three articles compose this part. The first focuses on predictors of short-term cerebrovascular events post-TAVI, the second deals with conduction disturbances post-TAVI while the third aims at identifying predictors of global poor outcomes. We demonstrate the benefits of these analyses, which will remain necessary in the future, but also address their limitations, which support the use of new methods to store, sort, retrieve, and even augment relevant information to facilitate operators’ decision, especially at the pre-procedural step.The purpose of Part 3 is to address a case-based reasoning (CBR) decision-support system that could benefit from the identification of these prognostic factors and ultimately integrate them into a global and ergonomic interface for decision support. We have worked in the framework of the European project H2020 EurValve on the development of a CBR whose problematic is,for the time being, limited to the optimal choice of the approach, type and size of prosthesis. Our work focused on an analytical step in the design of this type of system dealing with the study and improvement of the similarity measure used to identify nearest neighbours (previously treated cases and their therapeutic "solution") of the current problem (case which clinicians are planning to treat). Finally, the last part focuses on increasing the information available for preoperative decision support through patient-specific numerical simulation. After a state of the art of the methods used in the field of TAVI, we worked on the elaboration and parameterization of a simulation model of the insertion of the stiff guidewire in the left ventricle (one of the first steps of the procedure that can condition the positioning of the prosthesis and thus the final result). In order to perform a first validation of this patient-specific simulation using preoperative 3D CT imaging, the proposed approach is based on the extraction of the region of interest in the 3D volume (segmentation) and its mapping to intraoperative 2D fluoroscopy through 3D / 2D registration. Our work on these image processing methods needed to implement and validate our simulation strategy is also discussed in this section. Finally, we present a potential clinical application of the simulation model regarding the influence of the shape of the guide and its insertion conditions on its stability and the pressure forces exerted on the left ventricle
9
Zenses, Anne-Sophie. "Performance hémodynamique de prothèses valvulaires aortiques percutanées et stratégies d'implantation lors de procédures "valve-in-valve" : études in vitro et in vivo." Thesis, Aix-Marseille, 2018. http://www.theses.fr/2018AIXM0417/document.
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L’implantation valvulaire aortique percutanée (TAVI) a émergé comme une alternative à la chirurgie pour les patients avec sténose sévère et haut risque chirurgical. Cette technique s’étend à une population plus large (e.g. anatomie plus complexe, risque chirurgical plus bas), ainsi qu'au traitement Valve-in-Valve (ViV) des bioprothèses (BPs) chirurgicales défaillantes. Cependant, deux complications majeures en limitent la généralisation. En TAVI « classique », la présence de fuites péripothétiques a été associée à une mortalité augmentée. Les effets du surdimensionnement de la prothèse percutanée pour assurer son étanchéité, ou de la forme de l’anneau souvent non circulaire, sur la performance hémodynamique, sont mal connus. En ViV, la présence de hauts gradients est fréquente et associée à une mortalité augmentée. Les BPs de taille nominale ≤ 21 mm et le mode de dégénérescence par sténose, facteurs mis en cause dans la sténose résiduelle et associés à une mortalité augmentée, ne sont pas assez spécifiques et il n’existe actuellement aucune recommandation pour le traitement des petites BPs. Par ailleurs, le bénéfice hémodynamique réel du ViV par rapport aux statuts avant ViV n’a pas été étudié.L’objectif général de ce travail doctoral est de comprendre les interactions entre la prothèse percutanée et l’anneau aortique ou la BP à traiter, impliquées dans la performance hémodynamique, en particulier dans des conditions d’implantation complexes, afin d’étendre les indications du TAVI. En ViV, le défi est de préciser les facteurs associés à sa performance et son utilité hémodynamique et de proposer des stratégies d’implantation afin d’optimiser le succès de la procédureTranscatheter aortic valve implantation (TAVI) has emerged as an alternative to surgery for patients with severe aortic stenosis and high surgical risk. This technique is extending to a wider population (e.g. with more complex anatomy or lower surgical risk), as well as to patients with degenerated surgical bioprostheses (BPs). However, two major concerns remain limiting. Regarding “classical TAVI”, periprosthetic leaks have been associated with increased mortality. Oversizing is used to secure the device within the aortic annulus which is often non circular. The effects of oversizing and annulus shape on the hemodynamic performance are unknown. Regarding ViV implantations, elevated post-procedural gradients are common and have been associated with increased mortality. The principal factors associated with this residual stenosis as well as with increased risk of mortality, have been BPs label size ≤ 21 mm and mode of failure by stenosis. These factors are not specific enough and there is currently no recommendation for the treatment of small BPs. Besides, the actual hemodynamic benefit associated with ViV has not been evaluated (vs. pre ViV status).The general objective of this work is to understand the interactions between the transcatheter prosthesis and the aortic annulus or the BP to be treated, which impact the hemodynamic performance, especially in complex conditions of implantation, in order to extend the indications of TAVI. In the context of ViV, the objective is to specify the factors associated with the hemodynamic performance and utility of the treatment. The final aim is to provide strategies of implantation in order to optimize the success of the procedure
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Abdul-Jawad, Altisent Omar. "Caracterización del daño neurológico asociado a la TAVI y estrategias terapéuticas para su prevención." Doctoral thesis, Universitat Autònoma de Barcelona, 2017. http://hdl.handle.net/10803/456574.
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Actualmente la implantación de prótesis aórtica transcatéter (TAVI) representa la principal opción terapéutica para pacientes con estenosis aórtica severa y alto riesgo quirúrgico. La ampliación de las indicaciones TAVI a una población de menor riesgo está limitada por la relativa alta incidencia de eventos cerebrovasculares. El daño neurológico relacionado con la TAVI se ha clasificado en distintos niveles: clínico (ictus y accidente cerebral transitorio); subclínico (infartos silentes detectados por resonancia magnética con ponderación de difusión [DWI]); y cognitivo. Estudios con DWI realizados en pacientes con un perfil de riesgo elevado han mostrado una alta incidencia de daño cerebral subclínico tras la TAVI. No obstante, la repercusión clínica en forma de variaciones del estado cognitivo ha mostrado resultados poco concluyentes. Tampoco conocemos el riesgo de daño subclínico ni las consecuencias cognitivas en una población TAVI con un perfil de riesgo menor.
Existen dos principales estrategias para prevenir el daño neurológico asociado a la TAVI: farmacológica (agentes antitrombóticos) y mecánica (dispositivos de protección embólica). Las guías de práctica clínica recomiendan una terapia antiplaquetar (TAP) post-TAVI para reducir el riesgo de ictus. No obstante, no hay datos sobre la eficacia y seguridad de esta recomendación en pacientes que se encuentren en tratamiento concomitante con antagonistas de la vitamina K (AVK) por fibrilación auricular (FA).
El primer objetivo (estudio 1) fue comparar el grado de daño neurológico subclínico (mediante DWI) y las variaciones del estado cognitivo entre la TAVI y el recambio valvular aórtico quirúrgico (RVA) en una población considerada de riesgo quirúrgico intermedio. El segundo objetivo fue examinar el riesgo de eventos isquémicos y hemorrágicos asociados a dos estrategias antitrombóticas distintas en pacientes con FA sometidos a TAVI.
Los dos estudios presentados son observacionales. El estudio 1 se realizó en el Hospital Vall Hebron. Cuarenta y seis pacientes sometidos a TAVI (78,8±8.3 años, STS score 4,4±1.7) se compararon con 37 pacientes sometidos a RVA (78,9±6,2 años, STS score 4,7±1,7). La DWI se realizó durante los primeros 15 días tras la intervención y la valoración cognitiva a nivel basal y a los 3 meses tras la intervención. No se observaron diferencias en la incidencia de ictus (2,2% en TAVI vs. 5,4% en RVA, p=0.58), ni en la incidencia de lesiones cerebrales subclínicas detectadas por DWI (45% vs. 40,7%, OR-ajustada 0,95 [0,25-3,65], p=0,94). La edad fue un predictor de nuevas lesiones (p=0,01), y el tratamiento con antagonistas de la vitamina K (AVK) tuvo un efecto protector (p=0,037). No se observaron cambios significativos en las puntuaciones de los test cognitivos tras la intervención.
El estudio 2 incluyó a 621 pacientes con FA sometidos a TAVI. Se compararon dos estrategias antitrombóticas utilizadas en mundo real: monoterapia (MT) con el uso único de AVK (n=101) vs. terapia multi-antitrombótica (MAT) con el uso de TAP más AVK (n=520). Durante un seguimiento medio de 13 meses no se observaron diferencias en la incidencia de ictus (p=0.67), eventos cardiovasculares mayores (combinado de ictus, infarto o muerte cardiaca, p=0.33), o muerte (p=0.76). No obstante sí se documentó un mayor riesgo de hemorragia mayor o amenazante en el grupo MAT (HR 1,85 [1,05-3,28], p=0,04).
El estudio 1 mostró que en una población de riesgo intermedio el daño neurológico tras la TAVI fue similar que tras el RVA. Aunque la incidencia de daño subclínico era elevada (tras la TAVI o RVA) su impacto clínico no pareció relevante. En el estudio 2 se observó que añadir una TAP a pacientes que están en tratamiento con AVK por FA y son sometidos a TAVI no aportó ningún beneficio y en cambio sí aumentó el riesgo de hemorragia.Transcatheter aortic valve implantation (TAVI) is now the principal therapeutic option in patients with severe aortic stenosis deemed at high surgical risk. Implementing TAVI in a lower risk profile population could be limited by relatively high incidence of neurological damage related with the procedure. Neurological damage has been classified at different levels: clinical (stroke or transient ischemic attack), subclinical (silent embolic infarcts after procedure demonstrated by Diffusion Weighted resonance Imaging [DWI]), and cognitive. DWI studies performed in high risk patients have demonstrated the ubiquitous presence of subclinical damage following TAVI. However its effects on cognition showed inconclusive results. To date, the risk of subclinical damage and cognitive fluctuations following TAVI in a population deemed at lower risk is unknown. There are currently two main strategies to prevent neurological damage related with TAVI: pharmacological (antithrombotic agents) and mechanical (embolic protection devices). Guidelines recommend antiplatelet therapy (APT) post-TAVR to reduce the risk of stroke. However, data on the efficacy and safety of this recommendation in the setting of a concomitant indication for oral anticoagulation (due to atrial fibrillation [AF]) are scare. The first objective (study 1) was to compare the degree of neurological damage using DWI and cognitive testing between TAVI and surgical aortic valve implantation (SAVR) in patients deemed at intermediate surgical risk. The second objective (study 2) was to examine the risk of ischemic events and bleeding episodes associated with differing antithrombotic strategies in patients undergoing TAVI with concomitant AF. The two studies presented were observational. Study #1 was conducted in Vall Hebron Hospital. Forty-six patients undergoing TAVI (78.8±8.3 years, STS score 4.4±1.7) and 37 patients undergoing SAVR (78.9±6.2 years, STS score 4.7±1.7) were compared. DWI was performed within the first 15 days post-procedure. A cognitive assessment was performed at baseline and at 3 months follow-up. TAVI and SAVR groups were comparable in terms of baseline characteristics. There were no differences in incidence of stroke (2.2% in TAVR vs. 5.4% in SAVR, p=0.58), neither in the rate of acute ischemic cerebral lesions detected by DWI (45% vs. 40.7%, adjusted OR 0.95 [0.25-3.65], p=0.94). An older age was a predictor of new lesions (p=0.01), and therapy with vitamin K antagonist (VKA) had a protective effect (p=0.037). Overall no significant changes were observed in global cognitive scores post-intervention. Study #2 was a real world multicenter evaluation comprising 621 patients with AF undergoing TAVI. Two groups were compared: mono-therapy (MT) group (with the use of VKA alone, n=101) vs. multi-antithrombotic (MAT) group (with the use of VKA plus APT, as recommended by guidelines, n=520). During a follow-up of 13 months there were no differences between groups in the rates of stroke (MT 5% vs. MAT 5.2%, HR 1.25 [0.45-3.48], p=0.67), major cardiovascular endpoint (combined of stroke, myocardial infarction or cardiovascular death, p=0.33) or death (p=0.76), however a higher risk of major or life-threatening bleeding was found in the MAT group (HR 1.85 [1.05-3.28], p=0.04). Study #1 found similar rate of cerebral damage following TAVI and SAVR in patients at intermediate risk. Although acute lesions occurred frequently in both strategies, their cognitive impact was not clinically relevant. Study #2 found that in TAVI recipients prescribed VKA therapy for AF, concomitant APT use appears not to reduce the incidence of stroke, major adverse cardiovascular events, or death, while increasing the risk of major or life-threatening bleeding. Though only observational, the important lessons to be drawn from this thesis are that under a neurological perspective implementing TAVI in an intermediate risk populations appears reasonable; and that the currently recommendation of prescribing APT for patients with AF who are already on long-term anticoagulation does not confer any benefit while potentially being harmful.
Books on the topic "Transcatheter aortic valve implantation (TAVI)"
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Giordano, Arturo, Giuseppe Biondi-Zoccai, and Giacomo Frati, eds. Transcatheter Aortic Valve Implantation. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-030-05912-5.
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2
Ted, Feldman, ed. Transcatheter valve therapies. New York: Informa Healthcare, 2010.
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3
Huber, Christoph. Transcatheter valve therapies. New York: Informa Healthcare USA, 2009.
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4
Dake, Michael D. Transcaval Aortic Catheterization for Transcatheter Aortic Valve Replacement and Thoracic Endovascular Aortic Repair Device Delivery. Edited by S. Lowell Kahn, Bulent Arslan, and Abdulrahman Masrani. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199986071.003.0014.
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During the past decade, development of catheter-based techniques for treatment of thoracic aortic and aortic valve pathologies has required that interventionalists focus on the anatomic suitability of vascular access to allow safe introduction of large size devices. Both thoracic endovascular aortic repair (TEVAR) and transcatheter aortic valve implantation (TAVI) procedures require 20 French and larger sheaths and most of major complications during these procedures have been access related. This chapter reviews transcaval aortic access techniques for delivering large devices during TEVAR and TAVI. Alternative arterial access or adjunctive femoral access techniques that increase the safety of access and reduce the overall procedural risk for patients with challenging access are critically important for the success of TEVAR or TAVI. The procedure involves transcatheter puncture of the abdominal aorta from the inferior vena cava, with delivery of a large vascular sheath and tract closure post device delivery using a nitinol occlusion device.
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Nicolini, Davide, Bjørn Erik Mørk, Jasmina Masovic, and Ole Hanseth. Expertise as Trans-Situated. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780198806639.003.0002.
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The chapter contributes to the emerging understanding of expertise as social, relational, and material. The authors examine current views on expertise building in the study of an innovative medical procedure called Transcatheter Aortic Valve Implantation (TAVI). They find that expertise occurs in many locales concurrently—each with its own trajectory and history—and that expert activity feeds upon the connections established and maintained between locales. Accordingly, expertise is not so much distributed or relational as it is trans-situated. Being an expert implies not only being socialized and becoming versed in the local way of doing things, it also implies participating in, learning to navigate, and exploiting alternative potentially competing circuits of knowledge.
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Serruys, Patrick W., Nicolo Piazza, Alain Cribier, John Webb, Jean-Claude Laborde, and Peter de Jaegere, eds. Transcatheter Aortic Valve Implantation. CRC Press, 2009. http://dx.doi.org/10.3109/9780203092095.
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Biondi-Zoccai, Giuseppe, Arturo Giordano, and Giacomo Frati. Transcatheter Aortic Valve Implantation: Clinical, Interventional and Surgical Perspectives. Springer, 2019.
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W, Serruys P., ed. Transcatheter aortic valve transplantation: Tips and tricks to avoid failure. New York: Informa Healthcare USA, 2009.
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Waksman, Ron, Corrado Tamburino, Marco Zimarino, and Ignacio Amat-Santos. Practical Guide to Prevention and Treatment of Complications During Transcatheter Aortic Valve Implantation. Wiley & Sons, Incorporated, John, 2021.
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Waksman, Ron, Corrado Tamburino, Marco Zimarino, and Ignacio Amat-Santos. Practical Guide to Prevention and Treatment of Complications During Transcatheter Aortic Valve Implantation. Wiley & Sons, Incorporated, John, 2021.
Find full textBook chapters on the topic "Transcatheter aortic valve implantation (TAVI)"
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Brtko, Miroslav. "Transcatheter Aortic Valve Implantation (TAVI)." In Aortic Regurgitation, 153–54. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-74213-7_15.
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Varghese, Anitha, Neal Uren, and Peter F. Ludman. "Transcatheter Aortic Valve Implantation (TAVI)." In Cases in Structural Cardiac Intervention, 1–11. London: Springer London, 2017. http://dx.doi.org/10.1007/978-1-4471-4981-1_1.
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Arepalli, Chesnal Dey, Christopher Naoum, Philipp Blanke, and Jonathon A. Leipsic. "Transcatheter Aortic Valve Implantation (TAVI)." In Cardiac CT Imaging, 255–74. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-28219-0_15.
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Winters, Amalia, Jessica Forcillo, and Vinod H. Thourani. "Transcatheter Aortic Valve Implantation (TAVI)." In Minimally Invasive Cardiac Surgery, 133–42. First edition. | Boca Raton : CRC Press, [2021]: CRC Press, 2021. http://dx.doi.org/10.1201/9780429188725-11.
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Sazzad, Faizus, and Theo Kofidis. "Transcatheter Aortic Valve Implantation (TAVI)." In Minimally Invasive Cardiac Surgery, 171–82. First edition. | Boca Raton : CRC Press, [2021]: CRC Press, 2021. http://dx.doi.org/10.1201/9780429188725-13.
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Miles, Lachlan F., and Andrew A. Klein. "Anesthetic Management for Transcatheter Aortic Valve Implantation (TAVI)." In Evidence-Based Practice in Perioperative Cardiac Anesthesia and Surgery, 61–72. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-47887-2_7.
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Overtchouk, Pavel, and Thomas Modine. "Transcatheter Aortic Valve Implantation (TAVI) Using the Transapical Approach." In Advances in Treatments for Aortic Valve and Root Diseases, 331–47. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-66483-5_23.
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Swee, Joshua K. Y., and Saša Grbić. "Advanced Transcatheter Aortic Valve Implantation (TAVI) Planning from CT with ShapeForest." In Medical Image Computing and Computer-Assisted Intervention – MICCAI 2014, 17–24. Cham: Springer International Publishing, 2014. http://dx.doi.org/10.1007/978-3-319-10470-6_3.
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Cribier, Alain, and Helene Eltchaninoff. "Transcatheter Aortic Valve Implantation (TAVI) with the Edwards SAPIEN XT® Device." In Catheter-Based Cardiovascular Interventions, 721–44. Berlin, Heidelberg: Springer Berlin Heidelberg, 2012. http://dx.doi.org/10.1007/978-3-642-27676-7_43.
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Eltchaninoff, Helene, and Alain Cribier. "Transcatheter Aortic Valve Implantation." In Current Best Practice in Interventional Cardiology, 67–80. Oxford, UK: Wiley-Blackwell, 2010. http://dx.doi.org/10.1002/9781444314441.ch5.
Full textConference papers on the topic "Transcatheter aortic valve implantation (TAVI)"
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Azadani, Ali N. "Energy Loss for Evaluating Transcatheter Valve Performance." In ASME 2010 5th Frontiers in Biomedical Devices Conference. American Society of Mechanical Engineers, 2010. http://dx.doi.org/10.1115/biomed2010-32025.
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Transcatheter aortic valve implantation (TAVI) has emerged as a new intervention for high surgical risk patients with severe symptomatic aortic stenosis [1]. The outcomes of the early experiences have been promising and the treatment modality is evolving very rapidly. However, mild to moderate paravalvular leaks occur commonly, over 50% of the time, after TAVI. While mild to moderate aortic regurgitation after TAVI may not have significant clinical impact in high surgical risk elderly patients, this degree of regurgitation may have considerable consequences long-term if TAV are implanted in younger and healthier patients.
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Bosi, Giorgia M., Claudio Capelli, Robin Chung, Michael Mullen, Andrew M. Taylor, and Silvia Schievano. "Patient-Specific Computational Simulations of Transcatheter Aortic Valve Implantation (TAVI)." In ASME 2013 Conference on Frontiers in Medical Devices: Applications of Computer Modeling and Simulation. American Society of Mechanical Engineers, 2013. http://dx.doi.org/10.1115/fmd2013-16154.
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In the past decade, Transcatheter Aortic Valve Replacement (TAVI) has been shown to be a feasible, less invasive option to open heart surgery for aortic valve replacement; however, TAVI is indicated only in patients with severe, symptomatic, aortic stenosis and who are considered at high or prohibitive risk for conventional surgery [1]. To date, two different TAVI devices are available on the market — the balloon-expandable Edwards-Sapien® Valve (Edwards Lifesciences, CA, USA) and the self-expandable CoreValve ReValving System® (Medtronic, MN, USA) — with many other devices currently under development and clinical trials. The procedural success rate has been >90% in all studies [1], but vascular complications, electrical conduction abnormalities and paravalvular leak — 65–89% of cases, the majority being trivial to mild, with 0 to 26% moderate and 0 to 10% severe — still remain major safety concerns. In particular, a negative influence of moderate to severe paravalvular leak on survival rates has recently been demonstrated [2].
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Li, Kewei, and Wei Sun. "Probabilistic Computational Analysis of Transcatheter Aortic Valve Leaflet Design." In ASME 2013 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2013. http://dx.doi.org/10.1115/sbc2013-14418.
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Aortic stenosis (AS) is abnormal narrowing of the aortic valve which partially obstructs outflow of blood from the left ventricle to aorta. Symptomatic AS is associated with a high mortality rate, approximately 50% in the first 2 years, if left untreated [1, 2]. Transcatheter aortic valve (TAV) implantation has been recently developed as an effective endovascular treatment for high-risk AS patients, in which a stented bioprosthetic valve is deployed through a catheter within the diseased aortic valve. Since the first procedure in 2002 [3], there has been an explosive growth in TAV implantation. By the end of 2011, there were 10 TAV companies that had first-in-man implantation data [4]. More than 50,000 TAV implantations have been performed worldwide since 2007. Short-term and medium-term outcomes after TAV implantation are encouraging with significant reduction in rates of death. However, adverse events associated with TAV implantation were reported [5, 6]. Furthermore, long-term durability and safety of these devices are largely unknown and needed to be evaluated and studied carefully [7, 8]. It is widely accepted that valve designs that reduce leaflet stresses are likely to give improved performance in long-term applications. The objective of this study was to quantify the effect of 2D TAV leaflet geometry design on 3D valve stress distribution using probabilistic computational simulation.
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Bosmans, Bart, Toon Huysmans, Roel Wirix-Speetjens, Peter Verschueren, Jan Sijbers, Johan Bosmans, and Jos Vander Sloten. "Statistical Shape Modeling and Population Analysis of the Aortic Root of TAVI Patients." In ASME 2013 Conference on Frontiers in Medical Devices: Applications of Computer Modeling and Simulation. American Society of Mechanical Engineers, 2013. http://dx.doi.org/10.1115/fmd2013-16153.
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Transcatheter aortic valve implantation (TAVI) is a relatively new technique offering a treatment option to patients for whom an open-heart surgery represents a high risk of fatality. Due to the percutaneous delivery method of this treatment, there are challenges associated. In this technique the native aortic valve is not resected, making it difficult to judge the required size of the implant and making the sealing unpredictable. After implantation, 50% of the patients suffer from at least a mild degree of leakage alongside the implant, also known as paravalvular regurgitation [1].
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Mutlu, Onur, and Hüseyin Çağatay Yalçın. "Patient Specific Transcatheter Aortic Valve Replacement Therapy Pathway with Computational Fluid Structure Interaction Analysis." In Qatar University Annual Research Forum & Exhibition. Qatar University Press, 2021. http://dx.doi.org/10.29117/quarfe.2021.0084.
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Total cardiovascular disease (CVD) prevalence has risen dramatically from 271 million in 1990 to 523 million in 2019, and CVD fatalities rose gradually from 12.1 million in 1990 to 18.6 million in 2019. According to American Heart Association statistics, annual heart valve procedures in the United States were above 100,000 in 2013, with approximately 50,000 AV replacements. The ideal replacement valve should be durable, resistant to thrombosis, and have excellent hemodynamics features. Transcatheter aortic valve replacement (TAVR) has been introduced about two decades ago as an alternative for minimally invasive implantation of new generation bioprosthetic heart valves. Computational modeling can be used during therapy planning for the selection of appropriate replacement valves for TAVR. In this NPRP funded project, we are establishing a mechanical and FSI analysis path, for a detailed patient-specific hemodynamics analysis for TAVR, considering the most important parameters affecting TAV efficiency. This approach will enable the choice of the most suitable TAV type and deployment position for the treatment. TAV which is crimped and placed into the catheter by mechanical analysis is deployed in a patient-specific geometry in a virtual treatment then contact pressure and the stress are measured on the aortic root, stent, and aortic leaflets. TAV performance indicators are determined by FSI analysis using coupled ABAQUS and Flow-vision software. With this advanced analysis and simulation path, we expect to estimate accurately the clinical TAVR parameters such as contact pressure, contact area, principal stress, etc. before the operation during therapy planning. This approach will help clinicians in optimal valve selection for TAVR patients.
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Claiborne, Thomas E., Michalis Xenos, Jawaad Sheriff, Dinesh Peter, Yared Alemu, Yasushi Kato, Leonard Pinchuk, Shmuel Einav, Jolyon Jesty, and Danny Bluestein. "Development and Optimization of a Novel Polymeric Prosthetic Heart Valve Using the Device Thrombogenicity Emulation (DTE) Methodology." In ASME 2012 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2012. http://dx.doi.org/10.1115/sbc2012-80186.
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Calcific aortic valve disease (CAVD) is the most common and life threatening form of valvular heart disease, characterized by stenosis and regurgitation, which is currently treated at the symptomatic end-stages via open-heart surgical replacement of the diseased valve with typically either a xenograft tissue valve or mechanical heart valve. These options offer the clinician a choice between structural valve deterioration and anticoagulant therapy respectively, effectively replacing one disease with another [1]. Polymeric heart valves (PHV) offer the promise of reducing or eliminating these complications [2] and may be efficacious for patients who cannot tolerate cardiothoracic surgery by using instead transcatheter valve implantation (TAVI) [3], where there is evidence that tissue valves are damaged during implantation [4], and in pulsatile circulatory support devices such as the SynCardia Total Artificial Heart. But development of PHVs has been slow due to the lack of sufficiently durable and biocompatible formulations.
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Carande, Elliott, Alexander Chase, Ahmed Hailan, Ayush Khurana, Dave Smith, and Daniel Obaid. "28 Automatic aortic annulus sizing by the heart navigator III software in the planning of transcatheter aortic valve implantation (TAVI)." In British Cardiovascular Society Virtual Annual Conference, ‘Cardiology and the Environment’, 7–10 June 2021. BMJ Publishing Group Ltd and British Cardiovascular Society, 2021. http://dx.doi.org/10.1136/heartjnl-2021-bcs.28.
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"A PROPOSAL OF A WORKFLOW-BASED CBR FOR INTERVENTIONAL CDSS - Application to Transcatheter Aortic Valve Implantation (TAVI)." In International Conference on Health Informatics. SciTePress - Science and and Technology Publications, 2012. http://dx.doi.org/10.5220/0003771302010206.
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Grbic, Sasa, Razvan Ionasec, Tommaso Mansi, Bogdan Georgescu, Fernando Vega-Higuera, Nassir Navab, and Dorin Comaniciu. "Advanced intervention planning for Transcatheter Aortic Valve Implantations (TAVI) from CT using volumetric models." In 2013 IEEE 10th International Symposium on Biomedical Imaging (ISBI 2013). IEEE, 2013. http://dx.doi.org/10.1109/isbi.2013.6556801.
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Gunning, Paul S., Neelakantan Saikrishnan, Ajit P. Yoganathan, and Laoise M. McNamara. "Hemodynamic and Structural Implications of Asymmetric Deployment of Transcatheter Aortic Valves: An In Vitro Study." In ASME 2013 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2013. http://dx.doi.org/10.1115/sbc2013-14579.
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Aortic stenosis is an age related degenerative disease of the aortic valve that causes narrowing of the valve and aortic regurgitation [1]. Transcatheter Aortic Valve (TAV) implantation is a percutaneous alternative to open heart surgery, which allows for the treatment of a cohort of patients for whom conventional surgery is deemed excessively risky due to high postoperative mortality rates or pre-existing illness [2].
Reports on the topic "Transcatheter aortic valve implantation (TAVI)"
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Runjic, Frane, Andrija Matetic, Matjaz Bunc, Nikola Crncevic, and Ivica Kristic. Small Degenerated Surgical Bioprosthetic Valve should be Treated with SupraAnnular Valve-in-Valve Transcatheter Aortic Valve Replacement. Science Repository, December 2021. http://dx.doi.org/10.31487/j.jicoa.2021.04.02.
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Background: Patient-prothesis mismatch (PPM) is a serious potential complication following surgical aortic valve replacement (SAVR). If it develops, valve-in-valve transcatheter aortic valve replacement (TAVR) is a reasonable therapeutic option. However, there is low evidence on the management of small degenerated surgical bioprosthetic valves, not prone to balloon-valve fracture (BVF). Case Presentation: This case report presents a successful valve-in-valve TAVR in acute heart failure due to degenerative surgical bioprosthetic valve Trifecta (21 mm) that is not susceptible to BVF. Standard preparation for transfemoral TAVR with a self-expandable valve was conducted, including the over-the-wire pacing. Thereafter, a successful valve-in-valve primary implantation of the self-expanding, supra-annular valve Evolut R 26 (Medtronic™) has been achieved. Follow-up at 3 months showed mild paravalvular leak in the region with clinical and heart function improvements of the patient. Follow-up echocardiographic parameters showed the reduction of anterograde flow impairment and improved effective orifice area (~0.85 cm2/m2). Conclusion: In conclusion, supra-annular valve-in-valve TAVR is a potential therapeutic option for PPM of small degenerated surgical bioprosthetic valves which are not prone to BVF.
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Shao, Ruochen, and Junli Li. Efficacy and Safety of Emergent Transcatheter Aortic Valve Implantation in Patients with Decompensated Aortic Stenosis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, April 2021. http://dx.doi.org/10.37766/inplasy2021.4.0050.
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Song, Yumeng, Yutong Wang, Zuoxiang Wang, and Tingbo Jiang. Comparing clinical outcomes on oncology patients with severe aortic stenosis undergoing transcatheter aortic valve implantation： A systematic review and meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, February 2022. http://dx.doi.org/10.37766/inplasy2022.2.0009.
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Transcatheter aortic valve implantation may be an option for patients with aortic stenosis at lower surgical risk. National Institute for Health Research, September 2019. http://dx.doi.org/10.3310/signal-000818.
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