Preliminary analysis of subclinical leaflet thrombosis after percutaneous aortic valve replacement with balloon dilation / 中国胸心血管外科临床杂志

@#Objective    To analyze the factors influencing the occurrence of subclinical leaflet thrombosis (SLT) after percutaneous aortic valve replacement using balloon-expandable valve (Sapien3, S3). Methods     Retrospective analysis was made on 62 patients with severe aortic stenosis undergoing percutaneous aortic valve replacement using S3 in our center from September 2020 to June 2022. Patients with a history of vascular atherosclerosis or with significant increase or insignificant decrease of aortic valve flow or gradient pressure during follow-up were selected for CT examination. Results     A total of 26 patients were finally included, with an average age of 70.31±8.90 years, and the male proportion was higher (n=15, 57.69%). Among them, 5 patients had SLT. Compared with the non-SLT group, patients in the SLT group were older (68.52±8.80 years vs. 77.80±4.66 years, P=0.007). The age factor (≥75 years) and the diameter of the ascending aorta were associated with SLT (both P<0.05). Conclusion     The incidence of SLT is higher in the elderly patients. It is speculated that SLT is related to the characteristics of short balloon dilation valves and low blood flow dynamics of valve racks.

Transcatheter Aortic Valve Implantation: Where are we in 2020?

Abstract Aortic stenosis is an insidious disease of rapid progression after the onset of symptoms. Aortic valve replacement surgery is a well-established therapy that reduces symptoms and increases survival rates. However, the procedure may be associated with high operative mortality rates and promote comorbidity. Depending on the local reality, the prevalence of patients considered inoperable (due to medical comorbidities and age) may achieve 30%. For these patients, transcatheter aortic valve implantation (TAVI) was initially indicated; over time, the method has advanced technologically and been simplified, and become an alternative therapy for patients at low and intermediate surgical risk also, and considered one of the major advances of modern medicine.

Reemplazo percutáneo de la válvula aórtica en pacientes con estenosis aórtica grave y riesgo quirúrgico elevado / Percutaneous Aortic Valve Replacement in Patients with Severe Aortic Stenosis and High Surgical Risk / Percutaneous Aortic Valve Replacement in Patients with Severe Aortic Stenosis and High Surgical Risk

Introducción La cirugía de reemplazo valvular aórtico es el tratamiento de elección en pacientes con estenosis aórtica. Sin embargo, en una proporción considerable de pacientes, el riesgo quirúrgico y la presencia de algunas comorbilidades, que aumentan este riesgo, impiden la cirugía. El reemplazo percutáneo de la válvula aórtica representa una alternativa a la cirugía valvular convencional para pacientes seleccionados de riesgo elevado. Objetivo Comunicar la experiencia inicial de reemplazo percutáneo de la válvula aórtica con prótesis autoexpandible CoreValve® (Medtronic, Minneapolis, MN, USA) en pacientes portadores de estenosis aórtica grave. Material y métodos Registro multicéntrico en el que se incluyeron 21 pacientes con estenosis aórtica grave (área < 1 cm²) sintomática y riesgo quirúrgico elevado sometidos a implante percutáneo en cuatro centros cardiovasculares argentinos de alta complejidad. Para el procedimiento se implementó una estrategia multidisciplinaria que involucró a diversos especialistas: anestesiólogo, cirujano, expertos en imágenes y cardiólogos intervencionistas. Resultados La edad media fue de 80,8 ± 7,1 años (rango: 63-90), el 57% de sexo masculino, área valvular media de 0,59 ± 0,25 cm² y EuroSCORE de 18,1% ± 4%. El 73% y el 27% de los pacientes se encontraban en clase funcional III y IV, respectivamente. El éxito del procedimiento fue del 95,2% (20/21), que se tradujo en una reducción pronunciada del gradiente pico transvalvular aórtico (82 ± 14 mm Hg a 12 ± 3 mm Hg; p < 0,001), mientras que el desarrollo posprocedimiento de regurgitación aórtica de grado moderado-grave fue del 14%. El 85,8% de los pacientes evolucionaron a clase funcional I. El requerimiento de marcapasos definitivo fue del 38% (8/21). La mortalidad del procedimiento y a los 30 días fue del 4,7% y del 9,5%, respectivamente; se observó un caso de accidente cerebrovascular isquémico menor con restitución ad integrum dentro de la semana. Se detectaron 4 óbitos en el seguimiento alejado (mediana 7 meses), dos de origen cardíaco (mortalidad cardíaca 19%) y otros dos de causa no cardíaca. Conclusiones El tratamiento de la estenosis aórtica grave en pacientes de riesgo quirúrgico elevado mediante reemplazo valvular percutáneo con prótesis CoreValve® es una alternativa factible que se asocia con una mejoría funcional notoria. La selección adecuada de pacientes, el perfeccionamiento de la técnica del procedimiento y el desarrollo de nuevos diseños incrementarán su eficacia y seguridad.

Background Aortic valve replacement is the treatment of choice in patients with aortic stenosis. However, a significant number of patients are not candidates for surgery due to high surgical risk and to the presence of comorbidities. Percutaneous aortic valve replacement represents an alternative option to conventional aortic valve surgery for selected high risk patients. Objective To inform about the initial experience with percutaneous aortic valve replacement with a self-expanding CoreValve® aortic valve prosthesis (Medtronic, Minneapolis, MN, USA). Material and Methods We conducted a multicenter registry including 21 patients with severe symptomatic aortic stenosis (aortic valve area < 1 cm²) and high surgical risk undergoing percutaneous aortic valve replacement in four high complexity cardiovascular centers. A multidisciplinary strategy was used involving several specialists: anesthesiologist, surgeon, diagnostic images specialists and interventional cardiologists. Results Mean age was 80.8±7.1 years (range: 63-90); 57% were men. Mean aortic valve area was 0.59±0.25 cm² and mean EuroSCORE was 18.1%±4%. The percentages of patients in functional class III and IV were 73% and 27%, respectively. The procedure was successful in 95.2% (20/21) of patients, with a pronounced reduction in peak transvalvular aortic gradient (from 82±14 mm Hg to 12±3 mm Hg; p <0,001); 14% of patients developed moderate to severe aortic regurgi-tation after the procedure. 85.5% of patients evolved to FC I. Definite pacemaker implantation was required in 38% (8/21). Procedure-related mortality was 4.7% and mortality after 30 days was 9.5%. One patient developed a minor stroke with complete recovery within a week. Four patients died in the long-term follow-up (median 7 months): 2 due to cardiac causes (cardiac mortality 19%) and 2 due to non-cardiac causes. Conclusions Percutaneous aortic valve replacement with CoreValve® aortic valve prosthesis is a feasible option for patients with high surgical risk that is associated with significant clinical improvement. The adequate selection of patients, improvement of the surgical technique and the development of new designs will increase the efficacy and safeness of the procedure.