The Experts below are selected from a list of 312 Experts worldwide ranked by ideXlab platform
Tanya Rami - One of the best experts on this subject based on the ideXlab platform.
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transcatheter aortic valve replacement with different valve types in elliptic aortic Annuli
Circulation, 2017Co-Authors: Yoshio Maeno, Yigal Abramowitz, Sunghan Yoon, Hasan Jilaihawi, Sharma Raul, Sharjeel Israr, Masaki Miyasaka, Hiroyuki Kawamori, Yoshio Kazuno, Tanya RamiAbstract:BACKGROUND The aim of this study was to determine the influence of an elliptic annulus on acute device success rates following self-expanding (SE) transcatheter aortic valve replacement (TAVR) vs. balloon-expandable (BE) TAVR.Methods and Results:Outcomes were assessed using Valve Academic Research Consortium-2 definitions. Aortic annulus ratio (AAR) was measured as short axis diameter/long axis diameter. Mean AAR was 0.81±0.06. Patients were therefore divided into 2 groups: AAR <0.82 and AAR ≥0.82. For circular Annuli (AAR ≥0.82; 363 patients), high device success rates were achieved in both valve groups (SE valve, 90.5% vs. BE valve, 95.0%, P=0.14). Conversely, for AAR <0.82 (374 patients), SE valves had lower device success rates than BE valves (82.5% vs. 95.3%, P=0.002). For elliptic Annuli, SE-TAVR was an independent predictor of unsuccessful device implantation (OR, 6.34, P<0.001). Nonetheless, increased oversizing of SE valves for elliptic Annuli was associated with an exponential rise in device success (threshold ≥17.5%; area under the curve, 0.83) but not for BE-TAVR. Furthermore, optimally oversized SE valves and BE valves had a similarly high device success for elliptic Annuli (SE valve, 96.2% vs. BE valve, 95.3%). CONCLUSIONS For circular Annuli, similarly high device success was achieved for the 2 valve types. Conversely, for elliptic Annuli, SE valves had a lower device success than BE valves. Device success following optimal oversizing of SE valves, however, was similar to that for BE valves.
Franzjosef Neumann - One of the best experts on this subject based on the ideXlab platform.
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bioprosthetic valve performance after transcatheter aortic valve replacement with self expanding versus balloon expandable valves in large versus small aortic valve Annuli insights from the choice trial and the choice extend registry
Jacc-cardiovascular Interventions, 2018Co-Authors: Mohammad Abdelghani, Nader Mankerious, Abdelhakim Allali, Martin Landt, Jatinderjit Kaur, Dmitriy S Sulimov, Constanze Merten, Susanne Sachse, Julinda Mehilli, Franzjosef NeumannAbstract:Abstract Objectives The aim of this study was to compare self-expanding and balloon-expandable transcatheter heart valves (THVs) in large versus small aortic valve Annuli. Background The degree of THV oversizing varies according to annular size, and this can modify the hemodynamic performance of self-expanding and balloon-expandable THVs. Methods Patients undergoing transcatheter aortic valve replacement in the randomized CHOICE (Comparison of Transcatheter Heart Valves in High Risk Patients With Severe Aortic Stenosis: Medtronic CoreValve vs Edwards SAPIEN XT) trial (CoreValve [CV], n = 120; SAPIEN XT [SXT], n = 121) and the nonrandomized CHOICE-Extend registry (Evolut R [ER], n = 100; SAPIEN 3 [S3], n = 334) were compared for THV performance by echocardiography (in all patients) and by cardiac magnetic resonance imaging (MRI) regurgitant fraction (RF) (in a subgroup of patients). Patients were stratified according to aortic valve annular mean diameter into those with large (>23 mm) or small (≤23 mm) Annuli. Results THV percentage oversizing was 19.1 ± 6.4% with the CV, 11.4 ± 7.0% with the SXT, 18.8 ± 4.8% with the ER, and 3.7 ± 5.5% with the S3. Transvalvular mean pressure gradient was lower with the CV and ER than with the SXT and S3 in both the large and small annulus groups. In the randomized CHOICE trial, moderate to severe prosthetic valve regurgitation (PVR) was more with the CV than the SXT in large Annuli (15.1% vs. 0.0%; p = 0.002; MRI RF: 10.5 ± 10.2% vs. 4.4 ± 4.5%; p = 0.036) but not in small Annuli (0.0% vs. 5.7%; p = 0.50; MRI RF: 4.0 ± 4.1% vs. 4.0 ± 3.4%; p = 0.98). In the CHOICE-Extend registry, moderate to severe PVR occurred in 2 patients, and any PVR was not significantly different between the ER and the S3 in large (41.7% vs. 32.5%; p = 0.24) or small (47.1% vs. 43.8%; p = 0.84) Annuli. MRI RF was not different in large Annuli (5.0 ± 3.8% vs. 5.0 ± 6.1%; p = 0.99) but was significantly lower with the ER than the S3 in small Annuli (2.9 ± 2.3% vs. 4.8 ± 3.7%; p = 0.023). On multivariate analysis, transcatheter aortic valve replacement with the ER in small Annuli was associated with a lower rate of prosthesis-patient mismatch than with the S3, with no increased risk for PVR. Conclusions Older-generation balloon-expandable THVs were associated with less PVR than self-expanding THVs in patients with large but not small Annuli. The next-generation self-expanding THV has improved sealing in patients with large Annuli and may have potential advantages in patients with small Annuli.
Régis Rieu - One of the best experts on this subject based on the ideXlab platform.
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Effect of oversizing and elliptical shape of aortic annulus on transcatheter valve hemodynamics: An in vitro study
International Journal of Cardiology, 2016Co-Authors: Erwan Salaün, Philippe Pibarot, Morgane Evin, Anne-sophie Zenses, Frederic Collart, Gilbert Habib, Régis RieuAbstract:Background: Transcatheter aortic valve implantation (TAVI) is often performed in patients with non-circular aortic annulus and in oversizing (OS) conditions. The impact of elliptical annulus shape and the consequences of oversizing/underdeployment on the hemodynamic performance are still debated. Objective: This in-vitro study aims to assess and compare the valve hemodynamic performances of the Edwards SAPIEN transcatheter heart valve (THV) in the different current conditions of use: important oversizing in small circular Annuli and in elliptical Annuli, moderate oversizing in circular and in elliptical Annuli of various degrees of eccentricity. Methods: A pulsed cardiovascular simulator was used. Edwards SAPIEN 23 and 26 (mm) were implanted in different circular and elliptical Annuli of various sizes and eccentricity. Transvalvular mean pressure gradients (TPGm), effective orifice area (EOA) after implantation of Edwards SAPIEN THV were measured by Dopplere-chocardiography and the performance index (PI - 100 x EOA / Annulus Area) was calculated. Para and transvalvular regurgitation was assessed by color-Doppler and leakage volume was quantified by flowmeter measurement. Results: For a given aortic annulus area, EOAs after implantation of Edwards SAPIEN THV were generally larger and TPGms lower with elliptical Annuli compared to circular Annuli. The PI was higher (p = 0.047) for elliptical (48 +/- 3%) than for circular Annuli (43 +/- 5%). Paravalvular regurgitation occurred only in the case of the SAPIEN 26 implanted in the elliptical annulus with highest eccentricity. Conclusion: The results of this in-vitro study suggest that the EOAs of Edwards SAPIEN are better in elliptical than in circular Annuli. No transvalvular regurgitation occurred and only one paravalvular regurgitation was observed after implantation of SAPIEN 26 in the highly eccentric annulus. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
Yoshio Maeno - One of the best experts on this subject based on the ideXlab platform.
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transcatheter aortic valve replacement with different valve types in elliptic aortic Annuli
Circulation, 2017Co-Authors: Yoshio Maeno, Yigal Abramowitz, Sunghan Yoon, Hasan Jilaihawi, Sharma Raul, Sharjeel Israr, Masaki Miyasaka, Hiroyuki Kawamori, Yoshio Kazuno, Tanya RamiAbstract:BACKGROUND The aim of this study was to determine the influence of an elliptic annulus on acute device success rates following self-expanding (SE) transcatheter aortic valve replacement (TAVR) vs. balloon-expandable (BE) TAVR.Methods and Results:Outcomes were assessed using Valve Academic Research Consortium-2 definitions. Aortic annulus ratio (AAR) was measured as short axis diameter/long axis diameter. Mean AAR was 0.81±0.06. Patients were therefore divided into 2 groups: AAR <0.82 and AAR ≥0.82. For circular Annuli (AAR ≥0.82; 363 patients), high device success rates were achieved in both valve groups (SE valve, 90.5% vs. BE valve, 95.0%, P=0.14). Conversely, for AAR <0.82 (374 patients), SE valves had lower device success rates than BE valves (82.5% vs. 95.3%, P=0.002). For elliptic Annuli, SE-TAVR was an independent predictor of unsuccessful device implantation (OR, 6.34, P<0.001). Nonetheless, increased oversizing of SE valves for elliptic Annuli was associated with an exponential rise in device success (threshold ≥17.5%; area under the curve, 0.83) but not for BE-TAVR. Furthermore, optimally oversized SE valves and BE valves had a similarly high device success for elliptic Annuli (SE valve, 96.2% vs. BE valve, 95.3%). CONCLUSIONS For circular Annuli, similarly high device success was achieved for the 2 valve types. Conversely, for elliptic Annuli, SE valves had a lower device success than BE valves. Device success following optimal oversizing of SE valves, however, was similar to that for BE valves.
Francesco Bedogni - One of the best experts on this subject based on the ideXlab platform.
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transcatheter self expandable valve implantation for aortic stenosis in small aortic Annuli the tavi small registry
Jacc-cardiovascular Interventions, 2020Co-Authors: Damiano Regazzoli, Mauro Chiarito, Francesco Cannata, Matteo Pagnesi, Mizuki Miura, Francesca Ziviello, Andrea Picci, Jorg Reifart, Federico De Marco, Francesco BedogniAbstract:Abstract Objectives The aim of this study was to evaluate and compare the outcomes of transcatheter self-expandable prostheses in patients with small Annuli. Background Transcatheter aortic heart valves appear to have better performance than surgical valves in terms of prosthesis-patient mismatch, especially in patients with aortic stenosis with small aortic Annuli. Methods TAVI-SMALL (International Multicenter Registry to Evaluate the Performance of Self-Expandable Valves in Small Aortic Annuli) is a retrospective registry of patients with severe aortic stenosis and small Annuli (annular perimeter Results Pre-discharge gradients were consistently low in every group, with a slight benefit with the Evolut R (8.1 mm Hg; 95% confidence interval [CI]: 7.7 to 8.5 mm Hg) and Evolut PRO (6.9 mm Hg; 95% CI: 6.3 to 7.6 mm Hg) compared with the ACURATE (9.6 mm Hg; 95% CI: 8.9 to 10.2 mm Hg) and Portico (8.9 mm Hg; 95% CI: 8.2 to 9.6 mm Hg) groups (p Conclusions Transcatheter self-expandable valves showed optimal clinical and echocardiographic results in patients with small aortic Annuli, although supra-annular functioning transcatheter heart valves seemed to slightly outperform intra-annular functioning ones. The role of transcatheter aortic valve replacement with self-expandable valves for the treatment of aortic stenosis in patients with small Annuli needs to be confirmed in larger trials.