Efficacy and Safety of Postdilatation to Reduce Paravalvular Regurgitation During Balloon-Expandable Transcatheter Aortic Valve Replacement
BACKGROUND—Paravalvular regurgitation (PVR) is common after transcatheter aortic valve replacement (TAVR) and may be associated with adverse outcomes. Postdilatation (PD) has been proposed to treat PVR without being formally studied. We performed a study to evaluate the safety and efficacy of PD aft...
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| Veröffentlicht in: | Circulation. Cardiovascular interventions 2013-02, Vol.6 (1), p.85-91 |
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| container_title | Circulation. Cardiovascular interventions |
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| creator | Daneault, Benoit Koss, Elana Hahn, Rebecca T Kodali, Susheel Williams, Mathew R Généreux, Philippe Paradis, Jean-Michel George, Isaac Reiss, George R Moses, Jeffrey W Smith, Craig R Leon, Martin B |
| description | BACKGROUND—Paravalvular regurgitation (PVR) is common after transcatheter aortic valve replacement (TAVR) and may be associated with adverse outcomes. Postdilatation (PD) has been proposed to treat PVR without being formally studied. We performed a study to evaluate the safety and efficacy of PD after balloon expandable TAVR.
METHODS AND RESULTS—Consecutive cases of TAVR were reviewed for clinical outcomes. Procedural transesophageal echocardiography imaging was reviewed for a subgroup of consecutive patients. PVR areas seen on a short-axis view were measured immediately after deployment, after PD, and at the completion of the study. Stent dimensions measured using angiography and the Paieon’s C-THV system pre- and post-PD were compared. Between May 2007 and November 2011, 259 patients underwent TAVR at our institution. PD was performed in 106 patients (41%). These patients had larger annulus, lower cover-index; more often had transfemoral access and implantation of a 26 mm valve. There was a nonsignificant greater rate of cerebrovascular events in PD patients. There was no significant difference in major aortic injury and permanent pacemaker implantation rates between groups. TTE studies were reviewed in 58 patients (35 with PD and 23 without PD). PD patients had larger PVR areas immediately after deployment (40.3±17.1 versus 15.4±14.2 mm; P |
| doi_str_mv | 10.1161/CIRCINTERVENTIONS.112.971614 |
| format | Article |
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METHODS AND RESULTS—Consecutive cases of TAVR were reviewed for clinical outcomes. Procedural transesophageal echocardiography imaging was reviewed for a subgroup of consecutive patients. PVR areas seen on a short-axis view were measured immediately after deployment, after PD, and at the completion of the study. Stent dimensions measured using angiography and the Paieon’s C-THV system pre- and post-PD were compared. Between May 2007 and November 2011, 259 patients underwent TAVR at our institution. PD was performed in 106 patients (41%). These patients had larger annulus, lower cover-index; more often had transfemoral access and implantation of a 26 mm valve. There was a nonsignificant greater rate of cerebrovascular events in PD patients. There was no significant difference in major aortic injury and permanent pacemaker implantation rates between groups. TTE studies were reviewed in 58 patients (35 with PD and 23 without PD). PD patients had larger PVR areas immediately after deployment (40.3±17.1 versus 15.4±14.2 mm; P<0.0001). There was significant reduction in PVR area attributable to PD (21.7±9.3 mm; P<0.0001). Spontaneous regression of PVR was seen in both groups. PD increased stent dimensions.
CONCLUSIONS—This study demonstrates the efficacy of PD at reducing PVR in patients with greater than mild PVR after balloon-expandable TAVR.</description><identifier>ISSN: 1941-7640</identifier><identifier>EISSN: 1941-7632</identifier><identifier>DOI: 10.1161/CIRCINTERVENTIONS.112.971614</identifier><identifier>PMID: 23339841</identifier><language>eng</language><publisher>United States: American Heart Association, Inc</publisher><subject>Aged ; Aged, 80 and over ; Angioplasty, Balloon - methods ; Aortic Valve - pathology ; Aortic Valve - surgery ; Aortic Valve Stenosis - surgery ; Cardiac Catheterization ; Female ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Mitral Valve Insufficiency - etiology ; Mitral Valve Insufficiency - prevention & control ; Postoperative Complications - prevention & control ; Survival Analysis ; Treatment Outcome</subject><ispartof>Circulation. Cardiovascular interventions, 2013-02, Vol.6 (1), p.85-91</ispartof><rights>2013 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4884-d131fd510830d156fb897133ecf0eea56c4fa1fbf43dcd9daa351864c35dd8c43</citedby><cites>FETCH-LOGICAL-c4884-d131fd510830d156fb897133ecf0eea56c4fa1fbf43dcd9daa351864c35dd8c43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23339841$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Daneault, Benoit</creatorcontrib><creatorcontrib>Koss, Elana</creatorcontrib><creatorcontrib>Hahn, Rebecca T</creatorcontrib><creatorcontrib>Kodali, Susheel</creatorcontrib><creatorcontrib>Williams, Mathew R</creatorcontrib><creatorcontrib>Généreux, Philippe</creatorcontrib><creatorcontrib>Paradis, Jean-Michel</creatorcontrib><creatorcontrib>George, Isaac</creatorcontrib><creatorcontrib>Reiss, George R</creatorcontrib><creatorcontrib>Moses, Jeffrey W</creatorcontrib><creatorcontrib>Smith, Craig R</creatorcontrib><creatorcontrib>Leon, Martin B</creatorcontrib><title>Efficacy and Safety of Postdilatation to Reduce Paravalvular Regurgitation During Balloon-Expandable Transcatheter Aortic Valve Replacement</title><title>Circulation. Cardiovascular interventions</title><addtitle>Circ Cardiovasc Interv</addtitle><description>BACKGROUND—Paravalvular regurgitation (PVR) is common after transcatheter aortic valve replacement (TAVR) and may be associated with adverse outcomes. Postdilatation (PD) has been proposed to treat PVR without being formally studied. We performed a study to evaluate the safety and efficacy of PD after balloon expandable TAVR.
METHODS AND RESULTS—Consecutive cases of TAVR were reviewed for clinical outcomes. Procedural transesophageal echocardiography imaging was reviewed for a subgroup of consecutive patients. PVR areas seen on a short-axis view were measured immediately after deployment, after PD, and at the completion of the study. Stent dimensions measured using angiography and the Paieon’s C-THV system pre- and post-PD were compared. Between May 2007 and November 2011, 259 patients underwent TAVR at our institution. PD was performed in 106 patients (41%). These patients had larger annulus, lower cover-index; more often had transfemoral access and implantation of a 26 mm valve. There was a nonsignificant greater rate of cerebrovascular events in PD patients. There was no significant difference in major aortic injury and permanent pacemaker implantation rates between groups. TTE studies were reviewed in 58 patients (35 with PD and 23 without PD). PD patients had larger PVR areas immediately after deployment (40.3±17.1 versus 15.4±14.2 mm; P<0.0001). There was significant reduction in PVR area attributable to PD (21.7±9.3 mm; P<0.0001). Spontaneous regression of PVR was seen in both groups. PD increased stent dimensions.
CONCLUSIONS—This study demonstrates the efficacy of PD at reducing PVR in patients with greater than mild PVR after balloon-expandable TAVR.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angioplasty, Balloon - methods</subject><subject>Aortic Valve - pathology</subject><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Cardiac Catheterization</subject><subject>Female</subject><subject>Heart Valve Prosthesis Implantation</subject><subject>Humans</subject><subject>Male</subject><subject>Mitral Valve Insufficiency - etiology</subject><subject>Mitral Valve Insufficiency - prevention & control</subject><subject>Postoperative Complications - prevention & control</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>1941-7640</issn><issn>1941-7632</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNplkcFuEzEQhi0EoqXwCsgHDly22GvvZlfiUsJSIlVplYZerYk9ThacdWp7W_IMfWmMEnrhYHn0-5_PmvkJ-cDZOec1_zSdLaaz-bJb3HXz5ex6fpvl8ryd5Df5gpzyVvJiUovy5XMt2Ql5E-NPxrJcl6_JSSmEaBvJT8lTZ22vQe8pDIbegsW0p97SGx-T6R0kSL0faPJ0gWbUSG8gwAO4h9FByNp6DOv-aPo6hn5Y0y_gnPdD0f3eZSasHNJlgCFqSBtMGOiFD6nX9C5TMCN2DjRucUhvySsLLuK7431GfnzrltPvxdX15Wx6cVVo2TSyMFxwayrOGsEMr2q7avL0QqC2DBGqWksL3K6sFEab1gCIije11KIyptFSnJGPB-4u-PsRY1LbPmp0Dgb0Y1S8bHnVNhPBs_XzwaqDjzGgVbvQbyHsFWfqbxzqvziyXKpDHLn9_fGncbVF89z8b__ZIA-GR-_yauIvNz5iUBsElzaK5akmsq2KMlesZIwV-WTuHxHLm-o</recordid><startdate>201302</startdate><enddate>201302</enddate><creator>Daneault, Benoit</creator><creator>Koss, Elana</creator><creator>Hahn, Rebecca T</creator><creator>Kodali, Susheel</creator><creator>Williams, Mathew R</creator><creator>Généreux, Philippe</creator><creator>Paradis, Jean-Michel</creator><creator>George, Isaac</creator><creator>Reiss, George R</creator><creator>Moses, Jeffrey W</creator><creator>Smith, Craig R</creator><creator>Leon, Martin B</creator><general>American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201302</creationdate><title>Efficacy and Safety of Postdilatation to Reduce Paravalvular Regurgitation During Balloon-Expandable Transcatheter Aortic Valve Replacement</title><author>Daneault, Benoit ; Koss, Elana ; Hahn, Rebecca T ; Kodali, Susheel ; Williams, Mathew R ; Généreux, Philippe ; Paradis, Jean-Michel ; George, Isaac ; Reiss, George R ; Moses, Jeffrey W ; Smith, Craig R ; Leon, Martin B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4884-d131fd510830d156fb897133ecf0eea56c4fa1fbf43dcd9daa351864c35dd8c43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angioplasty, Balloon - methods</topic><topic>Aortic Valve - pathology</topic><topic>Aortic Valve - surgery</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Cardiac Catheterization</topic><topic>Female</topic><topic>Heart Valve Prosthesis Implantation</topic><topic>Humans</topic><topic>Male</topic><topic>Mitral Valve Insufficiency - etiology</topic><topic>Mitral Valve Insufficiency - prevention & control</topic><topic>Postoperative Complications - prevention & control</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Daneault, Benoit</creatorcontrib><creatorcontrib>Koss, Elana</creatorcontrib><creatorcontrib>Hahn, Rebecca T</creatorcontrib><creatorcontrib>Kodali, Susheel</creatorcontrib><creatorcontrib>Williams, Mathew R</creatorcontrib><creatorcontrib>Généreux, Philippe</creatorcontrib><creatorcontrib>Paradis, Jean-Michel</creatorcontrib><creatorcontrib>George, Isaac</creatorcontrib><creatorcontrib>Reiss, George R</creatorcontrib><creatorcontrib>Moses, Jeffrey W</creatorcontrib><creatorcontrib>Smith, Craig R</creatorcontrib><creatorcontrib>Leon, Martin B</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation. Cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Daneault, Benoit</au><au>Koss, Elana</au><au>Hahn, Rebecca T</au><au>Kodali, Susheel</au><au>Williams, Mathew R</au><au>Généreux, Philippe</au><au>Paradis, Jean-Michel</au><au>George, Isaac</au><au>Reiss, George R</au><au>Moses, Jeffrey W</au><au>Smith, Craig R</au><au>Leon, Martin B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy and Safety of Postdilatation to Reduce Paravalvular Regurgitation During Balloon-Expandable Transcatheter Aortic Valve Replacement</atitle><jtitle>Circulation. Cardiovascular interventions</jtitle><addtitle>Circ Cardiovasc Interv</addtitle><date>2013-02</date><risdate>2013</risdate><volume>6</volume><issue>1</issue><spage>85</spage><epage>91</epage><pages>85-91</pages><issn>1941-7640</issn><eissn>1941-7632</eissn><abstract>BACKGROUND—Paravalvular regurgitation (PVR) is common after transcatheter aortic valve replacement (TAVR) and may be associated with adverse outcomes. Postdilatation (PD) has been proposed to treat PVR without being formally studied. We performed a study to evaluate the safety and efficacy of PD after balloon expandable TAVR.
METHODS AND RESULTS—Consecutive cases of TAVR were reviewed for clinical outcomes. Procedural transesophageal echocardiography imaging was reviewed for a subgroup of consecutive patients. PVR areas seen on a short-axis view were measured immediately after deployment, after PD, and at the completion of the study. Stent dimensions measured using angiography and the Paieon’s C-THV system pre- and post-PD were compared. Between May 2007 and November 2011, 259 patients underwent TAVR at our institution. PD was performed in 106 patients (41%). These patients had larger annulus, lower cover-index; more often had transfemoral access and implantation of a 26 mm valve. There was a nonsignificant greater rate of cerebrovascular events in PD patients. There was no significant difference in major aortic injury and permanent pacemaker implantation rates between groups. TTE studies were reviewed in 58 patients (35 with PD and 23 without PD). PD patients had larger PVR areas immediately after deployment (40.3±17.1 versus 15.4±14.2 mm; P<0.0001). There was significant reduction in PVR area attributable to PD (21.7±9.3 mm; P<0.0001). Spontaneous regression of PVR was seen in both groups. PD increased stent dimensions.
CONCLUSIONS—This study demonstrates the efficacy of PD at reducing PVR in patients with greater than mild PVR after balloon-expandable TAVR.</abstract><cop>United States</cop><pub>American Heart Association, Inc</pub><pmid>23339841</pmid><doi>10.1161/CIRCINTERVENTIONS.112.971614</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1941-7640 |
| ispartof | Circulation. Cardiovascular interventions, 2013-02, Vol.6 (1), p.85-91 |
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| language | eng |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Aged Aged, 80 and over Angioplasty, Balloon - methods Aortic Valve - pathology Aortic Valve - surgery Aortic Valve Stenosis - surgery Cardiac Catheterization Female Heart Valve Prosthesis Implantation Humans Male Mitral Valve Insufficiency - etiology Mitral Valve Insufficiency - prevention & control Postoperative Complications - prevention & control Survival Analysis Treatment Outcome |
| title | Efficacy and Safety of Postdilatation to Reduce Paravalvular Regurgitation During Balloon-Expandable Transcatheter Aortic Valve Replacement |
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