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  • 1
    Online Resource
    Online Resource
    Novel insights on outcome in horizontal aorta with self‐expandable new‐generation transcatheter aortic valve replacement devices
    Wiley ; 2020
    In:  Catheterization and Cardiovascular Interventions Vol. 96, No. 7 ( 2020-12), p. 1511-1519
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    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 96, No. 7 ( 2020-12), p. 1511-1519
    Abstract: The impact of a horizontal aorta (HA) on adverse events (AE) following in transcatheter aortic valve replacement (TAVR) is dealt controversially. Using new‐generation self‐expandable devices, we aimed to reevaluate an appropriate threshold of the aortic root angulation (ARA) in terms of HA and its impact on outcome. Methods The 466 consecutive patients, who underwent transfemoral TAVR with self‐expandable new‐generation devices, were analyzed. Patients were classified into cases with HA (ARA ≥ 51°; n = 225; 48%) and without HA (ARA  〈 51°; n = 241; 52%). Primary endpoints were device success and 30‐day mortality. Secondary endpoints were specific AE according to VARC‐2 definitions. Results Contrast use (107.6 ± 50.1 vs. 94.1 ± 46.1 ml; p = .033) and radiation dose (3,176 [1,928–5,596] vs. 2,651 [1,643–4,394] Gyxcm 2 ; p = .016) were higher in HA. Primary device success was comparable (97.1 vs. 97.8%; p = .773). A 30‐day mortality (3.3 vs. 0.4%; p = .038, plogrank = 0.025), stroke (7.1 vs. 2.7%; p = .033), and major vascular complications (MVASC) (6.6 vs. 2.7%; p = .050) were more frequent in HA. Pronounced calcification of the noncoronary cusp and left ventricular outflow tract, the condition of HA, as well as repositioning maneuvers were independent predictors for overall specific AE. Conclusion An HA above 51° is associated with an increased rate of stroke, MVASC, and 30‐day mortality. Valve size and asymmetric calcification affect the incidence of repositioning maneuvers and subsequent VARC‐2 AE, indicating that an HA—together with specific anatomic features—remains a crucial factor for TAVR‐related outcome with self‐expandable new‐generation devices.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v96.7
    DOI: 10.1002/ccd.28961
    Language: English
    Publisher: Wiley
    Publication Date: 2020
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  • 2
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    Online Resource
    Early restenosis of a direct flow transcatheter aortic valve prosthesis
    Wiley ; 2021
    In:  Catheterization and Cardiovascular Interventions Vol. 97, No. 5 ( 2021-04)
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 97, No. 5 ( 2021-04)
    Abstract: Due to limited case numbers, severe Direct flow™ transcatheter device restenosis is, until now, a rare event with unknown long‐term incidence, but challenging several treatment strategies. This case report gives an overview of possible interventional treatment considerations in this context that might occur more often in the future due to expected valve deterioration processes in the next years.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v97.5
    DOI: 10.1002/ccd.28806
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 3
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    Acute stroke intervention for acute embolic procedural strokes performed by cardiologists
    Wiley ; 2021
    In:  Catheterization and Cardiovascular Interventions Vol. 98, No. 6 ( 2021-11-15)
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    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 98, No. 6 ( 2021-11-15)
    Abstract: Acute ischemic stroke is a feared complication during cardiovascular procedures associated with high morbidity and mortality if not immediately recognized and treated. We conducted a review of cases at our center where patients experienced an acute, procedure‐related ischemic stroke and underwent immediate endovascular stroke treatment by the interventional cardiologists trained in acute endovascular stroke intervention. Baseline demographics, procedural and follow‐up data were collected. Three patients were identified in whom the percutaneous procedure (peripheral arterial intervention, transapical NeoChord [NeoChord Inc, Minnesota, USA] implantation and transcatheter aortic valve implantation, respectively) was complicated by an acute embolic ischemic stroke. In all cases, cerebral vessel re‐canalization was technically successful with thrombolysis in cerebral infarction (TICI) IIB/III flow. Follow‐up computed tomography scans showed no infarct demarcation, oedema or intracranial hemorrhage. One patient survived with no neurological symptoms at 6‐month follow‐up whereas the two other patients died of unrelated intensive care complications and decompensated heart failure. We conclude that endovascular stroke treatment during cardiovascular interventions can be performed by interventional cardiologists with appropriate training. It offers the unique opportunity to treat cerebral embolization in a time‐efficient manner, potentially improving morbidity and mortality of affected patients.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v98.6
    DOI: 10.1002/ccd.29820
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 4
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    Optimal protamine‐to‐heparin dosing ratio for the prevention of bleeding complications in patients undergoing TAVR—A multicenter experience
    Wiley ; 2023
    In:  Clinical Cardiology Vol. 46, No. 1 ( 2023-01), p. 67-75
    Details
    In: Clinical Cardiology, Wiley, Vol. 46, No. 1 ( 2023-01), p. 67-75
    Abstract: Despite major advances, transcatheter aortic valve replacement (TAVR) is still associated with procedure‐specific complications. Although previous studies reported lower bleeding rates in patients receiving protamine for heparin reversal, the optimal protamine‐to‐heparin dosing ratio is unknown. Hypothesis The aim of this study was a comparison of two different heparin antagonization regimens for the prevention of bleeding complications after TAVR. Methods The study included 1446 patients undergoing TAVR, of whom 623 received partial and 823 full heparin antagonization. The primary endpoint was a composite of 30‐day mortality, life‐threatening, and major bleeding. Safety endpoints included stroke and myocardial infarction at 30 days. Results Full antagonization of heparin resulted in lower rates of the primary endpoint as compared to partial heparin reversal (5.6% vs. 10.4%, p   〈  .01), which was mainly driven by lower rates of life‐threatening (0.5% vs. 1.6%, p  = .05) and major bleeding (3.2% vs. 7.5%, p   〈  .01). Moreover, the incidence of major vascular complications was significantly lower in patients with full heparin reversal (3.5% vs. 7.5%, p   〈  .01). The need for red‐blood‐cell transfusion was lower in patients receiving full as compared to partial heparin antagonization (10.4% vs. 15.9%, p   〈  .01). No differences were observed in the incidence of stroke and myocardial infarction between patients with full and partial heparin reversal (2.2% vs. 2.6%, p  = .73 and 0.2% vs. 0.4%, p  = .64, respectively). Conclusions Full heparin antagonization resulted in significantly lower rates of life‐threatening and major bleeding after TAVR as compared to partial heparin reversal. The occurrence of stroke and myocardial infarction was low and comparable between both groups.
    Type of Medium: Online Resource
    ISSN: 0160-9289 , 1932-8737
    URL: Issue
    URL: Article
    DOI: 10.1002/clc.v46.1
    DOI: 10.1002/clc.23936
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2048223-1
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  • 5
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    Online Resource
    Contemporary use of balloon aortic valvuloplasty and evaluation of its success in different hemodynamic entities of severe aortic valve stenosis
    Wiley ; 2021
    In:  Catheterization and Cardiovascular Interventions Vol. 97, No. 1 ( 2021-01)
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 97, No. 1 ( 2021-01)
    Abstract: To evaluate outcome assessment of percutaneous balloon aortic valvuloplasty (BAV) in different flow and gradient patterns of severe aortic stenosis (AS). Background The mean pressure gradient reduction after BAV is an often‐used surrogate parameter to evaluate procedural success. The definition of a successful BAV has not been evaluated in different subgroups of severe AS, which were introduced in the latest guidelines on the management of patients with valvular heart disease. Methods In this observational study, consecutive patients from July 2009 to March 2018 undergoing BAV were divided into normal‐flow high‐gradient (NFHG), low‐flow low‐gradient (LFLG), and paradoxical low‐flow low‐gradient (pLFLG) AS. Baseline characteristics, hemodynamic, and clinical information were collected and compared. Results One‐hundred‐fifty‐six patients were grouped into NFHG (n = 68, 43.5%), LFLG (n = 68, 43.5%), and pLFLG (n = 20, 12.8%) AS. Mean age of the study population was 81 years. Cardiogenic shock or refractory heart failure (46.8%) was the most common underlying reasons for BAV. Spearman correlation revealed that the mean pressure gradient reduction, determined by echocardiography, had a moderate correlation with the increase in the aortic valve area (AVA) in patients with NFHG AS (ρ: 0.529, p 〈  .001) but showed no association in patients with LFLG (ρ: 0.017, p = .289) and pLFLG (ρ: 0.030, p = .889) AS. BAV as bridge to surgical or transcatheter aortic valve replacement was possible in 44.2% of patients, with no difference between groups ( p = .070). Conclusion The mean pressure gradient reduction might be an adequate surrogate parameter for BAV success in patients with NFHG AS but is not suitable for patients with other hemodynamic entities.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v97.1
    DOI: 10.1002/ccd.28950
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 6
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    Online Resource
    Computed tomography derived predictors of permanent pacemaker implantation after transcatheter aortic valve replacement: A meta‐analysis
    Wiley ; 2021
    In:  Catheterization and Cardiovascular Interventions Vol. 98, No. 6 ( 2021-11-15)
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 98, No. 6 ( 2021-11-15)
    Abstract: This meta‐analysis sought to assess predictors of permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) with focus on preprocedural multi‐slice computed tomography (MSCT) derived data. Background Transcatheter aortic valve replacement (TAVR) has expanded to a well‐established treatment for severe symptomatic aortic stenosis at high and intermediate surgical risk. PPI after TAVR remains one of the most frequent procedure‐related complications and appears to be influenced by several factors. Methods The authors conducted a literature search in PubMed/MEDLINE and EMBASE databases to identify studies that investigated preprocedural MSCT data and the rate of PPI following TAVR with new‐generation devices. Results Ten observational studies ( n  = 2707) met inclusion criteria for the final analysis. PPI was performed in 387 patients (14.3%) after TAVR. Patients requiring PPI had a larger annulus perimeter (MD: 1.66 mm; p  〈  .001) and a shorter membranous septum length (MD: −1.1 mm; p  〈  .05). Concerning calcification distribution, patients with requirement for new pacemaker implantation showed increased calcification of the left coronary cusp (MD: 47.6 mm 3 ; p  〈  .001), and the total left ventricular outflow tract (MD: 24.42 mm 3 ; p  〈  .01). Lower implantation depth (MD: 0.95 mm; p  〈  .05) and oversizing (MD: 1.52%; p  〈  .05) were procedural predictors of PPI following TAVR. Conclusions Besides the well‐known impact of electrocardiographic and procedure‐related factors on conduction disturbances, MSCT derived distribution of the aortic valve and left ventricular outflow tract calcification, as well as membranous septum length, are associated with an increased risk of PPI following TAVR.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v98.6
    DOI: 10.1002/ccd.29805
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 7
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    A simplified cardiac damage staging predicts the outcome of patients undergoing TAVR—A multicenter analysis
    Wiley ; 2022
    In:  Catheterization and Cardiovascular Interventions Vol. 100, No. 5 ( 2022-11), p. 850-859
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 100, No. 5 ( 2022-11), p. 850-859
    Abstract: A significant number of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) suffer from extra‐aortic cardiac damage. Few studies have investigated strategies to quantify cardiac damage and stratify patients accordingly in different risk groups. The aim of this retrospective multicenter study was to provide a user‐friendly simplified staging system based on the proposed classification system of Généreux et al. as a tool to evaluate the prognosis of patients undergoing TAVR more easily. Moreover, we analyzed changes in cardiac damage after TAVR. Methods We assessed cardiac damage in patients, who underwent TAVR at the Heart Center Bonn or Düsseldorf, using pre‐ and postprocedural transthoracic echocardiography. Patients were assigned to the staging system proposed by Généreux et al. according to the severity of their baseline cardiac damage. Based on the established system, we created a simplified staging system to facilitate improved applicability. Finally, we compared clinical outcomes between the groups and evaluated changes in cardiac damage after TAVR. Results A total of 933 TAVR patients were included in the study. We found a significant association between cardiac damage and 1‐year all‐cause mortality (stage 0: 0% vs. stage 1: 3% vs. stage 2: 6.6%; p   〈  0.009). In multivariate analysis, cardiac damage was an independent predictor of 1‐year all‐cause mortality (hazard ratio: 2.0, 95% confidence interval: 1.1–3.8; p  = 0.03). Conclusions In patients undergoing TAVR, cardiac damage is associated with enhanced mortality. A simplified staging system can help identify patients at high risk for an adverse outcome.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v100.5
    DOI: 10.1002/ccd.30368
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 8
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    Online Resource
    Duplex echocardiography in multivalvular heart disease after percutaneous mitral valve repair?
    Wiley ; 2020
    In:  European Journal of Clinical Investigation Vol. 50, No. 12 ( 2020-12)
    Details
    In: European Journal of Clinical Investigation, Wiley, Vol. 50, No. 12 ( 2020-12)
    Type of Medium: Online Resource
    ISSN: 0014-2972 , 1365-2362
    URL: Issue
    URL: Article
    DOI: 10.1111/eci.v50.12
    DOI: 10.1111/eci.13340
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2004971-7
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