*  Abstract 13401: Clinical Outcome after Transfemoral Aortic Valve Replacement in Patients with Low-Gradient Aortic Stenosis in...
Objectives The aim of this study was to evaluate clinical outcome after CoreValve implantation in patients (pts) with low-gradient aortic stenosis (LGAS). We were especially interested in the 30 days mortality and in longterm outcome in respect to the presence or absence of contractile reserve (CR) evaluated by low dose dobutamine stessechocardiography (LDSE). Background Pts with LGAS have a considerable high operative mortality, especially if pts show no CR during LDSE. Percutaneous aortic valve repair (TAVI) is a new emerging technology for interventional treatment of severe aortic valve stenosis in surgical high-risk patients and offers a less invasive approach in these pts. Hence one might speculate that TAVI represents a promising treatment for these patients. Methods From April 2010 to february 2012 in total 165 patients (age 80.6 +0.8 years ) with ...
  http://circ.ahajournals.org/content/126/Suppl_21/A13401
*  Transcatheter Aortic Valve Implantation in a Patient With Severe Bicuspid Aortic Valve Stenosis and Ascending Aortic Aneurysm |...
A 78-year-old woman with chest discomfort and progressive exertional dyspnea was admitted to our center. Transthoracic echocardiography (TTE) suggested severe aortic stenosis (AS) (mean pressure gradient 70 mm Hg; peak jet velocity 5.4 m/s) and moderate aortic regurgitation (AR). Left ventricular ejection fraction was 64%. Bicuspidy of the aortic valve and aneurysmal dilation of the ascending aorta (56 mm in diameter) were noted on TTE. She was declined for surgery on account of high operative risk (logistic EuroSCORE 31.67%) after consultations by the heart team, thus she was evaluated for transcatheter aortic valve implantation (TAVI). Coronary angiogram showed the absence of significant coronary lesions. Three-dimensional computed tomographic angiography (CTA) confirmed the bicuspidy (Fig. 1A) and measured the diameter of the ascending aorta at 53 mm ...
  http://interventions.onlinejacc.org/content/7/7/e83
*  Cerebral Protection in Transcatheter Aortic Valve Replacement - Full Text View - ClinicalTrials.gov
The Sentinel™ Cerebral Protection System is indicated for use as an embolic capture and retrieval system intended to reduce the ischemic burden in the cerebral anterior circulation while performing transcatheter aortic valve replacement.. The objective of this study is to assess the safety and efficacy of the Claret Medical Sentinel Cerebral Protection System used for embolic protection during Transcatheter Aortic Valve Replacement (TAVR) compared to TAVR standard of care (without embolic protection).. The study population is comprised of subjects with severe symptomatic calcified native aortic valve stenosis who meet the commercially approved indications for TAVR with the Edwards SAPIEN THV or SAPIEN XT and comply with the inclusion/exclusion criteria. ...
  https://clinicaltrials.gov/ct2/show/study/NCT02214277
*  Transcatheter aortic valve implantation: Periprocedural management
Aortic valve replacement (AVR) has been the mainstay of treatment of symptomatic severe aortic stenosis (AS). The role of transcatheter aortic valve implantation (TAVI; also known as transcatheter aortic valve replacement or TAVR) as an alternative t
  https://www.uptodate.com/contents/transcatheter-aortic-valve-implantation-periprocedural-management
*  Calcific Aortic Valve Stenosis in Old Hypercholesterolemic Mice | Circulation
The most important finding of the present study is that old mice with a moderate, clinically relevant degree of hypercholesterolemia are prone to develop physiologically important aortic valvular stenosis and the syndrome of valvular heart disease. Furthermore, LDLr−/−ApoB100/100 mice with aortic stenosis have oxidant stress in valve tissue, a feature of aortic valve disease not reported previously.. The correlation between the ≈75% decrease in aortic valve area and a hemodynamically significant transvalvular gradient in LDLr−/−ApoB100/100 mice reproduces the relationship seen in clinical disease.16 The findings of left ventricular hypertrophy and impairment of systolic function in LDLr−/−ApoB100/100 mice with aortic stenosis verify the pathophysiological responses to pressure overload. These findings are ...
  http://circ.ahajournals.org/content/114/19/2065
*  Abstract 8171: Invasive Assessment of Atrioventricular Conduction Changes Following Transcatheter Aortic Valve Implantation...
Background: Atrio-ventricular block (AVB) is one of the complications after transcatheter aortic valve implantation (TAVI), and is more frequent after implantation of a Medtronic CoreValve (MCV) than after implantation of an Edwards Sapien prosthesis (ES). The aim of this prospective study was to quantify and compare by invasive measurement the exact influence of TAVI with MCV or ES valve on atrioventricular conduction.. Methods: between February 2010 and March 2011, consecutive patients who underwent TAVI with a MCV or an ES valve were included in this prospective, single center study. The His-Ventricle (HV) interval was measured during an electrophysiology study (EPS) before and at least 4 days after the procedure. Patients with pre-existent permanent PM implanted for AVB were excluded. Results: 60 patients were included. 25 (42%) were treated with a MCV, and 35 (58%) with an ES valve. Mean age was 83±6 ...
  http://circ.ahajournals.org/content/124/Suppl_21/A8171
*  Safety and Efficacy Study of the Medtronic CoreValve® System in the Treatment of Severe, Symptomatic Aortic Stenosis in...
The purpose of the study is to investigate the safety and efficacy of transcatheter aortic valve implantation (TAVI) in patients with severe, symptomatic Aortic Stenosis (AS) at intermediate surgical risk by randomizing patients to either Surgical Aortic Valve Replacement (SAVR) or TAVI with the Medtronic CoreValve® System.. Single Arm: The purpose of this trial is to evaluate the safety and effectiveness of transcatheter aortic valve implementation (TAVI) in patients with sever symptomatic Aortic Stenosis (AS) at intermediate surgical risk with TAVI. This is a non-randomized phase of the pivotal clinical trial. ...
  https://clinicaltrials.gov/ct2/show/record/NCT01586910
*  Safety and Efficacy Study of the Medtronic CoreValve® System in the Treatment of Severe, Symptomatic Aortic Stenosis in...
The purpose of the study is to investigate the safety and efficacy of transcatheter aortic valve implantation (TAVI) in patients with severe, symptomatic Aortic Stenosis (AS) at intermediate surgical risk by randomizing patients to either Surgical Aortic Valve Replacement (SAVR) or TAVI with the Medtronic CoreValve® System.. Single Arm: The purpose of this trial is to evaluate the safety and effectiveness of transcatheter aortic valve implementation (TAVI) in patients with sever symptomatic Aortic Stenosis (AS) at intermediate surgical risk with TAVI. This is a non-randomized phase of the pivotal clinical trial. ...
  https://clinicaltrials.gov/ct2/show/record/NCT01586910?term=Stroke&lup_s=11%2F20%2F2013&lup_d=14&show_rss=Y&sel_rss=mod14
*  Safety and Efficacy Study of the Medtronic CoreValve® System in the Treatment of Severe, Symptomatic Aortic Stenosis in...
The purpose of the study is to investigate the safety and efficacy of transcatheter aortic valve implantation (TAVI) in patients with severe, symptomatic Aortic Stenosis (AS) at intermediate surgical risk by randomizing patients to either Surgical Aortic Valve Replacement (SAVR) or TAVI with the Medtronic CoreValve® System.. Single Arm: The purpose of this trial is to evaluate the safety and effectiveness of transcatheter aortic valve implementation (TAVI) in patients with sever symptomatic Aortic Stenosis (AS) at intermediate surgical risk with TAVI. This is a non-randomized phase of the pivotal clinical trial. ...
  https://clinicaltrials.gov/ct2/show/study/NCT01586910?term=Aortic+Valve+Stenosis&lup_s=08%2F03%2F2013&lup_d=14&show_rss=Y&sel_rss=mod14&show_locs=Y
*  Safety and Efficacy Study of the Medtronic CoreValve® System in the Treatment of Severe, Symptomatic Aortic Stenosis in...
The purpose of the study is to investigate the safety and efficacy of transcatheter aortic valve implantation (TAVI) in patients with severe, symptomatic Aortic Stenosis (AS) at intermediate surgical risk by randomizing patients to either Surgical Aortic Valve Replacement (SAVR) or TAVI with the Medtronic CoreValve® System.. Single Arm: The purpose of this trial is to evaluate the safety and effectiveness of transcatheter aortic valve implementation (TAVI) in patients with sever symptomatic Aortic Stenosis (AS) at intermediate surgical risk with TAVI. This is a non-randomized phase of the pivotal clinical trial. ...
  https://clinicaltrials.gov/ct2/show/study/NCT01586910?term=Aortic+Valve+Stenosis&lup_s=08%2F04%2F2013&lup_d=14&show_rss=Y&sel_rss=mod14&show_locs=Y
*  Safety and Efficacy Study of the Medtronic CoreValve® System in the Treatment of Severe, Symptomatic Aortic Stenosis in...
The purpose of the study is to investigate the safety and efficacy of transcatheter aortic valve implantation (TAVI) in patients with severe, symptomatic Aortic Stenosis (AS) at intermediate surgical risk by randomizing patients to either Surgical Aortic Valve Replacement (SAVR) or TAVI with the Medtronic CoreValve® System.. Single Arm: The purpose of this trial is to evaluate the safety and effectiveness of transcatheter aortic valve implementation (TAVI) in patients with sever symptomatic Aortic Stenosis (AS) at intermediate surgical risk with TAVI. This is a non-randomized phase of the pivotal clinical trial. ...
  https://clinicaltrials.gov/ct2/show/study/NCT01586910?term=Stroke&lup_s=10%2F11%2F2013&lup_d=14&show_rss=Y&sel_rss=mod14&show_locs=Y
*  Transfemoral aortic valve implantation under sedation and monitored anaesthetic care - a feasibility study.
Surgical aortic valve replacement is the conventional treatment for symptomatic aortic valve stenosis; however, the technique of transfemoral transcatheter aortic valve implantation has recently been developed for older patients at high risk for surg
  http://www.biomedsearch.com/nih/Transfemoral-aortic-valve-implantation-under/21933156.html
*  Exercise testing in asymptomatic aortic stenosis.
AIMS: To determine the safety of exercise testing (ET) in patients with moderate or severe asymptomatic aortic stenosis (AAS) and its accuracy to predict the need for surgery and mortality. METHODS: 106 consecutive patients with AAS performed a maxim
  http://www.biomedsearch.com/nih/Exercise-testing-in-asymptomatic-aortic/17114879.html
*  CorpusUL: Open issues in transcatheter aortic valve implantation. Part 1 : patient selection and treatment strategy for...
An exponential increase in the use of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis has been witnessed over the recent years. The current article reviews different areas of uncertainty related to patient selection. The use and limitations of risk scores are addressed, followed by an extensive discussion on the value of three-dimensional imaging for prosthesis sizing and the assessment of complex valve anatomy such as degenerated bicuspid valves. The uncertainty about valvular stenosis severity in patients with a mismatch between the transvalvular gradient and the aortic valve area, and how integrated use of echocardiography and computed tomographic imaging may help, is also addressed. Finally, patients referred for TAVI may have concomitant mitral regurgitation and/or ...
  http://corpus.ulaval.ca/jspui/handle/20.500.11794/7268
*  Transcatheter and surgical aortic valve replacement did not differ for mortality in severe aortic stenosis | Annals of Internal...
Mack MJ, Leon MB, Smith CR, et al; PARTNER 1 trial investigators. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet. 2015 Mar 15. Epub ahead of print. 25788234 ...
  http://annals.org/aim/article-abstract/2427628/transcatheter-surgical-aortic-valve-replacement-did-differ-mortality-severe-aortic
*  Transapical Transcatheter Aortic Valve Implantation in Humans | Circulation
Aortic valve replacement is the treatment of choice in patients with severe symptomatic acquired aortic stenosis, offering both symptomatic relief and the potential of improved long-term survival.1 Symptomatic patients managed medically have a poor prognosis.2-4 Balloon valvuloplasty is palliative, and although it may result in temporary relief of symptoms, benefit is modest and restenosis is certain.6,22. Unfortunately, many potential surgical candidates have significant comorbidities, and open heart surgery with cardiopulmonary bypass may pose risks that are unacceptable to them or their physicians. According to the Society of Thoracic Surgery Database (1998 to 2001), surgical aortic valve replacement carries a rate of serious complication or mortality of 16.8%. Operative risk is increased in the setting of comorbidities such as advanced age and ...
  http://circ.ahajournals.org/content/114/6/591.full
*  CorpusUL: Early regression of severe left ventricular hypertrophy after transcatheter aortic valve replacement is associated...
Objectives: This study sought to examine the relationship between left ventricular mass (LVM) regression and clinical outcomes after transcatheter aortic valve replacement (TAVR). Background: LVM regression after valve replacement for aortic stenosis is assumed to be a favorable effect of LV unloading, but its relationship to improved clinical outcomes is unclear. Methods: Of 2,115 patients with symptomatic aortic stenosis at high surgical risk receiving TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) randomized trial or continued access registry, 690 had both severe LV hypertrophy (left ventricular mass index [LVMi] 149 g/m2 men, 122 g/m2 women) at baseline and an LVMi measurement at 30-day post-TAVR follow-up. Clinical outcomes were compared for patients with greater than versus lesser than median percentage ...
  http://corpus.ulaval.ca/jspui/handle/20.500.11794/7168
*  Heart failure after aortic valve replacement for aortic valve stenosis : possible mechanisms - Institutional Repository...
Introduction: Aortic valve stenosis imposes a pressure overload on the left ventricle. Congestive heart failure is one of the complications which can appear, even years after the operation. The main questions are: why do patients still develop heart failure? Which types of congestive heart failure can be expected? Which factors related to it are known? Methods: A literature search was performed with the terms aortic valve disease/replacement AND heart failure. Some secondary references derived from their reference list were also included. The study design of the selected papers differed considerably. Therefore, the analysis is descriptive and concerns factors which can be related to congestive heart failure. Furthermore, surrogate outcomes are ejection fraction, hypertrophy, long axis ventricular function, torsion, left atrial indices, ...
  https://repository.uantwerpen.be/link/irua/122680
*  Percutaneous Aortic Valve Implantation in Patients with Coronary Artery Disease: Review of Therapeutic Strategies | Journal of...
ABSTRACT: The optimal treatment for coronary artery disease in patients who are candidates for percutaneous aortic valve implantation (PAVI) remains unclear. The operating team should take into consideration that the symptoms of ischemic heart disease could be identical to those of severe aortic stenosis and that performing percutaneous coronary intervention (PCI) in these frail patients prior to, or following PAVI, is not trivial. We describe a patient with severe aortic stenosis and significant coronary artery disease who was treated during the same interventional session: PCI that was followed immediately by PAVI. We review the different treatment strategies for patients who are candidates for PAVI and have coronary artery disease, discuss the relative advantages of each approach, and propose an algorithm for their treatment. ...
  https://www.invasivecardiology.com/articles/Percutaneous-Aortic-Valve-Implantation-Patients-with-Coronary-Artery-Disease-Review-Therape?page=2
*  Abstract 12281: Outcomes in Patients Treated With Transfemoral Aortic Valve Implantation After Admission to the Intensive Care...
Introduction: Transcatheter aortic valve implantation (TAVI) has become established as a treatment option for patients with severe symptomatic aortic valve stenosis. Postoperative treatment of these old patients presents a new challenge for intensive care specialists. Although numerous studies have addressed perioperative anesthetic management, little is known about risk factors that lead to a longer intensive care unit (ICU) stay.. Hypothesis: We retrospectively analyzed data focusing on the risk factors and indications for a prolonged ICU stay and their outcomes. We also compared predictive value of the SAPS II and EuroSCORE risk evaluation scales.. Methods: From 2006 to 2012 a total of 214 consecutive patients (age: 80 ± 6 years) were admitted to the ICU after transfemoral TAVI.. Results: Total 30-day mortality was 7%. Non-survivors differed from survivors in the rates of catecholamine therapy on ICU ...
  http://circ.ahajournals.org/content/132/Suppl_3/A12281
*  Abstract 19083: Predicting Aortic Valve Stenosis Progression: Discordance Between Anatomical and Hemodynamic Assessment of...
Background: The aortic valve area (AVA) is a marker of severity in aortic stenosis (AS) patients and has prognostic and treatment implications. However, there is limited data on predictors of severity progression.. Methods: We analyzed 509 consecutive patients with AS who underwent paired echocardiographic studies ,180 days apart. Anatomic and haemodynamic assessments of aortic valve stenosis severity were performed. Two hundred and sixty-seven patients (52%) had significant decrease (,20%) in AVA. We compare their baseline echocardiographic parameters to the group without progression.. Results: The mean time interval between the paired studies (1252±910 days) and the mean LV ejection fraction (60±12%) were not significantly different between the two groups. One hundred and forty patients (28.8%) had mild AS (defined as AVA ,1.5cm2), 217 (44.7%) had moderate AS (AVA 1 - 1.5 cm2) and 129 ...
  http://circ.ahajournals.org/content/126/Suppl_21/A19083
*  Abstract 20031: Transcatheter Aortic Valve Replacement Using Transfemoral vs Transapical Approach: A comprehensive Meta...
Background: Transcatheter Aortic valve replacement (TAVR) has emerged as new technique for the management of patient with severe Aortic Stenosis (AS). Stroke is a potential complication associated with the procedure, when performed via both transfemoral (TF) and transapical approach (TA). Due to limited data, we performed a comprehensive meta-analysis comparing 30-day and 1-year stroke rates with TAVR performed using TF vs TA approach.. Methods: We searched SCOPUS since inception to July 2014 using pre-defined criteria. The cerebrovascular event rates and type were estimated at different time points using standard random effects model.. Results: 5 studies, with total 1956 valves placed, reported 30-day stroke rates with TA approach, and 9 studies, with 1146 valves, reported stroke rates with TF approach. No significant difference (p=0.313) was noted with TA ...
  http://circ.ahajournals.org/content/132/Suppl_3/A20031
*  Transcatheter aortic valve implantation: what's the bleeding problem? | Heart
The importance of bleeding and its sequelae have been increasingly recognised by interventional cardiologists. We are undertaking increasingly complex percutaneous interventions, performed upon higher-risk patients, who are more elderly with a greater range of comorbidities,1 and using multiple anticoagulant pharmacotherapies,2 which may all increase susceptibility to bleeding. The advent of transcatheter aortic valve implantation (TAVI) has allowed cardiologists and surgeons to offer treatment for aortic valve disease to a similarly high-risk cohort of patients. The PARTNER randomised trial having demonstrated a survival benefit,3 the challenge is now to improve the safety profile of the procedure, and addressing the risk of bleeding is paramount to this.. Borz et al4 present data from a single centre using the Edwards bioprosthesis (Edwards Lifesciences, Irvine, California, USA). They report notable bleeding and life-threatening bleeding ...
  http://heart.bmj.com/content/99/12/822
*  How Stable Are Patients with Moderate Aortic Stenosis and Left Ventricular Dysfunction? | Anesthesia Experts
Authors: WJ., J Am Coll Cardiol 2017 May 16; 69:2393. A high rate of adverse events prompts the question of whether earlier intervention would improve outcomes.. The authors of this international, four-site study examined longitudinal outcomes data on 305 patients (mean age, 73; 75% men) who were identified on baseline echocardiograms with moderate aortic stenosis (AS; defined by aortic valve area [AVA] ,1.0 and ,1.5 cm2) and left ventricular (LV) dysfunction (ejection fraction, ,50%).. Coronary artery disease was present in 72% of patients. On echocardiography, the mean ejection fraction was 38%, mean AVA was 1.24 cm2, and mean transaortic gradient was 15 mm Hg. Dobutamine stress echocardiography was used in 11% of patients to exclude severe AS.. At 4 years of follow-up, 61% had a clinical event included in the primary composite endpoint: death (36%), heart-failure hospitalization (27%), or ...
  http://anesthesiaexperts.com/uncategorized/stable-patients-moderate-aortic-stenosis-left-ventricular-dysfunction/