Antoinette Neylon

Comparison between the SAPIEN S3 and the SAPIEN XT transcatheter heart valves: A single-center experience

AIM To investigate the clinical outcomes of transcatheter aortic valve implantation (TAVI) with the SAPIEN 3 transcatheter heart valve (S3-THV) vs the SAPIEN XT valve (XT-THV). METHODS We retrospectively analyzed 507 patients that underwent TAVI with the XT-THV and 283 patients that received the S3-THV at our institution between March 2010 and December 2015. RESULTS Thirty-day mortality (3.5% vs 8.7%; OR = 0.44, P = 0.21) and 1-year mortality (25.7% vs 20.1%, P = 0.55) were similar in the S3-THV and the XT-THV groups. The rates of both major vascular complication and paravalvular regurgitation (PVR) > 1 were almost 4 times lower in the S3-THV group than the XT-THV group (major vascular complication: 2.8% vs 9.9%, P < 0.0001; PVR > 1: 2.4% vs 9.7%, P < 0.0001). However, the rate of new pacemaker implantation was almost twice as high in the S3-THV group (17.3% vs 9.8%, P = 0.03). In the S3 group, independent predictors of new permanent pacemaker were pre-procedural RBBB (OR = 4.9; P = 0.001), pre-procedural PR duration (OR = 1.14, P = 0.05) and device lack of coaxiality (OR = 1.13; P = 0.05) during deployment. CONCLUSION The S3-THV is associated to lower rates of major vascular complications and PVR but higher rates of new pacemaker compared to the XT-THV. Sub-optimal visualization of the S3-THV in relation to the aortic valvular complex during deployment is a predictor of new permanent pacemaker.

Comparison of Transradial vs Transfemoral Access for Aortoiliac and Femoropopliteal Interventions A Single-Center Experience

Purpose: To compare the procedure and safety outcomes of the transradial approach (TRA) with the femoral approach (FA) for treating aortoiliac and femoropopliteal stenoses and occlusions. Methods: A single-center retrospective study was conducted involving 188 patients (mean age 66.4±10.8 years; 116 men) with lower limb claudication or critical limb ischemia who underwent aortoiliac (131, 62.4%) or femoropopliteal (79, 37.6%) interventions on 210 lesions over a 3-year period. Operator discretion determined TRA suitability; exclusions included Raynaud’s disease, upper limb occlusive disease, previous TRA difficulties, or planned hemodialysis. Lesion characteristics, clinical endpoints, and access site complications were compared. Results: FA was used primarily in 123 patients and the TRA (12 left and 53 right radial arteries) in 65 procedures. Eleven (16.9%) TRAs failed vs 9 (7.3%) FAs (p=0.42). Crossover to FA was due to occlusive lesions requiring alternative equipment in 9 cases and to tortuosity of the aortic arch vessels in 2 patients. The 134 FA interventions (balloon angioplasty, stents) were retrograde (112, 83.6%) or antegrade (22, 16.4%). There were significantly more TASC C/D lesions in the FA group (p=0.02). Sheath sizes (5-F to 8-F) did not differ between groups, and no significant differences were found between FA vs TRA in terms of procedure time (50.0±28.9 vs 46.8±25.1 minutes, p=0.50) or length of stay (2.2±0.6 vs 2.1±0.3 days, p=0.24). While there were no strokes, access site complications occurred in 6.0% of the FA patients vs 3.7% of the TRA patients (p=0.12). Conclusion: The transradial approach for aortoiliac and femoropopliteal interventions is safe and efficacious compared with the transfemoral approach for a range of lesion subtypes. Nevertheless, there remains a need for improvements in peripheral device and catheter technology to decrease transradial failure rates.

Very Early Thrombosis of Sapien 3 Valve.

A 74-year-old man at moderate risk for surgical aortic valve replacement underwent transcatheter aortic valve replacement (TAVR) with an Edwards S3 valve (Edwards Lifesciences, Irvine, California) via the transfemoral route. Past medical history was significant for coronary artery bypass graft

Does geographical variability influence five-year MACCE rates in the multicentre SYNTAX revascularisation trial?

AIMS The use of multiple geographical sites for randomised cardiovascular trials may lead to important heterogeneity in treatment effects. This study aimed to determine whether treatment effects from different geographical recruitment regions impacted significantly on five-year MACCE rates in the SYNTAX trial. METHODS AND RESULTS Five-year SYNTAX results (n=1,800) were analysed for geographical variability by site and country for the effect of treatment (CABG vs. PCI) on MACCE rates. Fixed, random, and linear mixed models were used to test clinical covariate effects, such as diabetes, lesion characteristics, and procedural factors. Comparing five-year MACCE rates, the pooled odds ratio (OR) between study sites was 0.58 (95% CI: 0.47-0.71), and countries 0.59 (95% CI: 0.45-0.73). By homogeneity testing, no individual site (X2=93.8, p=0.051) or country differences (X2=25.7, p=0.080) were observed. For random effects models, the intraclass correlation was minimal (ICC site=5.1%, ICC country=1.5%, p<0.001), indicating minimal geographical heterogeneity, with a hazard ratio of 0.70 (95% CI: 0.59-0.83). Baseline risk (smoking, diabetes, PAD) did not influence regional five-year MACCE outcomes (ICC 1.3%-5.2%), nor did revascularisation of the left main vs. three-vessel disease (p=0.241), across site or country subgroups. For CABG patients, the number of arterial (p=0.49) or venous (p=0.38) conduits used also made no difference. CONCLUSIONS Geographic variability has no significant treatment effect on MACCE rates at five years. These findings highlight the generalisability of the five-year outcomes of the SYNTAX study.

TCT-521 Novel non-invasive quantitative flow ratio for estimating fractional flow reserve

TCT-521 Novel non-invasive quantitative flow ratio for estimating fractional flow reserve Antoinette Neylon, Andrew Roy, Thomas Hovasse, Bernard Chevalier, Philippe Garot, Hakim Benamer, Yves Louvard, Leticia Fernandez-Lopez, Fadi Sawaya, Marco Spaziano, Yann Roux, Thierry Lefevre Institut Cardiovasculaire Paris Sud, Paris, France; ICPS, Paris, France; United States; Institut Cardiovasculaire Paris Sud, Massy, France; Institut Cardiovasculaire Paris SUD-Hopital Jacques Cartier, Massy, France; ICPS Massy, France, Massy, France; Institut Hospitalier Jacques Cartier, Massy, France; Institut Hospitalier Jacques Cartier, Paris, France; ICPS, Paris, France; McGill University Health Center, Montreal, Quebec, Canada; Clinque Pasteur, Toulouse, France; Institut Hospitalier Jacques Cartier, Massy, France

An Unusual Complication After Rupture of the SAPIEN 3 Valve Balloon During Transcatheter Aortic Valve Replacement

A 56-year-old man with a history of chest radiation and severe aortic stenosis was transferred to our institution for percutaneous aortic valve replacement. The multislice computed tomography scan showed an aortic annulus measuring 482 cm2 with an area-derived diameter of 24.8 mm and prominent

TCT-275 Management strategies for wire crossable undilatable CTO lesions

BACKGROUND The Stingray balloon and wire (Boston Scientific, Natick, MA) have been instrumental in improving true lumen re-entry when antegrade dissection (ADR) is used in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Current guidelines on the utilization of the device are based on expert operator opinion and experience without empiric data. We sought to characterize the utilization of Stingray assisted re-entry in a large contemporary registry of CTO PCI.

Reply: Very Early, Early, and Late Thrombus Formation Following Transcatheter Aortic Valve Replacement: A Kounis Syndrome Involvement?

The issue of transcatheter heart valve (THV) thrombosis is a poorly understood emerging entity of great clinical importance. There are now a number of papers describing both clinically apparent and silent THV thrombosis [(1)][1]. The literature describes a very heterogenous cohort in terms of the

Platypnea-Orthodeoxia Syndrome after Transcatheter Aortic Valve Implantation.

Progressive dyspnea and hypoxaemia in the subacute phase after transcatheter aortic valve implantation (TAVI) are uncommon and warrant immediate assessment of valve and prosthesis leaflet function to exclude thrombosis, as well as investigation for other causes related to the procedure, such as left ventricular dysfunction, pulmonary embolism, and respiratory sepsis. In this case, we report the observation of a patient presenting two weeks after TAVI with arterial hypoxaemia in an upright position, relieved by lying flat, and coupled with an intracardiac shunt detected on echocardiography in the absence of pulmonary hypertension, raising the suspicion of Platypnea-Orthodeoxia Syndrome (POS). Invasive intracardiac haemodynamic assessment showed a significant right-to-left shunt (Qp/Qs = 0.74), which confirmed the diagnosis, with subsequent closure of the intracardiac defect resulting in immediate relief of symptoms and hypoxaemia. To our knowledge, this is the first reported case of an interatrial defect and shunt causing Platypnea-Orthodeoxia Syndrome after transcatheter aortic valve implantation, resolved by percutaneous device closure.

TCT-398 Restenosis of Left Main –Is One Shot All You’ve Got?

RESULTS CR was achieved in 4,423 patients (46.2%); IR was more common after PCI than CABG (62.1% vs. 39.6%, p<0.001) and IR group presented with more myocardial infarction than CR group (30.4% vs.24.6%, p<0.001). During a 10-year follow-up, MACE occurred more in IR than CR group(44.4% vs. 36.9%, P<0.001). Relative to IR, CR was associated with lower long-term mortality (adjusted hazard ratio [HR]: 0.876, 95% confidence interval [CI]:0.782 to 0.982, p1⁄40.023), myocardial infarction (HR: 0.680, 95% CI: 0.524 to 0.882, p1⁄40.004), and repeat revascularization (HR: 0.777, 95% CI: 0.682 to 0.887, p<0.001). And the survival free from MACE was most benefited in completely revascularized CABG patients (HR: 0.575, 95% CI: 0.509 to 0.648, p1⁄40.005).