Arend de Weger
Leiden University Medical Center
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JAMA | 2014
Danny Dvir; John G. Webb; Sabine Bleiziffer; M. Pasic; Ron Waksman; Susheel Kodali; Marco Barbanti; Azeem Latib; Ulrich Schaefer; Josep Rodés-Cabau; Hendrik Treede; Nicolo Piazza; David Hildick-Smith; Dominique Himbert; Thomas Walther; Christian Hengstenberg; Henrik Nissen; Raffi Bekeredjian; Patrizia Presbitero; Enrico Ferrari; Amit Segev; Arend de Weger; Stephan Windecker; Neil Moat; Massimo Napodano; M. Wilbring; Alfredo Cerillo; Stephen Brecker; Didier Tchetche; Thierry Lefèvre
IMPORTANCE Owing to a considerable shift toward bioprosthesis implantation rather than mechanical valves, it is expected that patients will increasingly present with degenerated bioprostheses in the next few years. Transcatheter aortic valve-in-valve implantation is a less invasive approach for patients with structural valve deterioration; however, a comprehensive evaluation of survival after the procedure has not yet been performed. OBJECTIVE To determine the survival of patients after transcatheter valve-in-valve implantation inside failed surgical bioprosthetic valves. DESIGN, SETTING, AND PARTICIPANTS Correlates for survival were evaluated using a multinational valve-in-valve registry that included 459 patients with degenerated bioprosthetic valves undergoing valve-in-valve implantation between 2007 and May 2013 in 55 centers (mean age, 77.6 [SD, 9.8] years; 56% men; median Society of Thoracic Surgeons mortality prediction score, 9.8% [interquartile range, 7.7%-16%]). Surgical valves were classified as small (≤21 mm; 29.7%), intermediate (>21 and <25 mm; 39.3%), and large (≥25 mm; 31%). Implanted devices included both balloon- and self-expandable valves. MAIN OUTCOMES AND MEASURES Survival, stroke, and New York Heart Association functional class. RESULTS Modes of bioprosthesis failure were stenosis (n = 181 [39.4%]), regurgitation (n = 139 [30.3%]), and combined (n = 139 [30.3%]). The stenosis group had a higher percentage of small valves (37% vs 20.9% and 26.6% in the regurgitation and combined groups, respectively; P = .005). Within 1 month following valve-in-valve implantation, 35 (7.6%) patients died, 8 (1.7%) had major stroke, and 313 (92.6%) of surviving patients had good functional status (New York Heart Association class I/II). The overall 1-year Kaplan-Meier survival rate was 83.2% (95% CI, 80.8%-84.7%; 62 death events; 228 survivors). Patients in the stenosis group had worse 1-year survival (76.6%; 95% CI, 68.9%-83.1%; 34 deaths; 86 survivors) in comparison with the regurgitation group (91.2%; 95% CI, 85.7%-96.7%; 10 deaths; 76 survivors) and the combined group (83.9%; 95% CI, 76.8%-91%; 18 deaths; 66 survivors) (P = .01). Similarly, patients with small valves had worse 1-year survival (74.8% [95% CI, 66.2%-83.4%]; 27 deaths; 57 survivors) vs with intermediate-sized valves (81.8%; 95% CI, 75.3%-88.3%; 26 deaths; 92 survivors) and with large valves (93.3%; 95% CI, 85.7%-96.7%; 7 deaths; 73 survivors) (P = .001). Factors associated with mortality within 1 year included having small surgical bioprosthesis (≤21 mm; hazard ratio, 2.04; 95% CI, 1.14-3.67; P = .02) and baseline stenosis (vs regurgitation; hazard ratio, 3.07; 95% CI, 1.33-7.08; P = .008). CONCLUSIONS AND RELEVANCE In this registry of patients who underwent transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic valves, overall 1-year survival was 83.2%. Survival was lower among patients with small bioprostheses and those with predominant surgical valve stenosis.
Circulation-cardiovascular Imaging | 2010
Arnold C.T. Ng; Victoria Delgado; Frank van der Kley; Miriam Shanks; Nico Van de Veire; Matteo Bertini; Gaetano Nucifora; Rutger J. van Bommel; Laurens F. Tops; Arend de Weger; Giuseppe Tavilla; Albert de Roos; Lucia J. Kroft; Dominic Y. Leung; Joanne D. Schuijf; Martin J. Schalij; Jeroen J. Bax
Background—3D transesophageal echocardiography (TEE) may provide more accurate aortic annular and left ventricular outflow tract (LVOT) dimensions and geometries compared with 2D TEE. We assessed agreements between 2D and 3D TEE measurements with multislice computed tomography (MSCT) and changes in annular/LVOT areas and geometries after transcatheter aortic valve implantations (TAVI). Methods and Results—Two-dimensional circular (&pgr;×r2), 3D circular, and 3D planimetered annular and LVOT areas by TEE were compared with “gold standard” MSCT planimetered areas before TAVI. Mean MSCT planimetered annular area was 4.65±0.82 cm2 before TAVI. Annular areas were underestimated by 2D TEE circular (3.89±0.74 cm2, P<0.001), 3D TEE circular (4.06±0.79 cm2, P<0.001), and 3D TEE planimetered annular areas (4.22±0.77 cm2, P<0.001). Mean MSCT planimetered LVOT area was 4.61±1.20 cm2 before TAVI. LVOT areas were underestimated by 2D TEE circular (3.41±0.89 cm2, P<0.001), 3D TEE circular (3.89±0.94 cm2, P<0.001), and 3D TEE planimetered LVOT areas (4.31±1.15 cm2, P<0.001). Three-dimensional TEE planimetered annular and LVOT areas had the best agreement with respective MSCT planimetered areas. After TAVI, MSCT planimetered (4.65±0.82 versus 4.20±0.46 cm2, P<0.001) and 3D TEE planimetered (4.22±0.77 versus 3.62±0.43 cm2, P<0.001) annular areas decreased, whereas MSCT planimetered (4.61±1.20 versus 4.84±1.17 cm2, P=0.002) and 3D TEE planimetered (4.31±1.15 versus 4.55±1.21 cm2, P<0.001) LVOT areas increased. Aortic annulus and LVOT became less elliptical after TAVI. Conclusions—Before TAVI, 2D and 3D TEE aortic annular/LVOT circular geometric assumption underestimated the respective MSCT planimetered areas. After TAVI, 3D TEE and MSCT planimetered annular areas decreased as it assumes the internal dimensions of the prosthetic valve. However, planimetered LVOT areas increased due to a more circular geometry.
European Heart Journal | 2010
Victoria Delgado; Arnold C.T. Ng; Nico R.L. van de Veire; Frank van der Kley; Joanne D. Schuijf; Laurens F. Tops; Arend de Weger; Giuseppe Tavilla; Albert de Roos; Lucia J. Kroft; Martin J. Schalij; Jeroen J. Bax
AIMS Aortic regurgitation after transcatheter aortic valve implantation (TAVI) is one of the most frequent complications. However, the underlying mechanisms of this complication remain unclear. The present evaluation studied the anatomic and morphological features of the aortic valve annulus that may predict aortic regurgitation after TAVI. METHODS AND RESULTS In 53 patients with severe aortic stenosis undergoing TAVI, multi-detector row computed tomography (MDCT) assessment of the aortic valve apparatus was performed. For aortic valve annulus sizing, two orthogonal diameters were measured (coronal and sagittal). In addition, the extent of valve calcifications was quantified. At 1-month follow-up after procedure, MDCT was repeated to evaluate and correlate the prosthesis deployment to the presence of aortic regurgitation. Successful procedure was achieved in 48 (91%) patients. At baseline, MDCT demonstrated an ellipsoid shape of the aortic valve annulus with significantly larger coronal diameter when compared with sagittal diameter (25.1 +/- 2.4 vs. 22.9 +/- 2.0 mm, P < 0.001). At follow-up, MDCT showed a non-circular deployment of the prosthesis in six (14%) patients. Moderate post-procedural aortic regurgitation was observed in five (11%) patients. These patients showed significantly larger aortic valve annulus (27.3 +/- 1.6 vs. 24.8 +/- 2.4 mm, P = 0.007) and more calcified native valves (4174 +/- 1604 vs. 2444 +/- 1237 HU, P = 0.005) at baseline and less favourable deployment of the prosthesis after TAVI. CONCLUSION Multi-detector row computed tomography enables an accurate sizing of the aortic valve annulus and constitutes a valuable imaging tool to evaluate prosthesis location and deployment after TAVI. In addition, MDCT helps to understand the underlying mechanisms of post-procedural aortic regurgitation.
American Heart Journal | 2010
See Hooi Ewe; Nina Ajmone Marsan; Mauro Pepi; Victoria Delgado; Gloria Tamborini; Manuela Muratori; Arnold C.T. Ng; Frank van der Kley; Arend de Weger; Martin J. Schalij; Melissa Fusari; Paolo Biglioli; Jeroen J. Bax
BACKGROUND This study aimed to evaluate the impact of baseline left ventricular (LV) systolic function on clinical and echocardiographic outcomes following transcatheter aortic valve implantation (TAVI). Survival of patients undergoing TAVI was also compared with that of a population undergoing surgical aortic valve replacement. METHODS One hundred forty-seven consecutive patients (mean age=80±7 years) undergoing TAVI in 2 centers were included. Mean follow-up period was 9.1±5.1 months. RESULTS At baseline, 34% of patients had impaired LV ejection fraction (LVEF) (<50%) and 66% had normal LVEF (≥50%). Procedural success was similar in these 2 groups (94% vs 97%, P=.41). All patients achieved improvement in transvalvular hemodynamics. At follow-up, patients with a baseline LVEF<50% showed marked LV reverse remodeling, with improvement of LVEF (from 37%±8% to 51%±11%). Early and late mortality rates were not different between the 2 groups, despite a higher rate of combined major adverse cardiovascular events (MACEs) in patients with a baseline LVEF<50%. The predictors of cumulative MACEs were baseline LVEF (HR=0.97, 95% CI=0.94-0.99) and preoperative frailty (HR=4.20, 95% CI=2.00-8.84). In addition, long-term survival of patients with impaired or normal LVEF was comparable with that of a matched population who underwent surgical aortic valve replacement. CONCLUSIONS TAVI resulted in significant improvement in LV function and survival benefit in high-risk patients with severe aortic stenosis, regardless of baseline LVEF. Patients with a baseline LVEF<50% were at higher risk of combined MACEs.
European Journal of Cardio-Thoracic Surgery | 2013
Fleur Descoutures; Dominique Himbert; Francesco Maisano; Filip Casselman; Arend de Weger; Oana Bodea; Frank van der Kley; Antonio Colombo; Cristina Giannini; Kjell Arne Rein; Bernard De Bruyne; Anna Sonia Petronio; Gry Dahle; Ottavio Alfieri; Alec Vahanian
OBJECTIVES Redo surgery after failed mitral valve repair may be high risk, or contraindicated in patients with comorbidities. Because of this high risk, other interventional possibilities like transcatheter valve implantation might be of benefit. We report our experience with transcatheter mitral valve-in-ring implantation (TVIR) in high-risk patients after failure of surgical ring annuloplasty. METHODS From January 2010 to February 2012, following a multidisciplinary discussion, 17 high-risk patients underwent TVIR using Edwards SAPIEN XT prostheses, via either a transvenous transseptal (n = 8), or a transapical approach (n = 9). RESULTS Patients were aged 70 ± 16 years, in New York Association classes III/IV. Their mean logistic EuroSCORE was 36 ± 17% and mean Society of Thoracic Surgeons risk score 13 ± 9%. The mean time interval between surgery and repair failure was 7 ± 3 years. Annuloplasty rings were semi-rigid in 14 cases, flexible in 2, and rigid in 1. Manufacturers ring diameters were 26 mm in 4 patients, 27 mm in 1, 28 mm in 9, 30 mm, 31 mm and 34 mm in 1. The predominant failure mode was regurgitation in 12 cases and stenosis in 5. SAPIEN XT diameters were 26 mm in 15 patients, 23 mm and 29 mm in 1. Procedural success rate was 88% (15/17). Emergency surgery was needed in 1 patient due to acute dislodgement of the ring. The degree of mitral regurgitation was reduced to none or mild in all but 2 patients; final mean gradient was 7 ± 3 mmHg. Thirty-day survival was 82% (14/17 patients). At last follow-up (13 ± 5 months), survival rate was 71% (12/17). CONCLUSIONS These preliminary results suggest that TVIR is feasible, with low operative risk, and may provide short-term clinical and haemodynamic improvement in selected high-risk patients with failure of mitral ring annuloplasty.
The Annals of Thoracic Surgery | 2011
See Hooi Ewe; Victoria Delgado; Arnold C.T. Ng; M. Louisa Antoni; Frank van der Kley; Nina Ajmone Marsan; Arend de Weger; Giuseppe Tavilla; Eduard R. Holman; Martin J. Schalij; Jeroen J. Bax
BACKGROUND Transcatheter aortic valve implantation is commonly implanted through a transfemoral (TFA) or transapical approach (TAA) for patients with severe aortic stenosis. This study aimed to describe the clinical and echocardiographic outcomes of TFA versus TAA. METHODS Clinical and echocardiographic evaluations were performed at baseline, post-TAVI (transcatheter aortic valve implantation), at 6 and 12 months follow-up in 107 consecutive patients who underwent TAVI with balloon-expandable valves. RESULTS The TFA was performed in 44% and the remaining patients underwent TAA. Although procedural complications were not significantly different in both approaches, more vascular complications were observed in the TFA group (18% vs 5%, p = 0.053). Patients with TAA required shorter fluoroscopy time (median 5 vs 12 min, p < 0.001), less contrast volume (median 80 vs 173 mL, p < 0.001), and similar length of hospitalization, as compared with TFA. Importantly, the early 30-day mortality (TFA: 11.1% vs TAA: 8.5%, p = 0.74) were not significantly different between the 2 approaches. Midterm survival at 6 months and 1 year was comparable between TFA and TAA (6 months: 88.9% vs 85.7% and 1 year: 80.2% vs 85.7%). All patients achieved immediate and sustained improvements in transvalvular hemodynamics, together with significant left ventricular mass regression (137 ± 39 vs 113 ± 30 g/m(2), p < 001) and left atrial volume reduction (48 ± 17 vs 34 ± 14 mL/m(2), p < 0.001) at 6 months or less. CONCLUSIONS Early, midterm, clinical, and echocardiographic outcomes were comparable in both approaches. However, TAA has the additional benefit of reducing radiation exposure and contrast use intraoperatively without prolonging the length of hospital stay.
European Journal of Cardio-Thoracic Surgery | 2011
Arend de Weger; See Hooi Ewe; Victoria Delgado; Jeroen J. Bax
The trans-catheter valve-in-valve concept has become a feasible therapeutic option for patients with failing degenerated bioprosthesis, who are deemed inoperable. However, little is known about the feasibility of this technique in failed valve annuloplasty. We report the first-in-man implantation of a trans-catheter aortic valve within a mitral annuloplasty ring. Through a trans-apical trans-catheter approach, a 26-mm Sapien-Edwards valve was successfully implanted in a 72-year-old man with ischemic heart failure and failed mitral-valve annuloplasty. The present case report provides a critical appraisal of the procedural technique.
International Journal of Artificial Organs | 2011
Jurgen de Hart; Arend de Weger; Sjoerd van Tuijl; Johannes M. A. Stijnen; Cn Chantal van den Broek; Marcel C. M. Rutten; Bas de Mol
Purpose Cardiac research and development of therapies and devices is being done with in silico models, using computer simulations, in vitro models, for example using pulse duplicators or in vivo models using animal models. These platforms, however, still show essential gaps in the study of comprehensive cardiac mechanics, hemodynamics, and device interaction. The PhysioHeart platform was developed to overcome these gaps by the ability to study cardiac hemodynamic functioning and device interaction ex vivo under in vivo conditions. Methods Slaughterhouse pig hearts (420 ± 30 g) were used for their morphological and physiological similarities to human hearts. Hearts were arrested, isolated and transported similar to transplantation protocols. After preparation, the hearts were connected to a special circulatory system that has been engineered using physical and medical principles. Through coronary reperfusion and controlled cardiac loading, physiological cardiac performance was achieved while hemodynamic parameters were continuously monitored. Results Normal cardiac hemodynamic performance was achieved both qualitatively, in terms of pulse waveforms, and quantitatively, in terms of average cardiac output (4 l/min) and pressures (110/75 mmHg). Cardiac performance was controlled and kept at normal levels for up to 4 hours, with only minor deterioration of hemodynamic performance. Conclusions With the PhysioHeart platform we were able to reproduce normal physiological cardiac conditions ex vivo. The platform enables us to study, under different but controlled physiological conditions, form, function, and device interaction through monitoring of performance parameters and intra-cardiac visualization. Although the platform has been used for pig hearts, application of the underlying physical and engineering principles to physiologically comparable hearts from different origin is rather straightforward.
Jacc-cardiovascular Imaging | 2009
Arnold C.T. Ng; Frank van der Kley; Victoria Delgado; Miriam Shanks; Rutger J. van Bommel; Arend de Weger; Giuseppe Tavilla; Eduard R. Holman; Joanne D. Schuijf; Nico Van de Veire; Martin J. Schalij; Jeroen J. Bax
Although percutaneous aortic valve replacement (PAVR) has been used to treat severe aortic stenosis for high-risk surgical patients not suitable for conventional surgery, the feasibility of using PAVR for treatment of severe paravalvular regurgitation in patients with prior aortic valve replacement
European Heart Journal | 2017
E. Mara Vollema; William K.F. Kong; S. Katsanos; Vasileios Kamperidis; Philippe J. van Rosendael; Frank van der Kley; Arend de Weger; Nina Ajmone Marsan; Victoria Delgado; Jeroen J. Bax
Aims The presence of hypo-attenuated leaflet thickening (HALT) and/or reduced leaflet motion on multi-detector row computed tomography (MDCT) has been proposed as a possible marker for early transcatheter aortic valve thrombosis. However, its association with abnormal valve haemodynamics on echocardiography (another potential marker of thrombosis) and clinical outcomes (stroke) remains unclear. The present study evaluated the prevalence of HALT on MDCT and abnormal valve haemodynamics on echocardiography. In addition, the occurrence of ischemic stroke and/or transient ischemic attack (TIA) was assessed. Methods and results A total of 434 patients (mean age 80 ± 7 years, 51% male) who underwent transcatheter aortic valve replacement (TAVR) were evaluated. Transcatheter valve haemodynamics were assessed on echocardiography at discharge, 6 months, and thereafter yearly (up to 3 years post-TAVR). The presence of HALT and/or reduced leaflet motion was assessed on MDCT performed 35 days [interquartile range 19–210] after TAVR in 128 of these 434 patients. Possible TAVR valve thrombosis was defined by mean transvalvular gradient ≥20 mmHg and aortic valve area (AVA) ⩽1.1cm2 on echocardiography or by the presence of HALT or reduced leaflet motion on MDCT. The occurrence of ischemic stroke/TIA at follow-up was recorded. HALT and/or reduced leaflet motion was present in 12.5% of 128 patients undergoing MDCT, and was associated with a slightly higher mean transvalvular gradient (12.4 ± 8.0 mmHg vs. 9.4 ± 4.3 mmHg; P = 0.026) and smaller AVA (1.49 ± 0.39 cm2 vs. 1.78 ± 0.45 cm2, P = 0.017). Only one patient with HALT on MDCT revealed abnormal valve haemodynamics on echocardiography. At 3-year follow-up, abnormal valve haemodynamics on echocardiography were observed in 3% of patients. HALT on MDCT and abnormal valve haemodynamics on echocardiography were not associated with increased risk of ischemic stroke/TIA. Conclusion On MDCT, 12.5% of patients showed HALT or reduced leaflet motion, whereas only one of these patients had abnormal valve haemodynamics on echocardiography. Neither HALT nor increased transvalvular gradient were associated with stroke/TIA.