Nahid El Faquir

Patient-Specific Computer Modeling to Predict Aortic Regurgitation after Transcatheter Aortic Valve Replacement

Outcome of transcatheter aortic valve replacement (TAVR) depends on a combination of patient-, procedure-, and operator-related variables. Specific device–host-related interactions may also be involved and may result in, for instance, incomplete and/or nonuniform frame expansion that in turn may

Comparison of valve performance of the mechanically expanding Lotus and the balloon-expanded SAPIEN3 transcatheter heart valves: an observational study with independent core laboratory analysis.

AimsnThe Lotus and SAPIEN3 are second-generation transcatheter heart valves, which are designed to minimize paravalvular aortic regurgitation (PAR) after transcatheter aortic valve replacement (TAVR). We sought to compare both devices for valve performance and with emphasis on PAR by independent core laboratory analysis.nnnMethods and resultsnA total of 162 (79 Lotus and 83 SAPIEN3) consecutive patients (51% female, 80u2009±u20098 years, Logistic EuroSCORE 14.8u2009±u20099.4%) who underwent TAVR because of aortic stenosis were included. Patients with aortic valve-in-valve treatment were excluded. Pre-discharge echocardiograms were analysed by an independent core laboratory using the Valve Academic Research Consortium 2 criteria. There were no differences in baseline and procedural characteristics, except for a larger aortic annulus and sizing indices in SAPIEN3-treated patients and frequency of post-dilatation (0% in Lotus and 13.1% in SAPIEN3). Both valves have similar mean residual gradient, indexed effective orifice area and Doppler velocity index when adjusted to valve size. The frequency of mild (13.9% vs. 31.3%) and at least moderate (1.3% vs. 3.6%) PAR was less after Lotus than after SAPIEN3 implantation (Pu2009=u20090.02). Multi-slice computed tomography-based annulus and left ventricular outflow tract diameters, calcification and percentage of oversizing were not different between those with or without mild or more PAR. On multivariate analysis, the use of Lotus valve was associated with less (odds ratio OR, 0.41, Pu2009=u20090.03) occurrence of PAR.nnnConclusionnOverall, haemodynamic performance was comparable between the Lotus and SAPIEN3 valves. Lotus valve required less oversizing and was associated with less PAR than SAPIEN3.

Patient-specific computer simulation to elucidate the role of contact pressure in the development of new conduction abnormalities after catheter-based implantation of a self-expanding aortic valve

Background— The extent to which pressure generated by the valve on the aortic root plays a role in the genesis of conduction abnormalities after transcatheter aortic valve replacement (TAVR) is unknown. This study elucidates the role of contact pressure and contact pressure area in the development of conduction abnormalities after TAVR using patient-specific computer simulations. Methods and Results— Finite-element computer simulations were performed to simulate TAVR of 112 patients who had undergone TAVR with the self-expanding CoreValve/Evolut R valve. On the basis of preoperative multi-slice computed tomography, a patient-specific region of the aortic root containing the atrioventricular conduction system was determined by identifying the membranous septum. Contact pressure and contact pressure index (percentage of area subjected to pressure) were quantified and compared in patients with and without new conduction abnormalities. Sixty-two patients (55%) developed a new left bundle branch block or a high-degree atrioventricular block after TAVR. Maximum contact pressure and contact pressure index (median [interquartile range]) were significantly higher in patients with compared with those without new conduction abnormalities (0.51 MPa [0.43–0.70 MPa] and 33% [22%–44%], respectively, versus 0.29 MPa [0.06–0.50 MPa] and 12% [1%–28%]). By multivariable regression analysis, only maximum contact pressure (odds ratio, 1.35; confidence interval, 1.1–1.7; P=0.01) and contact pressure index (odds ratio, 1.52; confidence interval, 1.1–2.1; P=0.01) were identified as independent predictors for conduction abnormalities, but not implantation depth. Conclusions— Patient-specific computer simulations revealed that maximum contact pressure and contact pressure index are both associated with new conduction abnormalities after CoreValve/Evolut R implantation and can predict which patient will have conduction abnormalities.

Impact of device-host interaction on paravalvular aortic regurgitation with different transcatheter heart valves

AIMSnWe sought to evaluate the interaction of different aortic root phenotypes with self-expanding (SEV), balloon-expandable (BEV) and mechanically expanded (MEV) and the impact on significant aortic regurgitation.nnnMETHODS AND RESULTSnWe included 392 patients with a SEV (Nu202f=u202f205), BEV (Nu202f=u202f107) or MEV (Nu202f=u202f80). Aortic annulus eccentricity index and calcification were measured by multi-slice CT scan. Paravalvular aortic regurgitation was assessed by contrast aortography (primary analysis) and transthoracic echocardiography (secondary analysis). In mildly calcified roots paravalvular regurgitation incidence was similar for all transcatheter heart valves (SEV 8.4%; BEV 9.1%; MEV 2.0% pu202f=u202f0.27). Conversely, in heavily calcified roots paravalvular regurgitation incidence was significantly higher with SEV (SEV 45.9%; BEV 0.0%; MEV 0.0% pu202f<u202f0.001). When paravalvular regurgitation was assessed by TTE, the overall findings were similar although elliptic aortic roots were associated with more paravalvular regurgitation with SEV (20.5% vs. BEV 4.5% vs. MEV 3.2%; pu202f=u202f0.009).nnnCONCLUSIONSnIn heavily calcified aortic roots, significant paravalvular aortic regurgitation is more frequent with SEV than with BEV or MEV, but similar in mildly calcified ones. These findings may support patient-tailored transcatheter heart valve selection.nnnCLASSIFICATIONSnAortic stenosis; multislice computed tomography; transcatheter aortic valve replacement; paravalvular aortic regurgitation.nnnCONDENSED ABSTRACTnWe sought to evaluate the interaction of different aortic root phenotypes with self-expanding (SEV), balloon-expandable (BEV) and mechanically expanded (MEV) and the impact on significant aortic regurgitation. We included 392 patients with a SEV (Nu202f=u202f205), BEV (Nu202f=u202f107) or MEV (Nu202f=u202f80). Aortic annulus eccentricity index and calcification were measured by multi-slice CT scan. Paravalvular aortic regurgitation was assessed by contrast aortography and transthoracic echocardiography. We found that in heavily calcified aortic roots, significant paravalvular aortic regurgitation is more frequent with SEV than with BEV or MEV, but similar in mildly calcified ones.

The Erasmus Frailty Score is associated with delirium and 1-year mortality after Transcatheter Aortic Valve Implantation in older patients. The TAVI Care & Cure program

BACKGROUNDnFrailty in patients undergoing Transcatheter Aortic Valve Implantation (TAVI) has been associated with an increased 1-year mortality rate but the relation of frailty and short term outcomes yields conflicting results. This study investigated the association of a novel and self-developed Erasmus Frailty Score with both short and long term outcomes after TAVI.nnnMETHODSnTAVI Care & Cure is an observational ongoing study, which includes consecutive patients undergoing TAVI at the Erasmus University Medical Centre. Prior to the TAVI, frailty status was assessed. The Erasmus Frailty Score (EFS) was defined as follows: 1 point assigned if: MMSE was <27 points, MUST ≥2 points, grip strength <20u202fkg for females, <30u202fkg for males, KATZ index ≥1 limited activity, Lawton and Brody index ≥2 limited activity. The maximum score was 5. Patients were classified as frail when the score was ≥3. Presence of delirium was evaluated by daily clinical assessment by a geriatrician pre- and post-TAVI. Mortality data were obtained from the Dutch Civil Registry. The impact of frailty on short and long term outcomes was evaluated.nnnRESULTSn213 patients were included for analysis. Frailty was present in 28.6% (nu202f=u202f61), (EFSu202f≥u202f3). Baseline frailty was associated with patients developing a delirium [OR 3.3 (95% CI 1,55-7,10), pu202f=u202f0.002] and with increased risk of 1-year mortality [HR 2.1 (95% CI 1.01-4.52), pu202f=u202f0.047].nnnCONCLUSIONnThe Erasmus Frailty Score is associated with delirium and 1u202fyear mortality in older patients after TAVI and can be used as a complement to traditional risk factors.

Long-Term Structural Integrity and Durability of the Medtronic CoreValve System After Transcatheter Aortic Valve Replacement

Excellent outcome after transcatheter aortic valve replacement (TAVR) is demonstrated by preserved transcatheter heart valve (THV) function at 2 to 5 years and intact structural integrity at 2 years [(1,2)][1]. Hypoattenuated leaflet thickening (HALT) appears in up to 40% by multislice computed