Transcatheter aortic valve replacement: Difference between revisions

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Revision as of 15:54, 17 March 2011

Editors-in-Chief: Roger Laham, M.D., C. Michael Gibson, M.S., M.D.; Jeffrey J. Popma, M.D.

Assistant Editor-In-Chief: Saleh El Dassouki, MD [1]

Please Join in Editing This Page and Apply to be an Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Synonyms and keywords: TAVI, Edward's valve, Edward's SAPIEN transcatheter heart valve, CoreValve, percutaneous aortic valve replacement, PAVR

Introduction

Untill recent years, aortic valve replacement (AVR) was the only effective treatment to severe symptomatic aortic stenosis. However, over the past decade percutaneous treatment of aortic valve disease with implantation of a stent-based valve prosthesis has been introduced as a new treatment in patients considered inoperable because of severe co-morbidities.^[1] In Transcatheter Aortic Valve Implantation (TAVI) also known as Percutaneous Aortic Valve Replacement (PAVR), a synthetic valve is transported to the heart through a small hole made in groin. This procedure can be compared to that performed when placing a stent, or performing balloon angioplasty. Traditional aortic valve replacement is an invasive surgical procedure, with considerable mortality and morbidity, especially in more fragile patients. In the newly developed TAVI procedure, the dysfunctional aortic valve is replaced percutaneously, which removes the need for open heart surgery.

Valve types

CoreValve

The CoreValve device was first inserted in 2005^[1].

Complications

Following CoreValve implantation^[2]:

QRS duration: In one observational study of 270 patients, the QRS duration increased from 105±23 milliseconds at baseline to 135±29 milliseconds following TAVI. (P<0.01).
Left Bundle Branch Block (LBBB): The incidence of left bundle-branch block increased from 13% at baseline to 61% following TAVI (P<0.001).
Permanent pacemaker implantation: Approximately one third of patients will require a permanent pacemaker be implanted by 30 days with a median time to insertion of 4 days (interquartile range, 2.0 to 7.75 days).
Multivariate predictors of permanent pacemaker implantation included:

Periprocedural atrioventricular block (odds ratio, 6.29; 95% confidence interval, 3.55 to 11.15)
Balloon pre-dilatation (odds ratio, 2.68; 95% confidence interval, 2.00 to 3.47)
Use of a larger 29 mm CoreValve prosthesis (odds ratio, 2.50; 95% confidence interval, 1.22 to 5.11)
The interventricular septum diameter (odds ratio, 1.18; 95% confidence interval, 1.10 to 3.06)
A prolonged QRS duration (odds ratio, 3.45; 95% confidence interval, 1.61 to 7.40)

References

↑ ^1.0 ^1.1 Grube E, Laborde JC, Gerckens U, Felderhoff T, Sauren B, Buellesfeld L, Mueller R, Menichelli M, Schmidt T, Zickmann B, Iversen S, Stone GW (2006). "Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study". Circulation. 114 (15): 1616–24. doi:10.1161/CIRCULATIONAHA.106.639450. PMID 17015786. Retrieved 2011-03-17. Unknown parameter |month= ignored (help)
↑ Khawaja MZ, Rajani R, Cook A, Khavandi A, Moynagh A, Chowdhary S, Spence MS, Brown S, Khan SQ, Walker N, Trivedi U, Hutchinson N, De Belder AJ, Moat N, Blackman DJ, Levy RD, Manoharan G, Roberts D, Khogali SS, Crean P, Brecker SJ, Baumbach A, Mullen M, Laborde JC, Hildick-Smith D (2011). "Permanent Pacemaker Insertion After CoreValve Transcatheter Aortic Valve Implantation: Incidence and Contributing Factors (the UK CoreValve Collaborative)". Circulation. doi:10.1161/CIRCULATIONAHA.109.927152. PMID 21339482. Retrieved 2011-02-23. Unknown parameter |month= ignored (help)

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[pmid17015786-1] 1.0 ^1.1 Grube E, Laborde JC, Gerckens U, Felderhoff T, Sauren B, Buellesfeld L, Mueller R, Menichelli M, Schmidt T, Zickmann B, Iversen S, Stone GW (2006). "Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study". Circulation. 114 (15): 1616–24. doi:10.1161/CIRCULATIONAHA.106.639450. PMID 17015786. Retrieved 2011-03-17. Unknown parameter |month= ignored (help)

[pmid21339482-2] Khawaja MZ, Rajani R, Cook A, Khavandi A, Moynagh A, Chowdhary S, Spence MS, Brown S, Khan SQ, Walker N, Trivedi U, Hutchinson N, De Belder AJ, Moat N, Blackman DJ, Levy RD, Manoharan G, Roberts D, Khogali SS, Crean P, Brecker SJ, Baumbach A, Mullen M, Laborde JC, Hildick-Smith D (2011). "Permanent Pacemaker Insertion After CoreValve Transcatheter Aortic Valve Implantation: Incidence and Contributing Factors (the UK CoreValve Collaborative)". Circulation. doi:10.1161/CIRCULATIONAHA.109.927152. PMID 21339482. Retrieved 2011-02-23. Unknown parameter |month= ignored (help)

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 '''''Synonyms and keywords:''''' TAVI, Edward's valve, Edward's SAPIEN transcatheter heart valve, CoreValve, percutaneous aortic valve replacement, PAVR
+==Introduction==
+Untill recent years, aortic valve replacement (AVR) was the only effective treatment to severe symptomatic aortic stenosis. However, over the past decade [[percutaneous treatment]] of aortic valve disease with implantation of a stent-based valve prosthesis has been introduced as a new treatment in patients considered inoperable because of [[severe co-morbidities]].<ref name="pmid17015786">{{cite journal |author=Grube E, Laborde JC, Gerckens U, Felderhoff T, Sauren B, Buellesfeld L, Mueller R, Menichelli M, Schmidt T, Zickmann B, Iversen S, Stone GW |title=Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study |journal=[[Circulation]] |volume=114 |issue=15 |pages=1616–24 |year=2006 |month=October |pmid=17015786 |doi=10.1161/CIRCULATIONAHA.106.639450 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=17015786 |accessdate=2011-03-17}}</ref>
 In Transcatheter Aortic Valve Implantation (TAVI) also known as Percutaneous Aortic Valve Replacement (PAVR), a synthetic valve is transported to the heart through a small hole made in groin. This procedure can be compared to that performed when placing a [[stent]], or performing [[balloon angioplasty]]. Traditional [[aortic valve replacement]] is an invasive surgical procedure, with considerable mortality and [[morbidity]], especially in more fragile patients. In the newly developed TAVI procedure, the dysfunctional [[aortic valve]] is replaced [[percutaneously]], which removes the need for [[open heart surgery]].
 ==Valve types==