Transcatheter aortic valve replacement

Jump to navigation Jump to search

WikiDoc Resources for Transcatheter aortic valve replacement

Articles

Most recent articles on Transcatheter aortic valve replacement

Most cited articles on Transcatheter aortic valve replacement

Review articles on Transcatheter aortic valve replacement

Articles on Transcatheter aortic valve replacement in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Transcatheter aortic valve replacement

Images of Transcatheter aortic valve replacement

Photos of Transcatheter aortic valve replacement

Podcasts & MP3s on Transcatheter aortic valve replacement

Videos on Transcatheter aortic valve replacement

Evidence Based Medicine

Cochrane Collaboration on Transcatheter aortic valve replacement

Bandolier on Transcatheter aortic valve replacement

TRIP on Transcatheter aortic valve replacement

Clinical Trials

Ongoing Trials on Transcatheter aortic valve replacement at Clinical Trials.gov

Trial results on Transcatheter aortic valve replacement

Clinical Trials on Transcatheter aortic valve replacement at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Transcatheter aortic valve replacement

NICE Guidance on Transcatheter aortic valve replacement

NHS PRODIGY Guidance

FDA on Transcatheter aortic valve replacement

CDC on Transcatheter aortic valve replacement

Books

Books on Transcatheter aortic valve replacement

News

Transcatheter aortic valve replacement in the news

Be alerted to news on Transcatheter aortic valve replacement

News trends on Transcatheter aortic valve replacement

Commentary

Blogs on Transcatheter aortic valve replacement

Definitions

Definitions of Transcatheter aortic valve replacement

Patient Resources / Community

Patient resources on Transcatheter aortic valve replacement

Discussion groups on Transcatheter aortic valve replacement

Patient Handouts on Transcatheter aortic valve replacement

Directions to Hospitals Treating Transcatheter aortic valve replacement

Risk calculators and risk factors for Transcatheter aortic valve replacement

Healthcare Provider Resources

Symptoms of Transcatheter aortic valve replacement

Causes & Risk Factors for Transcatheter aortic valve replacement

Diagnostic studies for Transcatheter aortic valve replacement

Treatment of Transcatheter aortic valve replacement

Continuing Medical Education (CME)

CME Programs on Transcatheter aortic valve replacement

International

Transcatheter aortic valve replacement en Espanol

Transcatheter aortic valve replacement en Francais

Business

Transcatheter aortic valve replacement in the Marketplace

Patents on Transcatheter aortic valve replacement

Experimental / Informatics

List of terms related to Transcatheter aortic valve replacement

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

Overview

Untill recently, 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].[2]It consists of three leaflets of bioprosthetic pericardial tissue valve mounted on a self-expendable nitinol stent, which expands from the left ventricular outflow tract (LVOT) to the ascending aorta. Initially the device had a 25F profile, but it rapidly evolved to the current 18F device which lead to easier percutaneous insertion and better handling of the device. A third generation device is currently available, which measures 50 mm in height that is divided into 3 sections:

  1. An inflow portion designed to fix the valve to the annulus.
  2. An outflow portion designed to attach the frame of the device to the ascending aorta to stabilize it.
  3. A central portion designed to prevent the obstruction of the coronaries.


Complications

Following CoreValve implantation[3]:

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

References

  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)
  2. Heart Mirror J 2010; 157-159.
  3. 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)

Template:WH Template:WS