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Transcatheter Aortic Valve Replacement for Left Ventricular Assist Device–Related Aortic Regurgitation: The Michigan Medicine Experience

ABSTRACT:

SUBMITTER: Gondi K

PROVIDER: S-EPMC11307432 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

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Transcatheter aortic valve replacement for left ventricular assist device-related aortic regurgitation and prohibitive surgical risk: a case report.

Project description:BackgroundAortic regurgitation (AR) is a prevalent complication following left ventricular assist device (LVAD) implantation, which elevates the risk of mortality. Prompt recognition and intervention are crucial to mitigate this risk.Case summaryA 52-year-old male with severe left ventricular dysfunction secondary to Chagas cardiomyopathy and severe pulmonary hypertension underwent implantation of a HeartMate 3 device as a bridge to transplant candidacy. Post-implantation, he developed progressive AR and a decline in overall health, characterized by right ventricular dysfunction, worsening mitral regurgitation, and elevated pulmonary pressures. Given the very high surgical risk, transcatheter aortic valve replacement was successfully performed, yielding excellent outcomes, including normalization of right ventricular function, reduction in pulmonary pressures, and a decrease in mitral regurgitation.DiscussionAortic regurgitation is a progressive complication in patients with continuous flow-LVAD, limits effective blood flow, and can lead to severe outcomes like biventricular failure, high rates of hospitalization, and mortality. Managing AR is challenging, often requiring percutaneous interventions due to high surgical risks. Treatment choices depend on centre expertise and patient specifics.

| S-EPMC11811522 | biostudies-literature

J-Valve Transcatheter Treatment of Native Valve Aortic Regurgitation Associated With a Left Ventricular Assist Device.

Project description: Not available

| S-EPMC11307644 | biostudies-literature

A case report: transfemoral transcatheter aortic valve replacement with a dedicated valve system for severe aortic regurgitation in a patient with a left ventricular assist device

Project description:Abstract Background Up to 30% of patients with the left ventricular assist device (LVAD) develop moderate to severe aortic regurgitation (AR) within the first year. Surgical aortic valve replacement (SAVR) is the treatment of choice in patients with native AR. However, the high perioperative risk in patients with LVAD might prohibit surgery and choice of therapy is challenging. Case summary We report on a 55-year-old female patient with a severe AR 15 months after implantation of LVAD due to advanced heart failure (HF) as a consequence of ischaemic cardiomyopathy. Surgical aortic valve replacement was discarded due to high surgical risk. Thus, the decision was made to evaluate a transcatheter aortic valve replacement (TAVR) with the TrilogyXTä prothesis (JenaValve Technology, Inc., CA, USA). Echocardiographic and fluoroscopic control showed an optimal valve position with no evidence of valvular or paravalvular regurgitation. The patient was discharged 6 days later in a good general condition. At the 3-month follow-up, the patient showed noteworthy symptomatic improvement with no sign of HF. Discussion Aortic regurgitation is a common complication among advanced HF patients treated with LVADSystems and associated with a deterioration in the quality of life and worsen clinical prognosis. The treatment options are limited to percutaneous occluder devices, SAVR, off-label TAVR, and heart transplantation. With the approval of the TrilogyXT JenaValve system, a novel dedicated TF-TAVR option is now available. Our experience demonstrates the technical feasibility and safety of this system in patients with LVAD and AR resulting in effective elimination of AR.

| S-EPMC10266159 | biostudies-literature

Transcatheter Aortic Valve Embolization in a Patient With a Left Ventricular Assist Device.

Project description: Not available

| S-EPMC10899715 | biostudies-literature

Transcatheter aortic valve replacement in the management of aortic insufficiency secondary to left ventricular assist device implantation: a case report

Project description: Not available

| S-EPMC10797376 | biostudies-literature

Subacute Aortic Root and Valve Thrombosis following Transcatheter Aortic Valve Replacement in a Left Ventricular Assist Device Patient: From One Problem to the Next.

Project description: Not available

| S-EPMC8071813 | biostudies-literature

Mitral and aortic regurgitation following transcatheter aortic valve replacement.

Project description:To analyse the impact of postprocedural mitral regurgitation (MR), in an interaction with aortic regurgitation (AR), on mortality following transcatheter aortic valve implantation (TAVI).To assess the interaction between MR and AR, we compared the survival rate of patients (i) without both significant MR and AR versus (ii) those with either significant MR or significant AR versus (iii) with significant MR and AR, all postprocedure. 381 participants of the Polish Transcatheter Aortic Valve Implantation Registry (166 males (43.6%) and 215 females (56.4%), age 78.8±7.4 years) were analysed. Follow-up was 94.1±96.5 days.In-hospital and midterm mortality were 6.6% and 10.2%, respectively. Significant MR and AR were present in 16% and 8.1% patients, including 3.1% patients with both significant MR and AR. Patients with significant versus insignificant AR differed with respect to mortality (log rank p=0.009). This difference was not apparent in a subgroup of patients without significant MR (log rank p=0.80). In a subgroup of patients without significant AR, there were no significant differences in mortality between individuals with versus without significant MR (log rank p=0.44). Significant MR and AR had a significant impact on mortality only when associated with each other (log rank p<0.0001). At multivariate Cox regression modelling concomitant significant MR and AR were independently associated with mortality (OR 3.2, 95% CI 1.54 to 5.71, p=0.002).Significant MR or AR postprocedure, when isolated, had no impact on survival. Combined MR and AR had a significant impact on a patient's prognosis.

| S-EPMC4862065 | biostudies-other

Prognostic value of right ventricular dysfunction in aortic regurgitation after transcatheter aortic valve replacement.

Project description:BackgroundAortic regurgitation (AR) may lead to right ventricular dysfunction (RVD), but the prognostic value of RVD in patients undergoing transcatheter aortic valve replacement (TAVR) remains unclear. Our goal was to evaluate the clinical implications, predictors and prognostic significance of RVD in patients with pure AR after TAVR.MethodsIn this multicentre prospective study, patients undergoing TAVR were included between January 2019 and April 2021. The patients were divided into four groups according to the results of transthoracic echocardiography pre- and post-TAVR. The primary end point was 2-year all-cause mortality.ResultsA total of 648 patients were divided into four groups: 325 patients (54.3%) in the no RVD group; 106 patients (17.7%) in the new-onset RVD group; 73 patients (12.2%) in the normalized RVD group; and 94 patients (15.7%) in the residual RVD group. At the 2-year follow-up, there were significant differences in all-cause mortality among the four groups (5.2%, 12.3%, 11.0% and 17.0%, respectively; p < 0.05). New-onset RVD was correlated with an increased risk of all-cause death and a composite end point and normalized RVD improved clinical outcomes of baseline RVD. Predictors of new-onset RVD included a higher Society of Thoracic Surgeons score, larger left ventricular end-diastolic volume, lower left ventricular ejection fraction, higher systolic pulmonary artery pressure and smaller RV base diameter.ConclusionsChanges in periprocedural RVD status significantly affect the risk stratification outcomes after TAVR. Therefore, they may be used as part of decision-making and risk assessment strategies.Clinical trial registrationClinicalTrials.gov Protocol Registration System (NCT02917980).

| S-EPMC11392773 | biostudies-literature

Mitral regurgitation after transcatheter aortic valve replacement.

Project description:Patients undergoing transcatheter aortic valve replacement (TAVR) might have an associated significant MR that can potentially lead to left ventricular (LV) failure after procedure. Considering the specific alterations in the mitral valve in TAVR scenario and the widespread use of TAVR in recent years, it appears important to know and understand the anatomical, functional and clinical implications to develop adequate strategies for the future. Patients with severe mitral regurgitation (MR) have been generally excluded from randomized clinical trials, making poor the impact that associated MR can have on clinical outcomes after TAVR. Several factors must be considered whose presence influences the severity of MR. For example, the elevated prevalence of coronary disease with consequent ischemic MR may account for LV dilation observed at the end stage of aortic stenosis. Evidence randomized studies and registries suggests that the rate of concomitant moderate-to-severe MR in patients undergoing TAVR oscillates between 2% and 33%, and patients with moderate to severe MR may have hemodynamic frailty with clinical deterioration during mechanical intervention. Short- and long-term outcomes, including cardiac mortality, appear to be influenced by the existence of preoperative moderate-to-severe MR or by the postprocedural worsening of mild MR, generally due to adverse LV remodeling. The incidence and the prognostic effect of concomitant MR in patients undergoing TAVR requires specific attention as might trigger adjunctive strategy treatment which should be carefully evaluated in clinical trials.KeywordsMitral regurgitation (MR); mitral valve; transcatheter aortic valve; transcatheter aortic valve replacement (TAVR).

| S-EPMC7330403 | biostudies-literature

Aortic Valve Thrombosis after Valve-Sparing Aortic Root Replacement and Insertion of an Extracorporeal Left Ventricular Assist Device, Masked by Mediastinal Packing.

Project description:Aortic valve (AV) or aortic root thrombus related to a left ventricular assist device (LVAD) is a relatively uncommon but potentially life-threatening complication. In the present report, we describe a complex case where echocardiographic diagnosis of AV thrombosis was obscured by the presence of mediastinal packing in a patient who underwent valve-sparing aortic root replacement and insertion of the CentriMag™ LVAD for postcardiotomy cardiogenic shock. A large AV thrombus may develop rapidly in patients with LVADs. This case highlights the importance of a careful and thorough transesophageal echocardiography examination in detecting this complication and in altering surgical management.

| S-EPMC6172889 | biostudies-literature

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