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Challenges When Expanding Transcatheter Aortic Valve Implantation to Younger Patients.

ABSTRACT: The rapid expansion of transcatheter aortic valve implantation (TAVI) has been based upon robust clinical evidence derived from randomized controlled trials and large-scale international and national registries. Over the past decade, TAVI has evolved into a safe and effective procedure with predictable and reproducible outcomes. As a consequence, the TAVI technology is increasingly used to treat patients with a lower risk profile and the volume of TAVI now exceeds surgical aortic valve replacement (SAVR) in some countries. It may be anticipated that, in the near future, the majority of patients with severe symptomatic aortic valve stenosis will undergo TAVI as first line therapy, regardless of their age and risk profile. This article identifies some of the specific challenges that lie ahead when considering expansion of TAVI to younger patients.

SUBMITTER: De Backer O

PROVIDER: S-EPMC5958417 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Challenges When Expanding Transcatheter Aortic Valve Implantation to Younger Patients.

De Backer Ole O Søndergaard Lars L

Frontiers in cardiovascular medicine 20180511

The rapid expansion of transcatheter aortic valve implantation (TAVI) has been based upon robust clinical evidence derived from randomized controlled trials and large-scale international and national registries. Over the past decade, TAVI has evolved into a safe and effective procedure with predictable and reproducible outcomes. As a consequence, the TAVI technology is increasingly used to treat patients with a lower risk profile and the volume of TAVI now exceeds surgical aortic valve replaceme ...[more]

PMID: 29868611

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Project description:Chronic silent brain infarctions, detected as new white matter hyperintensities on magnetic resonance imaging (MRI) following transcatheter aortic valve implantation (TAVI), are associated with long-term cognitive deterioration. This is the first study to investigate to which extent the calcification volume of the native aortic valve (AV) measured with cardiac computed tomography angiography (CTA) predicts the increase in chronic white matter hyperintensity volume after TAVI. A total of 36 patients (79 ± 5 years, median EuroSCORE II 1.9%, Q1-Q3 1.5-3.4%) with severe AV stenosis underwent fluid attenuation inversion recovery (FLAIR) MRI < 24 h prior to TAVI and at 3 months follow-up for assessment of cerebral white matter hyperintensity volume (mL). Calcification volumes (mm3) of the AV, aortic arch, landing zone and left ventricle were measured on the CTA pre-TAVI. The largest calcification volumes were found in the AV (median 692 mm3) and aortic arch (median 633 mm3), with a large variation between patients (Q1-Q3 482-1297 mm3 and 213-1727 mm3, respectively). The white matter hyperintensity volume increased in 72% of the patients. In these patients the median volume increase was of 1.1 mL (Q1-Q3 0.3-4.6 mL), corresponding with a 27% increase from baseline (Q1-Q3 7-104%). The calcification volume in the AV predicted the increase of white matter hyperintensity volume (Δ%), with a 35% increase of white matter hyperintensity volume, per 100 mm3 of AV calcification volume (SE 8.5, p < 0.001). The calcification volumes in the aortic arch, landing zone and left ventricle were not associated with the increase in white matter hyperintensity volume. In 72% of the patients new chronic white matter hyperintensities developed 3 months after TAVI, with a median increase of 27%. A higher calcification volume in the AV was associated with a larger increase in the white matter hyperintensity volume. These findings show the potential for automated AV calcium screening as an imaging biomarker to predict chronic silent brain infarctions.

Dataset Information

Challenges When Expanding Transcatheter Aortic Valve Implantation to Younger Patients.

Publications

Challenges When Expanding Transcatheter Aortic Valve Implantation to Younger Patients.

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