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JACC Cardiovascular Interventions
Article
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JACC Cardiovascular Interventions
Article . 2012
License: Elsevier Non-Commercial
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JACC Cardiovascular Interventions
Article . 2012 . Peer-reviewed
License: Elsevier Non-Commercial
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Pathology of Transcatheter Valve Therapy

Authors: Nietlispach, Fabian; Webb, John G; Ye, Jian; Cheung, Anson; Lichtenstein, Samuel V; Carere, Ronald G; Gurvitch, Ronen; +4 Authors

Pathology of Transcatheter Valve Therapy

Abstract

This study sought to report on the pathology of transcatheter aortic valves explanted at early and late time points after transcatheter aortic valve implantation.Information on pathological findings following transcatheter aortic valve implantation is scarce, particularly late after transcatheter aortic valve implantation.This study included 20 patients (13 men, median age 80 years [interquartile range: 72 to 84] years) with previous transcatheter aortic valve implantation with a valve explanted at autopsy (n = 17) or surgery (n = 3) up to 30 months after implantation (10 transapical and 10 transfemoral procedures).Structural valve degeneration was not seen, although fibrous tissue ingrowth was observed at later time points with minimal effects on cusp mobility in 1 case. Minor alterations in valve configuration or placement were observed in up to 50% of cases, but they were not accompanied by substantial changes in valve function or reliably associated with chest compressions. Vascular or myocardial injury was common, especially within 30 days of transcatheter aortic valve implantation (about 69%), with the latter associated with left coronary ostial occlusion by calcified native aortic valve tissue in 2 cases. Mild to severe myocardial amyloidosis was present in nearly 33% of cases and likely played a role in the poor outcome of 3 patients. Endocarditis, migration of the valve, and embolization during the procedure led to surgical valve removal.Structural degeneration was not seen and minor alterations of valve configuration or placement did not affect valve function and were not reliably caused by chest compressions. Vascular or myocardial injury is very common early after transcatheter aortic valve implantation and myocardial amyloidosis represents a relatively frequent potentially significant comorbid condition.

Country
Switzerland
Keywords

Male, Cardiac Catheterization, Time Factors, long-term follow-up, autopsy, Foreign-Body Migration, Cause of Death, Humans, Device Removal, Aged, stent deformation, Aged, 80 and over, Heart Valve Prosthesis Implantation, British Columbia, Endocarditis, Myocardium, Amyloidosis, Aortic Valve Stenosis, Middle Aged, Treatment Outcome, Cardiovascular Diseases, Aortic Valve, tissue overgrowth, transcatheter aortic valve replacement, pathology, Female, Autopsy, Cardiology and Cardiovascular Medicine, Cardiomyopathies

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    selected citations
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    This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    85
    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 1%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Top 1%
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Top 10%
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
85
Top 1%
Top 1%
Top 10%
hybrid