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Virtual_Cardiology@ESC.journals: Issue 1

The first virtual issue of the ESC Journal Family on transarterial valve implantation (TAVI) provides an overview of all the manuscripts published in this moving area with a particular focus on imaging, available valves, implantation techniques, outcome of patients with aortic stenosis considered and/or undergoing this procedure. To that end, the most important papers of the European Heart Journal, EuroIntervention and EHJ Cardiovascular Imaging have been selected by our expert editor, i.e. associate editor Ronald K. Binder, MD, FESC. I hope that the virtual issue on TAVI will find the interest of our readers.

Thomas F. Lüscher, MD, FESC, Editor-in-Chief - European Heart Journal and ESC Publications Committee Chairman

Image: Transfemoral implantation of the Edwards Sapien prosthesis. From Buellesfeld L, Windecker S. Transcatheter aortic valve implantation: the evidence is catching up with reality. Eur Heart J 2011;32:133–137.

Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis: a meta-analysis of randomized trials.
Siontis GC, Praz F, Pilgrim T, Mavridis D, Verma S, Salanti G, Søndergaard L, Jüni P, Windecker S. Eur Heart J. 2016 Jul 7

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A clinical risk score of myocardial fibrosis predicts adverse outcomes in aortic stenosis.
Chin CW, Messika-Zeitoun D, Shah AS, Lefevre G, Bailleul S, Yeung EN, Koo M, Mirsadraee S, Mathieu T, Semple SI, Mills NL, Vahanian A, Newby DE, Dweck MR. Eur Heart J. 2016 Feb 21;37(8):713-23.
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Early hypo-attenuated leaflet thickening in balloon-expandable transcatheter aortic heart valves.
Pache G, Schoechlin S, Blanke P, Dorfs S, Jander N, Arepalli CD, Gick M, Buettner HJ, Leipsic J, Langer M, Neumann FJ, Ruile P. Eur Heart J. 2016 Jul 21;37(28):2263-71

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Filter-based cerebral embolic protection with transcatheter aortic valve implantation: the randomised MISTRAL-C trial.
Van Mieghem NM, van Gils L, Ahmad H, van Kesteren F, van der Werf HW, Brueren G, Storm M, Lenzen M, Daemen J, van den Heuvel AF, Tonino P, Baan J, Koudstaal PJ, Schipper ME, van der Lugt A, de Jaegere PP. EuroIntervention. 2016 Jul 20;12(4):499-507

RenalGuard System for the prevention of acute kidney injury in patients undergoing transcatheter aortic valve implantation.
Visconti G, Focaccio A, Donahue M, Golia B, Marzano A, Donnarumma E, Ricciardelli B, Selvetella L, Marino L, Briguori C. EuroIntervention. 2016 Apr 8;11(14):e1658-61.

Occurrence, fate and consequences of ventricular conduction abnormalities after transcatheter aortic valve implantation.
Houthuizen P, van der Boon RM, Urena M, Van Mieghem N, Brueren GB, Poels TT, Van Garsse LA, Rodés-Cabau J, Prinzen FW, de Jaegere P. EuroIntervention. 2014 Feb;9(10):1142-50

Early clinical and echocardiographic outcomes after SAPIEN 3 transcatheter aortic valve replacement in inoperable, high-risk and intermediate-risk patients with aortic stenosis.
Kodali S, Thourani VH, White J, Malaisrie SC, Lim S, Greason KL, Williams M, Guerrero M, Eisenhauer AC, Kapadia S, Kereiakes DJ, Herrmann HC, Babaliaros V, Szeto WY, Hahn RT, Pibarot P, Weissman NJ, Leipsic J, Blanke P, Whisenant BK, Suri RM, Makkar RR, Ayele GM, Svensson LG, Webb JG, Mack MJ, Smith CR, Leon MB. Eur Heart J. 2016 Jul 21;37(28):2252-62

TAVI or No TAVI: identifying patients unlikely to benefit from transcatheter aortic valve implantation.
Puri R, Iung B, Cohen DJ, Rodés-Cabau J. Eur Heart J. 2016 Jul 21;37(28):2217-25.

Predictive value for paravalvular regurgitation of 3-dimensional anatomic aortic annulus shape assessed by multidetector computed tomography post-transcatheter aortic valve replacement.
Ciobotaru V, Maupas E, Dürrleman N, Boulenc JM, Borton A, Pujadas-Berthault P, Rioux P, Maubon A. Eur Heart J Cardiovasc Imaging. 2016 Jan;17(1):85-95

Accuracy and reproducibility of novel echocardiographic three-dimensional automated software for the assessment of the aortic root in candidates for thanscatheter aortic valve replacement.
García-Martín A, Lázaro-Rivera C, Fernández-Golfín C, Salido-Tahoces L, Moya-Mur JL, Jiménez-Nacher JJ, Casas-Rojo E, Aquila I, González-Gómez A, Hernández-Antolín R, Zamorano JL. Eur Heart J Cardiovasc Imaging. 2016 Jul;17(7):772-8.

Device landing zone calcification and its impact on residual regurgitation after transcatheter aortic valve implantation with different devices.
Seiffert M, Fujita B, Avanesov M, Lunau C, Schön G, Conradi L, Prashovikj E, Scholtz S, Börgermann J, Scholtz W, Schäfer U, Lund G, Ensminger S, Treede H. Eur Heart J Cardiovasc Imaging. 2016 May;17(5):576-84

Editor Summaries

1) Recent developments and refinements of transcatheter aortic valve implantation (TAVI) have increased the safety, efficacy and predictability of the procedure. Considering the history of percutaneous coronary intervention, which is now routinely performed in hospitals without on-site cardiovascular surgery departments, the spread of TAVI may take a similar path. In a large German registry (AQUA) TAVI outcomes of 17’919 patients were compared between centers with or without on-site cardiovascular surgery departments. The investigators found no significant differences in major complications and in-hospital mortality between patients, who underwent TAVI in hospitals with or without on-site cardiovascular surgery departments. Back to top

2) Within the last decade transcatheter aortic valve implantation (TAVI) has spread as an alternative to surgical aortic valve replacement (SAVR). In this meta-analysis randomized controlled trials comparing TAVI to SAVR (total 3’806 patients) were analyzed and two-year all-cause mortality was the primary endpoint. The investigators found a significant 13% relative risk reduction of all-cause mortality in favor of TAVI. The mortality benefit of TAVI was homogenous across all included trials and all devices but particularly pronounced among patients undergoing transfemoral TAVI and in females. Back to top

3) In patients with severe aortic stenosis valve intervention is indicated once symptoms develop. However, some patients with asymptomatic severe aortic stenosis are at increased risk for adverse outcomes on medical therapy. Ventricular mid-wall fibrosis assessed by magnetic resonance imaging is known to be a predictor for worse prognosis. In this study a risk score based on clinical factors which are associated ventricular fibrosis was established and validated. The score consists of age, sex, high-sensitivity troponin I concentration and electrocardiographic strain pattern. This clinical score predicted adverse outcomes in patients with asymptomatic severe aortic stenosis and potentially identifies high-risk patients who may benefit from early valve intervention. Back to top

4) Dual antiplatelet therapy (DAPT) is most commonly prescribed after transcatheter aortic valve implantation (TAVI) aiming to avoid valve thrombosis. In this study hypo-attenuated leaflet thickening (HALT) was investigated by computed tomography angiography (CTA) post TAVI. One in ten patients exhibited HALT after TAVI which remained asymptomatic in most cases. Switching from DAPT to oral anticoagulation post TAVI completely reversed HALT. The risk of HALT was not higher in patients on single antiplatelet therapy compared to those on DAPT. These results suggest that in some patients oral anticoagulation post TAVI may be preferable over antiplatelet therapy.  Back to top

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