Structural heart disease - Aortic and mitral valves

Petr Kala, Michael Aschermann

Cor Vasa 2017, 59(1):e1 | DOI: 10.1016/j.crvasa.2017.02.001  

Coronary artery disease in patients undergoing transcatheter aortic valve implantation. A single centre registry on prevalence, management and immediate clinical impact

Carlo Zivelonghi, Mattia Lunardi, Gabriele Pesarini, Roberto Scarsini, Anna Piccoli, Valeria Ferrero, Leonardo Gottin, Aldo Milano, Giuseppe Faggian, Corrado Vassanelli, Flavio Ribichini

Cor Vasa 2017, 59(1):e23-e28 | DOI: 10.1016/j.crvasa.2017.01.012  

Introduction: Prevalence of coronary artery disease (CAD) ranges from 30% to 60% of all patients with aortic valve stenosis (AVS). At present, little is known about the best management of CAD in patients undergoing trans-catheter aortic valve implantation (TAVI). Aim of this study is to investigate the prevalence, management and the immediate clinical impact of CAD in this population, with a special focus on the feasibility and safety of a physiologically-guided revascularization strategy.Methods and results: A total of 287 consecutive patients undergoing TAVI in our centre were retrospectively included in the analysis. Those presenting CAD (123,...

Special considerations on TAVI implanted in bicuspid aortic valves. Experience of Institute of Cardiology in Warsaw, Poland

Mikołaj Kosek, Jan Jastrzębski, Krzysztof Kuśmierski, Maciej Dąbrowski, Piotr Szymański, Ilona Michałowska, Tomasz Hryniewiecki, Marcin Demkow, Janina Stępińska, Piotr Michałek, Zbigniew Chmielak, Adam Witkowski

Cor Vasa 2017, 59(1):e29-e34 | DOI: 10.1016/j.crvasa.2017.01.022  

Since the advent of transcatheter aortic valve implantation (TAVI), bicuspid aortic valves (BAVs) have been considered relative contraindication for this procedure. Patients with BAVs were excluded from the majority of large clinical TAVI trials. However, the development of the implantation technique and further studies have proven this method feasible and safe also in BAVs. Nowadays some clinicians claim that BAV should no longer be a contraindication. Nevertheless special aspects of the unique anatomy need to be taken into consideration when qualifying patients for this procedure. In our center since 2010 a total number of 28 patients with bicuspid...

Czech TAVI registry - Hospital outcome

Petr Kala, Milan Blaha, Martin Mates, Michael Želízko, Marian Branny, Viktor Kočka, Martin Třetina, Jiří Jarkovský, Petr Němec, Josef Šťásek, Pavel Červinka

Cor Vasa 2017, 59(1):e51-e56 | DOI: 10.1016/j.crvasa.2017.02.002  

The first TAVI in the Czech Republic was performed in 2008 and since then, more than 90% of TAVI procedures have been involved in the online all comers Czech TAVI Registry. From 2008 till June 2016 1 532 TAVI procedures in a high risk population with symptomatic severe aortic stenosis (logistic EuroSCORE 18.2, median age 80 years) were relatively safe (in-hospital mortality 3.9%, severe paravalvular leakage after TAVI 1.0%) and highly effective (index of aortic valve area before versus after TAVI was 0.4 cm2/m2 versus 1.0 cm2/m2, respectively). Majority of patients (83.7%) underwent TAVI because of their high risk for surgery assessed by the Heart...

Surgical treatment of mitral regurgitation

Petr Němec, Jiří Ondrášek

Cor Vasa 2017, 59(1):e92-e96 | DOI: 10.1016/j.crvasa.2017.01.017  

Introduction: Mitral regurgitation (MiR) is very common valvular disease. Surgical treatment improves patients' prognosis and quality of their life. Traditional mitral valve replacement was mostly substituted by mitral valve repair which improved early and long-term survival. The aim of our study was to assess results of mitral valve surgery in our department.Patients and methods: Retrospective study of data from cardiac operations registry was performed. From January 2009 to December 2014 seven hundred and eighty-six patients with mitral valve regurgitation were operated on. There were 471 men and 315 women, 78.9% of them were in NYHA class II...

TAVI - From patient selection to follow-up

Michael Želízko

Cor Vasa 2017, 59(1):e2-e9 | DOI: 10.1016/j.crvasa.2017.01.011  

This review aims to summarize the available clinical evidence of transcatheter aortic valve treatment focused on patient selection according to clinical criteria, risk stratification and anatomical eligibility, with attention on specific patient subgroups. Procedural technical aspects and specific complications are discussed and key principles of follow-up are mentioned.

Alternative access routes for transcatheter aortic valve implantation (TAVI

Marian Branny, Piotr Branny, Miroslav Hudec, Miroslav Billka, Libor Škňouřil, Jan Chovančík, Krystyna Kluzová, Pavla Kufová, Jaroslav Januška, Jiří Jarkovský, Milan Blaha

Cor Vasa 2017, 59(1):e10-e16 | DOI: 10.1016/j.crvasa.2017.01.024  

The transcatheter aortic valve implantation (TAVI) is a preferred treatment option among the patients with severe aortic stenosis who were considered to be non-operable or at high surgical risk. The basic principle of the crimped valve and the catheter-based implantation to the stenotic native valve remains unchanged, but several different concepts of bioprosthesis and approaches of valve implantation have been developed. All the concepts have proven their safety and efficiency, however, there are only limited data available comparing one approach to another. The objective of this paper is to offer an overview and more detailed specification of current...

Management of low-gradient aortic stenosis

Martin Mates, Karel Kopřiva

Cor Vasa 2017, 59(1):e17-e22 | DOI: 10.1016/j.crvasa.2017.01.023  

There is an important proportion of patients with significant aortic stenosis who present with low gradient. In clinical practice we distinguish three subpopulations: (1) "classical" type with low left ventricular ejection fraction, (2) paradoxical type with preserved ventricular ejection fraction and (3) patients with normal flow and low gradient. Differentiation between "true" severe aortic stenosis and pseudostenosis by means of low dose dobutamine stress test is sometimes necessary in order to set further management - operative or conservative respectively. Use of other imaging methods such as MSCT, proved also valuable. Intervention of severe...

Aortic valve-in-valve procedures for treatment of failing surgically implanted bioprosthesis

Tomasz Gąsior, Zenon Huczek, Dariusz Jagielak, Wojciech Wojakowski

Cor Vasa 2017, 59(1):e35-e41 | DOI: 10.1016/j.crvasa.2017.01.010  

The durability of bioprosthetic valves is limited to 12-20 years. Valve degeneration results in either severe stenosis (related to calcification and thrombosis) or regurgitation (related to structural leaflet deterioration, infectious endocarditis). The redo surgery is associated with an increased risk, so implantation of transcatheter (TAVI) valve is a reasonable option. Planning of the valve-in-valve procedure consists of imaging using multislice computed tomography which allows the assessment of the type of degeneration (calcification or leaflet destruction), measurement of the height of coronary ostia and most importantly the size of the valve....

Novel TAVI designs

Jan Kovac, Julia H. Baron, Hasan Jilaihawi, Derek T. Chin

Cor Vasa 2017, 59(1):e42-e50 | DOI: 10.1016/j.crvasa.2017.01.014  

"Novel" TAVI valves is a rapidly developing area. Since concept of TAVI was resolutely established in randomised trials with first generation valves, there was tremendous engineering development and finesse, enabling to achieve excellent acute and mid-term haemodynamic result with largely minimal aortic regurgitation, typically no residual gradient and miniaturisation enabling substantial majority of patients to be treated via transfemoral approach. To ease operator comfort designs enable reposionability or one attempt precision increasing acute safety. As current and future trials will bring this technology to broader spectrum of patients group, vigilance...

Current status of the Ross procedure in aortic valve surgery

Jan Vojáček, Ismail El-Hamamsy, Jiří Ondrášek, Pavel Žáček, Petr Fila, Martin Voborník, Jaroslav Špatenka

Cor Vasa 2017, 59(1):e71-e76 | DOI: 10.1016/j.crvasa.2017.01.018  

The Ross procedure represents a unique surgical concept of unrepairable diseased aortic valve replacement by patient's own pulmonary valve (pulmonary autograft). After pulmonary valve removal, the right ventricle outflow tract is reconstructed by pulmonary allograft transplantation. Pulmonary valve in aortic position (pulmonary autograft) displays excellent hemodynamic features, viability with a growth-potential (in children) and a low risk of thromboembolism and infective endocarditis unparalleled to other heart valve substitutes. Despite the advantages of a pulmonary autograft the Ross procedures arouse controversies and surgical respect due to its...

Aortic valve repair and valve sparing procedures

Jan Vojáček, Pavel Žáček, Jan Dominik

Cor Vasa 2017, 59(1):e77-e84 | DOI: 10.1016/j.crvasa.2017.01.025  

Aortic valve repair and valve sparing procedures enable restoration of competence in regurgitant aortic valve, and thus to avoid the risks related to valve replacement. Successful aortic valve repair requires deep understanding of the static and dynamic geometry of the aortic valve and aortic root. Aortic regurgitation originates from malapposition of the aortic leaflets and frequently is also connected to dilation the aortic root and ascending aorta. Techniques of surgical procedures for aortic regurgitation have been subject of historical development and currently tend to simplification and standardization. Basic principles stand upon morphological...

MitraClip: Catheter-based treatment of mitral regurgitation

Tomáš Ondrúš, Martin Pěnička, Martin Kotrč, Marc Vanderheyden, Jozef Bartunek

Cor Vasa 2017, 59(1):e85-e91 | DOI: 10.1016/j.crvasa.2017.01.015  

Mitral regurgitation (MR) is the second most prevalent heart valve disease requiring surgery. Despite the evidence of unfavourable prognosis, around half of patients with severe MR are not referred for surgery due to high per-operative risk. MitraClip (Abbott Vascular-Structural Heart, Menlo Park, California, United States) implantation is an emerging percutaneous technique with edge-to-edge mitral valve (MV) repair inspired by the Alfieri surgery. Favourable safety profile together with improvement of functional status and decrease of MR severity in high-surgical-risk patients have been demonstrated in randomized clinical trials and "real-world" registries...

Rescue TAVI in bicuspid aortic stenosis and aortic inflammation

Josef Bis, Josef Šťásek, Jaroslav Dušek, Miroslav Brtko, Pavel Polanský, Andrej Myjavec

Cor Vasa 2017, 59(1):e57-e59 | DOI: 10.1016/j.crvasa.2017.01.009  

Transfemoral implantation of CoreValve Evolut R in patient with functionally bicuspid aortic valve. Case report

Petr Kmoníček, Martin Mates

Cor Vasa 2017, 59(1):e60-e64 | DOI: 10.1016/j.crvasa.2017.01.020  

Catheter based aortic valve replacement became largely adopted technique to treat patients with severe aortic stenosis in the setting of prohibitive risk and in high risk operation patients. Based on the positive clinical data from the Nordic Aortic Valve Intervention (NOTION) Trial [1] and from a subset analysis from the CoreValve U.S. High Risk Pivotal Trial Medtronic plc. announced CE mark for the self-expanding CoreValve Evolut R to obtain an expanded indication to treat aortic stenosis in patients who are at intermediate risk for open-heart surgery. Bicuspid aortic valve was deemed contraindicated for CoreValve implantation and nowadays is considered...

Challenging TAVI imaging case with Portico valve

Martin Sluka, Jiří Ostřanský, Miloslav Špaček

Cor Vasa 2017, 59(1):e65-e67 | DOI: 10.1016/j.crvasa.2017.01.013  

Transcatheter aortic valve implantation (TAVI) is considered as an appropriate alternative to surgical valve replacement in patients with severe symptomatic aortic valve stenosis at moderate to high perioperative risk. There have also been case reports and patient series using TAVI system in patients with predominant or pure symptomatic aortic regurgitation. We report a case of a patient with symptomatic combined aortic valve disease that was successfully treated with self-expandable Portico system despite extremely elliptical annulus.

Challenging TAVI imaging case with Lotus valve

Pavel Červinka, Martin Kvašňák, Martin Vojtíšek, Miroslav Kolesár

Cor Vasa 2017, 59(1):e68-e70 | DOI: 10.1016/j.crvasa.2017.01.016  

The authors present successful TAVI procedure in a patient with bicuspid aortic valve with severe aortic stenosis, employing a second-generation heart valve.

Challenging MitraClip imaging case

Jaroslav Januška, Miroslav Hudec, Libor Škňouřil, Miloslav Dorda, Libor Gajdušek, Tomasz Berdzik, Marian Branny

Cor Vasa 2017, 59(1):e97-e101 | DOI: 10.1016/j.crvasa.2017.01.021  

MitraClip is a well-established method for treatment of mitral regurgitation. It is dedicated for patients who cannot undergo surgery. But we are facing some cases which are out of standard indication criteria and they are technically challenging and uncommon, finally with very good results. We present a case report of a man who suffered from severe mitral regurgitation after a previous surgical mitral valve repair.This was successfully solved with MitraClip implantation.

Zpráva ze služební cesty - XLIII. kongres European Society of Artificial Organs

MUDr. Roman Hájek, Ph.D.

Cor Vasa 2017, 59(1):115-116  

Erratum k: "Doporučené postupy ESC 2016 pro léčbu fibrilace síní formulované ve spolupráci s EACTS. Souhrn dokumentu připravený Českou kardiologickou společností" [Cor et Vasa 58 (2016) 728-771]

Robert Čihák, Luděk Haman, Miloš Táborský

Cor Vasa 2017, 59(1):109  

Alan Bulava a kolektiv: Intrakardiální echokardiografie v elektrofyziologii

Prof. MUDr. Jan Petrášek, DrSc.

Cor Vasa 2017, 59(1):112  

Thomas F. Lüscher, Al-Phuong Tran, Martin Meyer, Jan Steffel: Das gesunde und das kranke Herz

Prof. MUDr. Jan Petrášek, DrSc.

Cor Vasa 2017, 59(1):113  

Jan Vojáček, Pavel Žáček, Jan Dominik et al.: Aortální nedomykavost

Prof. MUDr. Jan Petrášek, DrSc.

Cor Vasa 2017, 59(1):114  

Editorial Board

Editorial board

Cor Vasa 2017, 59(1):i | DOI: 10.1016/S0010-8650(17)30028-0