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Incidence and predictors of transcatheter aortic valve replacement device emboligenic matter detected by transesophageal echocardiography

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Abstract

During transfemoral (TF) or transcatheter aortic valve replacement (TAVR), transesophageal echocardiography (TEE) sometimes reveals an unexpected mobile membranous mass on the catheter tip within the proximal part of the descending thoracic aorta. Such mobile masses may cause critical embolic events if the TAVR device advances into the ascending aorta in the absence of preventive measures. This study aimed to investigate the incidence and predictors of emboligenic matter (EM) during TAVR, impact of EM on the procedure, and incidence of symptomatic ischemic stroke post procedure. Among 436 consecutive patients who underwent TF–TAVR, 407 were evaluated in this study. The primary end point was incidence of symptomatic ischemic stroke within 24 h post procedure while taking appropriate preventive measures. Incidence of EM, factors associated with EM, and the impact of EM on the procedure were also investigated. Among the 407 cases, 15 cases (3.7%) of EM were identified but no ischemic stroke occurred in the EM (+) group (0% vs. 2.04%, p = 1.00). In the EM (+) group, a self-expandable valve was used in all 15 cases (100% vs. 42.6%, p < 0.0001) while 14 cases used a CoreValve’s InLine sheath system initially (93.3% vs. 27.3%, p < 0.0001). CoreValve’s InLine sheath system usage was the only independent predictor of EM. The CoreValve’s InLine delivery system was identified as a predictor of EM during TF–TAVR, but symptomatic ischemic stroke was avoided while taking appropriate embolization preventive measures.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Masaki Yashige, Kan Zen, Shunsuke Nakamura, Tomotaka Fujimoto, Kazuaki Takamatsu, Nobuyasu Ito, Yoshito Kadoya, Michiyo Yamano, Tetsuhiro Yamano, Takeshi Nakamura & Satoaki Matoba

  2. Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan

    Hitoshi Yaku

Authors
  1. Masaki Yashige
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  2. Kan Zen
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  3. Shunsuke Nakamura
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  4. Tomotaka Fujimoto
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  5. Kazuaki Takamatsu
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  6. Nobuyasu Ito
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  7. Yoshito Kadoya
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  8. Michiyo Yamano
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  9. Tetsuhiro Yamano
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  10. Takeshi Nakamura
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  11. Hitoshi Yaku
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  12. Satoaki Matoba
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Contributions

All authors contributed to the study conception and design. MY collected data, performed statistical analysis, and wrote the manuscript. KZ, MY, TY, TN, HY, and SM revised the manuscript and figures. SN, TF, KT, NI, and YK collected data and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kan Zen.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Approval was obtained from the Ethics Committee of Kyoto Prefectural University of Medicine. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study.

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Yashige, M., Zen, K., Nakamura, S. et al. Incidence and predictors of transcatheter aortic valve replacement device emboligenic matter detected by transesophageal echocardiography. Int J Cardiovasc Imaging 38, 1741–1750 (2022). https://doi.org/10.1007/s10554-022-02567-2

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  • DOI: https://doi.org/10.1007/s10554-022-02567-2

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