33 results on '"Toutouzas, Konstantinos"'
Search Results
2. Aortic valve: anatomy and structure and the role of vasculature in the degenerative process.
- Author
-
Katsi V, Magkas N, Antonopoulos A, Trantalis G, Toutouzas K, and Tousoulis D
- Subjects
- Fibrosis, Humans, Inflammation, Aortic Valve anatomy & histology, Aortic Valve pathology, Aortic Valve Stenosis pathology, Calcinosis pathology
- Abstract
Aortic valve stenosis is a degenerative disease affecting increasing number of individuals and characterised by thickening, calcification and fibrosis of the valve resulting in restricted valve motion. Degeneration of the aortic valve is no longer considered a passive deposition of calcium, but an active process that involves certain mechanisms, that is endothelial dysfunction, inflammation, increased oxidative stress, calcification, bone formation, lipid deposition, extracellular matrix (ECM) remodelling and neoangiogenesis. Accumulating evidence indicates an important role for neoangiogenesis (i.e. formation of new vessels) in the pathogenesis of aortic valve stenosis. The normal aortic valve is generally an avascular tissue supplied with oxygen and nutrients via diffusion from the circulating blood. In contrast, presence of intrinsic micro-vasculature has been demonstrated in stenotic and calcified valves. Importantly, presence and density of neovessels have been associated with inflammation, calcification and bone formation. It remains unclear whether neoangiogenesis is a compensatory mechanism aiming to counteract hypoxia and increased metabolic demands of the thickened tissue or represents an active contributor to disease progression. Data extracted mainly from animal studies are supportive of a direct detrimental effect of neoangiogenesis, however, robust evidence from human studies is lacking. Thus, there is inadequate knowledge to assess whether neoangiogenesis could serve as a future therapeutic target for a disease that no effective medical therapy exists. In this review, we present basic aspects of anatomy and structure of the normal and stenotic aortic valve and we focus on the role of valve vasculature in the natural course of valve calcification and stenosis.
- Published
- 2021
- Full Text
- View/download PDF
3. Transfemoral transcatheter aortic valve replacement in the presence of a mitral prosthesis.
- Author
-
Toutouzas K, Drakopoulou M, Latsios G, Synetos A, Stathogiannis K, Soulaidopoulos S, Oikonomou G, Trantalis G, Papanikolaou A, Aggeli C, Vavuranakis M, Mastrokostopoulos A, Katsimaglis G, Voudris V, Dardas P, and Tousoulis D
- Subjects
- Aged, Aged, 80 and over, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency physiopathology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis physiopathology, Female, Heart Valve Prosthesis Implantation adverse effects, Hemodynamics, Humans, Male, Middle Aged, Mitral Valve diagnostic imaging, Mitral Valve physiopathology, Prosthesis Design, Punctures, Recovery of Function, Severity of Illness Index, Transcatheter Aortic Valve Replacement adverse effects, Treatment Outcome, Aortic Valve surgery, Aortic Valve Insufficiency surgery, Aortic Valve Stenosis surgery, Catheterization, Peripheral adverse effects, Femoral Artery, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Mitral Valve surgery, Transcatheter Aortic Valve Replacement instrumentation
- Abstract
Purpose: In the current case series, we present our experience with the self-expanding CoreValve or Evolut R (Medtronic Inc.) in patients with severe symptomatic aortic valve stenosis and concomitant mitral valve prosthesis., Methods: Twelve patients with previous mitral valve prosthesis underwent transcatheter aortic valve replacement for severe symptomatic aortic valve stenosis and/or aortic valve regurgitation. All patients underwent evaluation with an echocardiogram, computed tomography and coronary angiogram. After the index intervention and before discharge all patients underwent transthoracic echocardiography. All outcomes were defined according to the Valve Academic Research Consortium-2 criteria., Results: Eleven patients underwent transcatheter aortic valve replacement for severe symptomatic aortic valve stenosis and one patient for severe aortic valve regurgitation. There was immediate improvement of patients' hemodynamic status; no cases of procedural death, stroke, myocardial infarction, or urgent cardiac surgery occurred. There was no 30-day mortality and all patients improved, with 91.6% in functional New York Heart Association class I-II., Conclusion: The current study demonstrates that in patients with severe aortic valve stenosis or regurgitation and mitral valve prosthesis, the implantation of a self-expanding aortic valve via the transfemoral route is safe and feasible, with maintained long-term results.
- Published
- 2019
- Full Text
- View/download PDF
4. Impact of Valve Over-Sizing After Transcatheter Aortic Valve Implantation With a Self-Expanding Valve: A Multislice Computed Tomography Study.
- Author
-
Drakopoulou M, Toutouzas K, Stathogiannis K, Latsios G, Sideris S, Xanthopoulou M, Penesopoulou V, Trantalis G, Synetos A, Papanikolaou A, Aggeli C, Vavuranakis M, and Tousoulis D
- Subjects
- Aged, Aged, 80 and over, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis surgery, Female, Greece, Humans, Male, Outcome and Process Assessment, Health Care, Preoperative Care methods, Prosthesis Failure etiology, Severity of Illness Index, Aortic Valve diagnostic imaging, Aortic Valve pathology, Aortic Valve surgery, Aortic Valve Insufficiency diagnosis, Aortic Valve Insufficiency etiology, Aortic Valve Insufficiency prevention & control, Heart Valve Prosthesis adverse effects, Heart Valve Prosthesis standards, Multidetector Computed Tomography methods, Multidetector Computed Tomography statistics & numerical data, Postoperative Complications diagnosis, Postoperative Complications etiology, Postoperative Complications prevention & control, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement instrumentation, Transcatheter Aortic Valve Replacement methods
- Abstract
Background: In transcatheter aortic valve implantation (TAVI), prosthesis over-sizing prevents paravalvular leak (PVL). Strategies of over-sizing for self-expanding bioprostheses are not well established at present., Methods: Patients with aortic valve stenosis scheduled for TAVI underwent preprocedural multislice computed tomography. Based on the degree of over-sizing, a ROC curve was drawn to define the optimal value of valve sizing for reducing PVL after TAVI., Results: A total of 152 consecutive patients were included in the study (mean age, 79.95 ± 7.71 years; log EuroScore: 23.87 ± 8.93%). Based on the ROC curve, sizing of 14% was the optimal that would lead to less moderate/severe PVL (P<.01). Group 1 was defined as sizing <14% (n = 49 patients) and group 2 was defined as sizing ≥14% (n = 103 patients). During a follow-up period of 36 ± 14 months, a total of 9 patients died from group 1 vs 4 patients from group 2 (P<.01). Two of the patients who died had moderate/severe PVL and 11 had no/mild PVL (P=.27). From the population, a total of 49 patients (32%) were found to be in the "borderline" zone. Patients who received the smaller valve had lower mean left ventricular outflow tract diameter (P=.048), higher rate of calcium load (mild: 10 [32%] vs 13 [72%]; moderate: 16 [52%] vs 3 [17%]; severe: 5 [16%] vs 2 [11%]; P=.02) and lower mean of sinus of Valsalva diameter (P=.046) compared with patients who received the bigger valve., Conclusions: In patients undergoing TAVI, over-sizing the prosthesis at least 14% reduces PVL. In borderline cases, taking into consideration additional anatomical parameters may result in low rates of PVL.
- Published
- 2019
5. Pre-Dilatation Versus No Pre-Dilatation for Implantation of a Self-Expanding Valve in All Comers Undergoing TAVR: The DIRECT Trial.
- Author
-
Toutouzas K, Benetos G, Voudris V, Drakopoulou M, Stathogiannis K, Latsios G, Synetos A, Antonopoulos A, Kosmas E, Iakovou I, Katsimagklis G, Mastrokostopoulos A, Moraitis S, Zeniou V, Danenberg H, Vavuranakis M, and Tousoulis D
- Subjects
- Aged, Aged, 80 and over, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis mortality, Aortic Valve Stenosis physiopathology, Female, Greece, Hemodynamics, Humans, Israel, Male, Prospective Studies, Prosthesis Design, Recovery of Function, Risk Factors, Severity of Illness Index, Time Factors, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement mortality, Treatment Outcome, Aortic Valve surgery, Aortic Valve Stenosis surgery, Balloon Valvuloplasty adverse effects, Balloon Valvuloplasty mortality, Heart Valve Prosthesis, Transcatheter Aortic Valve Replacement instrumentation
- Abstract
Objectives: The aim of this study was to compare the implantation of a self-expanding valve with or without balloon aortic valvuloplasty (BAV) in an open-label, noninferiority, randomized trial., Background: There are no randomized studies comparing the implantation of a self-expanding valve with (pre-BAV) or without BAV., Methods: Consecutive patients with severe aortic stenosis were randomly assigned to undergo transcatheter aortic valve replacement with the use of self-expanding prostheses with (pre-BAV) or without (no-BAV) pre-dilatation. The primary endpoint was device success according to the Valve Academic Research Consortium 2 criteria. Secondary endpoints included periprocedural mortality and stroke, new permanent pacemaker implantation, vascular complications, and 1-year mortality. The trial was scheduled to show noninferiority (Δ = 15%) of the direct versus the pre-BAV approach., Results: A total of 171 patients were randomized at 4 centers. Of these, 86 underwent transcatheter aortic valve replacement with pre-dilatation and 85 without. Device success was noninferior in the no-BAV group compared with the pre-BAV group (65 of 85 [76.5%] for no-BAV vs. 64 of 86 [74.4%] for pre-BAV; mean difference 2.1%; 90% confidence interval: -8.9% to 13%). In the no-BAV group, 25 patients (29.4%) underwent post-balloon dilatation, and in the pre-BAV group, 13 patients (15.1%) underwent post-balloon dilatation (p = 0.03). Regarding major vascular complications and permanent pacemaker implantation, there was no difference between the 2 groups (log-rank p = 0.49, log-rank p = 0.54). In 1-month completed follow-up for all patients, there was 1 periprocedural stroke (0.5%), without any deaths., Conclusions: Direct, without balloon pre-dilatation, transcatheter aortic valve replacement with a self-expanding prosthesis system is noninferior to the pre-dilatation procedure. Lower post-dilatation rates were encountered in the group with pre-dilatation. (The Predilatation in Transcatheter Aortic Valve Implantation Trial [DIRECT]; NCT02448927)., (Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
6. Inhibition of Aortic Valve Calcification by Local Delivery of Zoledronic Acid-an Experimental Study.
- Author
-
Synetos A, Toutouzas K, Drakopoulou M, Koutagiar I, Benetos G, Kotronias R, Anousakis-Vlachochristou N, Latsios G, Karanasos A, Agrogiannis G, Metaxas M, Stathogiannis K, Papanikolaou A, Georgakopoulos A, Pianou N, Tsiamis E, Patsouris E, Papalois A, Cokkinos D, Anagnostopoulos C, and Tousoulis D
- Subjects
- Animals, Aortic Valve diagnostic imaging, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis pathology, Calcinosis diagnostic imaging, Calcinosis pathology, Disease Models, Animal, Echocardiography, Male, Positron Emission Tomography Computed Tomography, Rabbits, Time Factors, Angioplasty, Balloon, Coronary instrumentation, Aortic Valve pathology, Aortic Valve Stenosis drug therapy, Bone Density Conservation Agents administration & dosage, Calcinosis drug therapy, Cardiac Catheters, Drug Delivery Systems instrumentation, Zoledronic Acid administration & dosage
- Abstract
The aim of this study was to evaluate in an experimental model of aortic valve (AV) stenosis the effectiveness of zoledronate on the inhibition of calcification. Sixteen New Zealand rabbits were placed on vitamin D-enriched diet for 3 weeks. All animals underwent PET/CT at baseline and before euthanasia to assess calcification. Thereafter, the AVs of eight animals were treated with local delivery of 500 μg/l zoledronate. A placebo mixture was administered in the remaining eight animals. Standardized uptake values were corrected for blood pool activity, providing mean tissue to background ratios (TBRmean). In the zoledronate group, there was no progression of AV calcification (TBRmean 1.20 ± 0.12 vs 1.17 ± 0.78,p = 0.29), while AV calcification progressed in the placebo group (1.22 ± 0.15 vs 1.53 ± 0.23,p = 0.006). Ascending aorta (AA) calcification progressed in both zoledronate and placebo groups. Histology confirmed the results of the PET/CT. Inhibition of AV calcification by local delivery of zoledronate is feasible and effective.
- Published
- 2018
- Full Text
- View/download PDF
7. The requirement of extracorporeal circulation system for transluminal aortic valve replacement: Do we really need it in the catheterization laboratory?
- Author
-
Toutouzas K, Synetos A, Latsios G, Mastrokostopoulos A, Stathogiannis K, Drakopoulou M, Trantalis G, Tsiamis E, and Tousoulis D
- Subjects
- Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis physiopathology, Evidence-Based Medicine, Humans, Randomized Controlled Trials as Topic, Registries, Risk Assessment, Risk Factors, Transcatheter Aortic Valve Replacement methods, Treatment Outcome, Aortic Valve surgery, Aortic Valve Stenosis surgery, Conversion to Open Surgery adverse effects, Conversion to Open Surgery methods, Extracorporeal Circulation adverse effects, Extracorporeal Circulation methods, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Transcatheter aortic valve replacement (TAVR) is the mainstay for treating high-risk patients with aortic stenosis. As the TAVR procedures worldwide keep increasing, it is inevitable that more issues and complications will arise. Such a complication that merits attention is the conversion of TAVR into open-heart surgery and the necessity this complication creates to have an extracorporeal circulation system in the catheterization laboratory. This review contains an analysis of all major randomized trials and registries on the number and cause of TAVR procedures that ended up in open-heart surgery and presents data to challenge the prerequisite of extracorporeal circulation system in the cath laboratory. © 2015 Wiley Periodicals, Inc., (© 2015 Wiley Periodicals, Inc.)
- Published
- 2018
- Full Text
- View/download PDF
8. Multi-slice CT (MSCT) imaging in pretrans-catheter aortic valve implantation (TAVI) screening. How to perform and how to interpret.
- Author
-
Latsios G, Spyridopoulos TN, Toutouzas K, Synetos A, Trantalis G, Stathogiannis K, Penesopoulou V, Oikonomou G, Brountzos E, and Tousoulis D
- Subjects
- Aortic Valve surgery, Aortic Valve Stenosis surgery, Humans, Aortic Valve diagnostic imaging, Aortic Valve Stenosis diagnosis, Multidetector Computed Tomography methods, Transcatheter Aortic Valve Replacement
- Abstract
Aortic valve stenosis (AS) is the most common valvular heart disease among elderly. Trans-catheter aortic valve implantation (TAVI) has become an established and effective alternative therapeutical procedure for inoperable and high-risk patients with symptomatic AS. The procedural success is greatly dependent on a thorough pre-TAVI imaging screening. This requires a comprehensive and multi-modality approach, in which multi-slice computed tomography (MSCT) is the cornerstone in the selection of eligible patients, in choosing the appropriate prosthesis and size, and in mapping the safest access route for the intervention. From our experience of more than 400 TAVI procedures and many more MSCTs for screening purposes, we provide clinical and technical details on the use of MSCT pre-TAVI and brief review of the knowledge so far., (Copyright © 2017 Hellenic Society of Cardiology. Published by Elsevier B.V. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
9. TAVR and Thrombosis.
- Author
-
Trantalis G, Toutouzas K, Latsios G, Synetos A, Brili S, Logitsi D, Penesopoulou V, and Tousoulis D
- Subjects
- Aged, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis physiopathology, Female, Fibrinolytic Agents therapeutic use, Heart Valve Prosthesis, Humans, Severity of Illness Index, Thrombosis diagnostic imaging, Thrombosis drug therapy, Tomography, X-Ray Computed, Transcatheter Aortic Valve Replacement instrumentation, Treatment Outcome, Aortic Valve surgery, Aortic Valve Stenosis surgery, Prosthesis Failure, Thrombosis etiology, Transcatheter Aortic Valve Replacement adverse effects
- Published
- 2017
- Full Text
- View/download PDF
10. One-year outcomes after direct transcatheter aortic valve implantation with a self-expanding bioprosthesis. A two-center international experience.
- Author
-
Toutouzas K, Latsios G, Stathogiannis K, Drakopoulou M, Synetos A, Sanidas E, Mastrokostopoulos A, Trantalis G, Kaitozis O, Lazaros G, Yuecel S, Gerckens U, Grube E, and Tousoulis D
- Subjects
- Aged, Aged, 80 and over, Echocardiography methods, Female, Hemorrhage complications, Hemorrhage etiology, Humans, Male, Retrospective Studies, Treatment Outcome, Aortic Valve surgery, Aortic Valve Stenosis surgery, Balloon Valvuloplasty methods, Bioprosthesis, Cardiac Catheterization methods, Heart Valve Prosthesis Implantation methods, Transcatheter Aortic Valve Replacement methods
- Abstract
Background: Balloon aortic valvuloplasty (BAV) is considered to be an essential part of the transcatheter aortic valve implantation (TAVI) procedure and is being performed routinely. At present there is insufficient long-term data as to the benefits of routine BAV prior to TAVI., Aim: The aim of this study was to evaluate the safety of direct TAVI and the mortality rate at 1-year in patients undergoing TAVI with or without BAV with a self-expanding bioprosthesis., Methods: Between January 2008 and September 2013 consecutive patients undergoing TAVI with the Medtronic CoreValve in two experienced centers in Athens, Greece and in Siegburg, Germany were studied. All data were prospectively collected and retrospectively analyzed. Primary endpoint was mortality at 1 year. Procedural data and clinical data (bleeding, vascular complications and echocardiographic parameters) were analyzed., Results: A total of 210 patients undergoing TAVI were evaluated (non-direct=120 patients, direct=90 patients). All-cause mortality at 30 days and at 1 year was similar in both groups (4% in non-direct versus 2% in direct, p=0.6 and 15% in non-direct versus 11% in direct, p=0.5, respectively). Device success rate was similar in both groups (77% in non-direct versus 83% in direct, p=0.2). Major vascular complications were comparable for both groups (5% in non-direct versus 3% in direct, p=0.5). The direct group had less moderate/severe paravalvular leakage than the non-direct group after the device implantation (7% versus 33%, p<0.01)., Conclusions: Performing direct TAVI with the self-expanding bioprosthesis is safe and feasible showing similar mortality rates compared to patients undergoing non-direct TAVI at 30 days and at 1-year., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
11. Are All Valves for All Aortas?
- Author
-
Drakopoulou M, Toutouzas K, and Tousoulis D
- Subjects
- Humans, Aorta physiology, Aortic Valve surgery, Bioprosthesis, Models, Cardiovascular, Transcatheter Aortic Valve Replacement methods
- Published
- 2015
12. Aortic sclerosis and mitral annulus calcification: a window to vascular atherosclerosis?
- Author
-
Lazaros G, Toutouzas K, Drakopoulou M, Boudoulas H, Stefanadis C, and Rajamannan N
- Subjects
- Aged, Calcinosis pathology, Heart Valve Diseases epidemiology, Heart Valve Diseases pathology, Humans, Prevalence, Risk Factors, Sclerosis, Aortic Valve pathology, Atherosclerosis pathology, Mitral Valve pathology
- Abstract
Several similarities exist between atherosclerosis in the vasculature and chronic degenerative changes in valvular structures. It has been suggested that aortic valve sclerosis (AVS) and mitral annulus calcification (MAC) are manifestations of a generalized atherosclerosis, have similar pathogenesis, share common risk factors and are observed with higher prevalence in patients with different forms of atherosclerotic vascular disease. Moreover, recent studies have shown a close relation of MAC and AVS with adverse cardiovascular and cerebrovascular outcomes. However, many patients with AVS or MAC do not have coexisting peripheral vascular atherosclerosis and vice versa. Lipid-reducing therapy has been uniformly unsuccessful in slowing valvular calcification. Thus, whether valve calcifications are the result of a more generalized atherosclerosis, or reflect a primary degenerative process, progressing with advancing age, still remains. From a clinical point of view, it is of great importance to identify common links between valve calcification and vascular atherosclerosis with a view to assess whether the detection of AVS, MAC or both are indicative of subclinical atherosclerosis and predicts cardiovascular or cerebrovascular events. Thus, in this article, the authors review current evidence regarding the association between AVS and MAC with vascular atherosclerosis.
- Published
- 2013
- Full Text
- View/download PDF
13. Prediction models in transcatheter aortic valve implantation: solid data or prophecies of Pythia?
- Author
-
Toutouzas K and Stefanadis C
- Subjects
- Heart Valve Prosthesis, Humans, Models, Biological, Risk Assessment methods, Aortic Valve surgery, Aortic Valve Stenosis surgery, Cardiac Catheterization methods, Heart Valve Prosthesis Implantation methods
- Published
- 2013
- Full Text
- View/download PDF
14. The Athens TAVR Registry of newer generation transfemoral aortic valves: 30-day outcomes.
- Author
-
Spargias K, Toutouzas K, Chrissoheris M, Synetos A, Halapas A, Paizis I, Latsios G, Stathogiannis K, Papametzelopoulos S, Zanos S, Pavlides G, Zacharoulis A, Antoniades A, and Stefanadis C
- Subjects
- Aged, Aged, 80 and over, Aortic Valve diagnostic imaging, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis mortality, Cardiac Catheterization adverse effects, Cardiac Catheterization mortality, Echocardiography, Female, Greece, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation mortality, Humans, Male, Registries, Treatment Outcome, Aortic Valve surgery, Aortic Valve Stenosis surgery, Cardiac Catheterization methods, Femoral Artery surgery, Heart Valve Prosthesis Implantation methods
- Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) is a documented treatment for patients with symptomatic aortic stenosis who are at very high or prohibitive operative risk. We sought to investigate the outcomes of transfemoral procedures with the newer generation valves in four TAVR centres in Athens, Greece., Methods: The ATHENS TAVR Registry included all patients who underwent transfemoral implantation of the newer generation valves in 4 Athens TAVR centres (self-expanding valve 67 patients, balloon-expandable valve 59 patients). We present the procedural and echocardiographic data and the 30-day clinical outcomes according to valve type., Results: A total of 126 patients underwent 126 procedures (67 CoreValve, Medtronic; 59 SAPIEN XT, Edwards Lifesciences). The mean age and logistic EuroSCORE were 80 ± 8 years and 25 ± 13%. The procedural and device success rates were 100% and 98%, respectively. The 30-day mortality was 1% (n=1), the major vascular event rates 9% (similar for both valve types), and a new permanent pacemaker was implanted more often during the same hospitalisation after CoreValve (33% vs. 9%, p=0.001). The mean effective aortic valve area increased and the mean transvalvular pressure gradient declined post implantation (from 0.66 ± 0.15 cm(2) to 1.61 ± 0.43 cm(2), p<0.001; from 51 ± 14 mm Hg to 10 ± 3 mm Hg, p<0.001). The mean grade of aortic insufficiency increased after CoreValve (from 1.2 ± 0.6 to 1.5 ± 0.7, p=0.03) but remained stable after SAPIEN XT (1.0 ± 0.8 and 1.0 ± 0.6, p=0.88) implantation., Conclusions: TAVR outcomes with both the newer generation transfemoral valves in the ATHENS Registry were excellent. We observed a greater need for a new permanent pacemaker and a greater degree of aortic valve insufficiency after CoreValve implantation.
- Published
- 2013
15. Recent valves used for transluminal implantation in patients with aortic valve stenosis.
- Author
-
Toutouzas KP, Stathogiannis KE, Latsios GS, Synetos AG, and Stefanadis CI
- Subjects
- Humans, Aortic Valve surgery, Aortic Valve Stenosis surgery, Cardiac Catheterization methods, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation methods, Prosthesis Design methods
- Abstract
Aortic valve stenosis is becoming a burden to society due to the constantly aging population. After the onset of the first symptoms it usually follows an ominous route with high mortality levels even at two years without any medical intervention. The gold standard for treating aortic valve stenosis is surgical replacement; nonetheless, 30% of patients are left untreated due to increased risk of surgery. A less invasive method has been developed in the past decade, transcatheter aortic valve implantation (TAVI), which allows implantation of prosthesis in the native stenosed aortic valve position, using a catheter that enters the body in a transvascular way or through a minimal surgical cut down. In this review, we briefly discuss where the TAVI field begun, focus on the recent valves that are being used and finally look at what lies ahead. The review of the patents will assist in the understanding of how this field evolved, how it became established and what is to be expected in the future.
- Published
- 2012
- Full Text
- View/download PDF
16. "Bail out" procedures for malpositioning of aortic valve prosthesis (CoreValve).
- Author
-
Vavouranakis M, Vrachatis DA, Toutouzas KP, Chrysohoou C, and Stefanadis C
- Subjects
- Aged, Aged, 80 and over, Aortic Valve pathology, Female, Humans, Male, Registries, Aortic Valve surgery, Heart Valve Prosthesis adverse effects, Heart Valve Prosthesis Implantation instrumentation, Prosthesis Failure adverse effects
- Abstract
Two techniques for correcting malpositioning occurring during percutaneous aortic valve replacement (PAVR) with the CoreValve ReValving™ System are described in this article. The "Removing and Reinserting Technique" was used in 2 patients, in whom the prosthesis was positioned too high. The "Snare Technique" was used in 1 patient, in whom the prosthesis was implanted too low. In all patients the aortic valve prosthesis was successfully re-implanted., (Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2010
- Full Text
- View/download PDF
17. Emerging Transcatheter Therapies for Valvular Heart Disease: Focus on Mitral and Tricuspid Valve Procedures.
- Author
-
Ktenopoulos, Nikolaos, Katsaros, Odysseas, Apostolos, Anastasios, Drakopoulou, Maria, Tsigkas, Grigorios, Tsioufis, Constantinos, Davlouros, Periklis, Toutouzas, Konstantinos, and Karanasos, Antonios
- Subjects
HEART valve diseases ,TRICUSPID valve insufficiency ,MITRAL valve insufficiency ,AORTIC valve ,OLDER patients ,TRICUSPID valve ,MITRAL valve - Abstract
The emergence of percutaneous treatment options provides novel therapeutic alternatives for older and feeble patients who are at high risk for any surgical procedure. The purpose of our review was to offer an up-to-date analysis of the rapidly expanding field of percutaneous technologies for mitral, tricuspid, and pulmonary procedures. Edge-to-edge repair is an established treatment for secondary mitral regurgitation (MR), while transcatheter mitral valve replacement is a potential and expanding option for managing both secondary and primary MR. However, additional advancements are necessary to enhance the safety and feasibility of this procedure. Transcatheter tricuspid intervention is an emerging option that was conceived after the success of transcatheter procedures in aortic and mitral valves, and it is currently still in the early stages of advancement. This can be attributed, at least in part, to the previously overlooked effect of tricuspid regurgitation on patient outcomes. The development of edge-to-edge repair represents the forefront of innovations in transcatheter procedures. There is a scarcity of data about tricuspid annuloplasty and replacement, and further study is necessary. Transcatheter mitral, tricuspid, and pulmonary procedures show prospects for the future, while their role in clinical practice has not been definitively established. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
18. Transcatheter Aortic Valve Implantation With or Without Predilation: A Meta-Analysis
- Author
-
Conrotto, Federico, D'Ascenzo, Fabrizio, Franchin, Luca, Bruno, Francesco, Mamas, Mamas A, Toutouzas, Konstantinos, Cuisset, Thomas, Leclercq, Florence, Dumonteil, Nicolas, Latib, Azeem, Nombela-Franco, Luis, Schaefer, Andreas, Anderson, R David, Marruncheddu, Laura, Gallone, Guglielmo, De Filippo, Ovidio, La Torre, Michele, Rinaldi, Mauro, Omedè, Pierluigi, Salizzoni, Stefano, and De Ferrari, Gaetano Maria
- Subjects
Balloon Valvuloplasty ,Transcatheter Aortic Valve Replacement ,balloon aortic valvuloplasty ,Treatment Outcome ,Aortic Valve ,Heart Valve Prosthesis ,aortic stenosis ,Humans ,transcatheter aortic valve implantation ,Aortic Valve Stenosis - Abstract
To evaluate the impact of systematic predilation with balloon aortic valvuloplasty (BAV) on transcatheter aortic valve implantation (TAVI).We performed a systematic meta-analysis investigating patients undergoing TAVI with systematic BAV vs no BAV in RCT or in adjusted studies. Device success was the primary endpoint, while all-cause mortality, 30-day moderate/severe aortic regurgitation (AR), stroke, permanent pacemaker implantation (PPI) and acute kidney injury (AKI) were the secondary endpoints. Subanalysis according to design of the study (RCT and adjusted analysis) and to the type of valve (balloon-expandable [BE] vs self-expanding [SE]) were conducted. We obtained data from 15 studies, comprising 16,408 patients: 10,364 undergoing BAV prior to TAVI and 6,044 in which direct TAVI has been performed. At 30-day follow-up, BAV did not improve the rate of device success in the overall population (OR, 1.09; 95% CI, 0.90-1.31), both in SE (OR, 0.93; 95% CI, 0.60-1.45) and in BE (OR, 1.16; 95% CI, 0.88-1.52) valves. Between BAV and direct TAVI, no differences in secondary outcomes were observed neither in overall population nor according to valve type between BAV and direct TAVI strategies. All endpoints results were consistent between RCTs and adjusted studies except for postdilation rate that did not differ in observational studies (OR, 0.70; 95% CI, 0.47-1.04), while it was lower in BAV when only RCTs were included in the analysis (OR, 0.48; 95% CI, 0.24-0.97).Direct TAVI is feasible and safe compared to predilation approach with similar device success rates and clinical outcomes. Direct TAVI could represent a first-choice approach in contemporary TAVI procedures.
- Published
- 2022
19. In Vivo Aortic Valve Thermal Heterogeneity in Patients With Nonrheumatic Aortic Valve Stenosis: The First In Vivo Experience in Humans
- Author
-
Toutouzas, Konstantinos, Drakopoulou, Maria, Synetos, Andreas, Tsiamis, Eleftherios, Agrogiannis, George, Kavantzas, Nikolaos, Patsouris, Eustratios, Iliopoulos, Dimitris, Theodoropoulos, Stergios, Yacoub, Magdi, and Stefanadis, Christodoulos
- Subjects
- *
AORTIC stenosis , *CYTOKINES , *INFLAMMATION , *AORTIC valve insufficiency - Abstract
Objectives: We investigated in vivo in aortic valve stenosis (AVS) whether there is: 1) thermal heterogeneity within the valve leaflets; 2) temperature difference between the leaflets and the ascending aortic wall; and 3) a possible correlation between heat production, inflammation, and neoangiogenesis. Background: Histological studies have demonstrated a potential role of inflammation and neoangiogenesis in AVS. Methods: We examined 96 leaflets scheduled for aortic valve replacement. Twenty-five patients had AVS, and 7 had aortic valve insufficiency (AVI). Temperature measurements were performed right before hypothermic cardioplegia. Temperature difference (ΔT) was assigned as the mean temperature of each leaflet minus the temperature of the aortic wall. Histological, immunohistological analysis, and vascular endothelial growth factor (VEGF) immunoreactivity was performed. Results: Significant thermal heterogeneity was recorded within the leaflets of AVS, compared with AVI (1.52 ± 1.35°C vs. 0.13 ± 0.11°C, p < 0.01). In AVS ΔT was greater in all leaflets compared with the AVI group (p < 0.01). Leaflets of AVS had increased inflammatory cell infiltration, calcium deposit, and anti-VEGF expression compared with AVI (p < 0.01). Conclusions: Thermal heterogeneity is increased in AVS and correlates with inflammatory mononuclear cell infiltration, expression of pro-inflammatory cytokines and neoangiogenic factors. [Copyright &y& Elsevier]
- Published
- 2008
- Full Text
- View/download PDF
20. In Vivo Aortic Valve Thermal Heterogeneity in Patients With Nonrheumatic Aortic Valve Stenosis The First In Vivo Experience in Humans
- Author
-
Toutouzas, Konstantinos, Drakopoulou, Maria, Synetos, Andreas, Tsiamis, Eleftherios, Agrogiannis, George, Kavantzas, Nikolaos, Patsouris, Eustratios, Iliopoulos, Dimitris, Theodoropoulos, Stergios, Yacoub, Magdi, and Stefanadis, Christodoulos
- Subjects
cardiovascular system ,inflammation thermography ,aortic valve - Abstract
ObjectivesWe investigated in vivo in aortic valve stenosis (AVS) whether there is: 1) thermal heterogeneity within the valve leaflets; 2) temperature difference between the leaflets and the ascending aortic wall; and 3) a possible correlation between heat production, inflammation, and neoangiogenesis.BackgroundHistological studies have demonstrated a potential role of inflammation and neoangiogenesis in AVS.MethodsWe examined 96 leaflets scheduled for aortic valve replacement. Twenty-five patients had AVS, and 7 had aortic valve insufficiency (AVI). Temperature measurements were performed right before hypothermic cardioplegia. Temperature difference (ΔT) was assigned as the mean temperature of each leaflet minus the temperature of the aortic wall. Histological, immunohistological analysis, and vascular endothelial growth factor (VEGF) immunoreactivity was performed.ResultsSignificant thermal heterogeneity was recorded within the leaflets of AVS, compared with AVI (1.52 ± 1.35°C vs. 0.13 ± 0.11°C, p < 0.01). In AVS ΔT was greater in all leaflets compared with the AVI group (p < 0.01). Leaflets of AVS had increased inflammatory cell infiltration, calcium deposit, and anti-VEGF expression compared with AVI (p < 0.01).ConclusionsThermal heterogeneity is increased in AVS and correlates with inflammatory mononuclear cell infiltration, expression of pro-inflammatory cytokines and neoangiogenic factors.
- Full Text
- View/download PDF
21. TCT-686 Mixed aortic valve disease: Impact on outcome after transcatheter aortic valve implantation.
- Author
-
Stathogiannis, Konstantinos, Toutouzas, Konstantinos, Drakopoulou, Maria, Latsios, George, Synetos, Andreas, Xanthopoulou, Maria, Penesopoulou, Vasiliki, Trantalis, George, George Oikonomou, Maria Karmpalioti, Tsiamis, Eleftherios, and Tousoulis, Dimitrios
- Subjects
- *
AORTIC valve , *AORTIC valve insufficiency - Published
- 2018
- Full Text
- View/download PDF
22. IMPACT OF AORTIC VALVE CALCIFICATION IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE IMPLANTATION.
- Author
-
Stathogiannis, Konstantinos, Toutouzas, Konstantinos, Drakopoulou, Maria, Latsios, George, Synetos, Andreas, Xanthopoulou, Maria, Penesopoulou, Vasiliki, Oikonomou, George, Soulaidopoulos, Stergios, Trantalis, George, and Tousoulis, Dimitris
- Subjects
- *
HEART valve prosthesis implantation , *AORTIC valve - Published
- 2019
- Full Text
- View/download PDF
23. IMPACT ON LONG TERM MORTALITY OF PERSISTENT PULMONARY HYPERTENSION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION.
- Author
-
Drakopoulou, Maria I., Toutouzas, Konstantinos, Michelongona, Archontoula, Stathogiannis, Konstantinos, Latsios, George, Synetos, Andreas, Brili, Styliani, Kaitozis, Odysseas, Tsiamis, Eleftherios, and Tousoulis, Dimitris
- Subjects
- *
AORTIC valve , *PULMONARY hypertension , *MORTALITY , *TERMS & phrases - Published
- 2017
- Full Text
- View/download PDF
24. THE EFFECT OF MIXED AORTIC VALVE DISEASE IN CLINICAL OUTCOMES AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT.
- Author
-
Stathogiannis, Konstantinos, Toutouzas, Konstantinos, Drakopoulou, Maria, Michelongona, Archontoula, Synetos, Andreas, Latsios, George, Trantalis, George, Kaitozis, Odysseas, Aggeli, Constantina, Tsiamis, Eleftherios, and Tousoulis, Dimitris
- Subjects
- *
AORTIC valve diseases , *AORTIC valve - Published
- 2017
- Full Text
- View/download PDF
25. ZOLEDRONIC ACID INHIBITS AORTIC VALVE CALCIFICATION: A PET/CT STUDY.
- Author
-
Synetos, Andreas, Toutouzas, Konstantinos, Drakopoulou, Maria, Stathogiannis, Konstantinos, Benetos, Georgios, Koutagiar, Iosif, Agrogiannis, George, Patsouris, Eftratios, Anagnostopoulos, Constantinos, Cokkinos, Dennis, and Tousoutis, Dimitris
- Subjects
- *
AORTIC valve , *ZOLEDRONIC acid , *CALCIFICATION - Published
- 2017
- Full Text
- View/download PDF
26. INHIBITION OF AORTIC VALVE CALCIFICATION IN AN EXPERIMENTAL MODEL OF AORTIC VALVE STENOSIS.
- Author
-
Synetos, Andreas, Toutouzas, Konstantinos, Drakopoulou, Maria, Kaitozis, Odysseas, Latsios, George, Papalois, Apostolos, Benetos, Georgios, Tsiamis, Eleftherios, Agrogiannis, George, Papanikolaou, Angelos, Patsouris, Eustratios, and Tousoulis, Dimitris
- Subjects
- *
AORTIC valve , *CARDIAC calcification , *AORTIC stenosis , *HEALTH outcome assessment , *MEDICAL research , *PHYSIOLOGY - Published
- 2016
- Full Text
- View/download PDF
27. Case reports of bail-out maneuvers for implantation of a second core valve prosthesis during the same TAVI procedure.
- Author
-
Latsios, George, Toutouzas, Konstantinos, Tousoulis, Dimitris, Michelongona, Archontoula, Synetos, Andreas, Stathogiannis, Kostantinos, Mastrokostopoulos, Antonios, and Stefanadis, Christodoulos
- Published
- 2013
- Full Text
- View/download PDF
28. Prosthetic aortic valve removal from the abdominal aorta after successful “valve-through” TAVI
- Author
-
Latsios, George, Toutouzas, Konstantinos, Tousoulis, Dimitris, Stathogiannis, Konstantinos, Tentolouris, Costas, Synetos, Andreas, Filis, Konstantinos, and Stefanadis, Christodoulos
- Published
- 2013
- Full Text
- View/download PDF
29. EXTRACELLULAR GLYCOPROTEINS AND ADVANCED GLYCATION END PRODUCTS ASSOCIATE WITH CALCIFICATION DEVELOPMENT IN HUMAN AND RABBIT CALCIFIED AORTIC VALVES.
- Author
-
Anousakis-Vlachochristou, Nikolaos, Athanasiadou, Dimitra, Mavroidis, Manolis, Miliou, Antigoni, Makridakis, Manousos, Kaklamanis, Loukas, Adamopoulos, Stamatis, Vlahou, Antonia, Cokkinos, Dennis V., Carneiro, Karina, and Toutouzas, Konstantinos P.
- Subjects
- *
AORTIC valve , *GLYCOPROTEINS , *CALCIFICATION , *RABBITS , *HUMAN beings - Published
- 2022
- Full Text
- View/download PDF
30. DRUG RELATED PLATELET INHIBITION: IS THERE A ROLE FOR REDUCTION OF CEREBRAL MICROEMBOLI IN TRANSCATHETER AORTIC VALVE IMPLANTATION PATIENTS?
- Author
-
Kalantzis, Charalampos, Vavuranakis, Michael, Voudris, Vassilis, Kosmas, Elias, Toutouzas, Konstantinos, Iakovou, Ioannis, Latsios, George, Kalogeras, Konstantinos, Bei, Evangelia, Moldovan, Carmen Maria, Kariori, Maria, Katsarou, Ourania, Kolokathis, Angelos-Michail, Vrachatis, Dimitrios, Katsianos, Efstratios, Siasos, Gerasimos, Tousoulis, Dimitris, and Vavuranakis, Manolis
- Subjects
- *
HEART valve prosthesis implantation , *PRASUGREL , *AORTIC valve - Published
- 2019
- Full Text
- View/download PDF
31. Abstract 16778: Effectiveness of Platelet Inhibition on Reducing High-Intensity Transient Signals to Cerebral Circulation During Tavi.
- Author
-
Kalantzis, Charalampos, Vavouranakis, Michael, Kariori, Maria, Voudris, Vasilios, Toutouzas, Konstantinos, Latsios, Georgios, Kosmas, Elias, Kalogeras, Konstantinos, Moldovan, Carmen-Maria, Bei, Evangelia, Kolokathis, Angel-Michail, Vrachatis, Dimitrios, Siasos, Gerasimos, Tousoulis, Dimitrios, and Vavuranakis, Manolis
- Subjects
- *
CEREBRAL circulation , *BLOOD platelet aggregation , *CEREBRAL arteries , *AORTIC valve , *BIOPROSTHESIS , *ASPIRIN - Abstract
Introduction: Despite the established dual antiplatelet treatment, embolic cerebrovascular events remain a major concern peri-operatively and following Transcatheter Aortic valve Implantation (TAVI). High Residual Platelet Reactivity (RPR) may contribute to platelet aggregation, propagating thrombosis on implanted materials. Therefore, we evaluated whether high RPR may predispose to an increased number of cerebrovascular emboli during the procedure. Methods: Consecutive patients who underwent transfemoral TAVI with Evolut™ R bioprosthesis were prospectively studied. Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor was administered to all patients 24 hours prior to the procedure at loading dose. The number of detected High Intensity Transient Signals (HITS) was assessed using Rimed Digi-Lite™ Transcranial Doppler on both cerebral arteries during the following phases of the procedure; Phase 0: 30 minutes prior to procedure initiation, Phase I: between access site puncture and introduction of the delivery system, Phase II: during the implantation of the bioprosthesis, until the removal of the delivery system. Platelet inhibition was measured prior to the procedure and expressed in PRU, using the VerifyNow® assay and defined as high RPR if PRU≥208. Results: Out of 28 total patients (81±7 years, 18 males (64%)), 12 patients (81±9 years, 8 males (66.7%)) had PRU ≥208 (high RPR group), while 16 patients (81±5 years, 10 males (62.5%)) had PRU<208 (low RPR group). All device implantations were performed without balloon pre-dilation. Among the high RPR group, a statistically significant higher number of HITS was recorded compared to the low RPR group (707±149 vs. 530±152, p: 0.004). This was mainly driven by the number of HITS detected during Phase II, compared to the rest procedure stages (247±84 vs. 165±28, p:0.004). A statistical significant correlation of PRU with the total number of HITS was found (r2: 0.25, p: 0.006). Conclusions: High RPR after dual antiplatelet loading resulted in larger burden of embolic HITS during TAVI. This may has implications for future strategies for cerebral embolic protection. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
32. Abstract 16066: Cerebrovascular Microemboli in Tavi Patients the Role of Drug Related Platelet Inhibition.
- Author
-
Vavouranakis, Michael, Kalantzis, Charalampos, Kariori, Maria, Voudris, Vasilios, Toutouzas, Konstantinos, Kosmas, Elias, Kalogeras, Konstantinos, Moldovan, Carmen-Maria, Latsios, Georgios, Kolokathis, Angel-Michail, Bei, Evangelia, Vrachatis, Dimitrios, Katsarou, Rania, Siasos, Gerasimos, Tousoulis, Dimitrios, and Vavuranakis, Manolis
- Subjects
- *
PRASUGREL , *CEREBRAL circulation , *CEREBRAL arteries , *AORTIC valve , *BIOPROSTHESIS , *RESPONSE inhibition - Abstract
Introduction: Whether non-thienopyridines (ticagrelor) may protect patients more efficiently from microembolic events during Transcatheter Aortic Valve Implantation (TAVI) has not been investigated. We assessed the hypothesis that ticagrelor+ASA will reduce the number of microemboli towards the cerebral circulation during TAVI comparing to the combination of clopidogrel+ASA. Methods: Consecutive patients from PTOLEMAIOS study who underwent TAVI with Evolut™ R bioprosthesis, were randomized into two groups. Group 1 patients treated with clopidogrel plus ASA, Group 2 patients treated with ticagrelor plus ASA. All patients received ASA 80mg od 7 days prior to the TAVI procedure and for 90 days afterwards. Patients randomized in Group 2 received ticagrelor 90mg bid one day prior to the procedure and for 90 days afterwards, while those randomized in Group 1 received a loading dose of 300 mg one day prior to the TAVI, followed by 75mg od for 90 days. The number of high intensity transient signals (HITS) was assessed with Rimed Digi-Lite™ Transcranial Doppler on both cerebral arteries peri-operatively during the following phases; Phase 0: 30 minutes prior to procedure initiation, Phase I: between access site puncture and introduction of the delivery system, Phase II: during the implantation of the bioprosthesis, until the removal of the delivery system. Patients were evaluated by neurologist before TAVI and on discharge day. Safety was evaluated by VARC-2 criteria. Results: Twenty eight patients were evaluated (81±7 years, 18 males (64%)) and 16969 HITS were recorded. Group 1 had higher number of total (737±133 vs. 475±71, p<0.001) as well as Phase I HITS (413±107 vs. 212±78, p<0.001). All implantations were performed without predilation. One cerebrovascular event was recorded in Group 1 and one patient randomized to Ticagrelor developed major bleeding due to conversion to femoral surgical cut-down. The average number of received blood units, was higher in Ticagrelor compared to Clopidogrel group (Group 1: 0.7±0.8 vs. Group 2: 1.4±2.8, p: 0.886), without however, reaching statistical significant. Conclusions: Ticagrelor+ASA decreased the number of HITS during TAVI. However, the long term clinical impact of this study needs to be further evaluated. [ABSTRACT FROM AUTHOR]
- Published
- 2018
33. TCT-609 Choosing Between Transcatheter, Surgical, and Medical Management in Cancer Patients With Severe Aortic Stenosis.
- Author
-
Balanescu, Dinu, Donisan, Teodora, Schechter, Michael, Dayah, Tariq, Sudasena, Daryl, Kar, Biswajit, Gregoric, Igor, Giza, Dana, Stone, James, Stone, Danielle, Boone, David, Lopez-Mattei, Juan, Kim, Peter, Yusuf, Syed, Cilingiroglu, Mehmet, Toutouzas, Konstantinos, Boccalandro, Fernando, Smalling, Richard, Marmagkiolis, Konstantinos, and Iliescu, Cezar
- Subjects
- *
CANCER patients , *AORTIC valve - Published
- 2018
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.