Publications by authors named "Martin Swaans"
Objectives: Screening for obstructive coronary artery disease (CAD) with coronary computed tomography angiography (CCTA) could prevent unnecessary invasive coronary angiography (ICA) procedures during work-up for trans-catheter aortic valve implantation (TAVI). CT-derived fractional flow reserve (CT-FFR) improves CCTA accuracy in chest pain patients. However, its reliability in the TAVI population is unknown.
View Article and Find Full Text PDFDespite the challenges associated with periprocedural imaging, transcatheter tricuspid valve interventions have shown important impact on outcomes. A comprehensive understanding of the anatomy of the right heart and surrounding structures is crucial. One way to optimize these interventions is by identifying the optimal fluoroscopic viewing angles along the S-curve of the tricuspid valve.
View Article and Find Full Text PDF: Paravalvular leak and permanent pacemaker implantation remain relevant issues after transcatheter aortic valve implantation (TAVI). Novel device development as well as adequate preprocedural device selection can contribute to optimal outcomes. : Computed tomography-based patient-specific computer anatomical analysis and simulation were used in addition to standard preprocedural preparation in three of the first Evolut FX cases in our center.
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- Patients with a heart condition called atrial fibrillation (AF) who have strokes can still be at very high risk of having more strokes, even when taking medication to prevent them.
- Left atrial appendage occlusion (LAAO) is a special procedure aimed at helping these patients avoid future strokes.
- A study compared two groups – one that had LAAO and one that only continued their usual medication – and found that there was still a risk of strokes in both groups over a two-year period.
Computed tomography-derived fractional flow reserve (CT-FFR) enhances the specificity of coronary computed tomography angiography (CCTA) to that of the most specific non-invasive imaging techniques, while maintaining high sensitivity in stable coronary artery disease (CAD). As gatekeeper for invasive coronary angiography (ICA), use of CT-FFR results in a significant reduction of negative ICA procedures and associated costs and complications, without increasing cardiovascular events. It is expected that CT-FFR algorithms will continue to improve, regarding accuracy and generalisability, and that introduction of new features will allow further treatment guidance and reduced invasive diagnostic testing.
View Article and Find Full Text PDFEchocardiographic and Clinical Outcomes of Concomitant Secondary Chordal Cutting to Surgical Myectomy in Hypertrophic Obstructive Cardiomyopathy: A Systematic Review and Meta-analysis.
Thorac Cardiovasc Surg
November 2024
In patients who underwent surgical myectomy for hypertrophic obstructive cardiomyopathy (HOCM), additional mitral valve repair may offer additional benefits in terms of further reducing left ventricular outflow tract (LVOT) gradients, systolic anterior motion (SAM), and mitral regurgitation (MR). We performed a systematic review of the literature to evaluate the evidence of surgical myectomy with additional secondary chordal cutting in patients with HOCM. A systematic literature search in MEDLINE and EMBASE was performed until April 2024.
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- * In a trial with 858 patients, results showed no significant difference in major complications between those who continued anticoagulation (16.5% experienced primary outcomes) and those who interrupted it (14.8%).
- * Continuation of anticoagulation led to higher incidences of major bleeding (31.1% vs. 21.3%), suggesting that interrupting anticoagulation is safer in this patient population undergoing TAVI.
Article Synopsis
- Left ventricular (LV) function is linked to the elasticity of the ascending aorta (AA), with stiffness in the AA potentially leading to reduced LV performance in patients with heart failure with preserved ejection fraction (HFpEF).
- A study using the Living Left Heart Human Model simulated different scenarios, including models with elastic and stiff AAs, as well as a stiff AA with a free LV apex.
- Results indicate that allowing the LV apex to move freely could counteract the negative effects of a stiff AA, suggesting a potential therapeutic approach to improve LV function in HFpEF patients.
Article Synopsis
- During systole, the left ventricle shortens, moving the aortic root and stretching the ascending aorta, which impacts heart function.
- A study revealed that stiffening of the ascending aorta increases stress in the left ventricle and leads to decreased muscle strain, particularly in the septal area.
- Overall, aortic stiffening negatively affects left ventricular function, but increasing myofiber contractility could help recover some lost stroke volume despite persistent reductions in specific muscle strains.
Article Synopsis
- Left atrial appendage occlusion (LAAO) is a treatment for patients with atrial fibrillation (AF) who can't use oral anticoagulation therapy (OAT) and those who face recurring thrombotic events despite OAT.
- This study compared the efficacy of LAAO in patients experiencing thrombotic events while on OAT against those who had contraindications for OAT, using data from a large registry and propensity score matching for accuracy.
- Results showed no significant difference in ischemic stroke rates between the two groups, but the LAAO patients on OAT had a higher thromboembolic risk but lower bleeding risk, suggesting LAAO is a viable option for these patients.
Background: Mitral transcatheter edge-to-edge repair (M-TEER) is a guideline-recommended treatment option for patients with severe symptomatic mitral regurgitation (MR). Outcomes with the PASCAL system in a post-market setting have not been established.
Objectives: The authors report 30-day and 1-year outcomes from the MiCLASP (Transcatheter Repair of Mitral Regurgitation with Edwards PASCAL Transcatheter Valve Repair System) European post-market clinical follow-up study.
Impact of the COVID-19 Pandemic on Global TAVR Activity: The COVID-TAVI Study.
JACC Cardiovasc Interv
February 2024
Article Synopsis
- The COVID-19 pandemic led to significant treatment delays for patients needing transcatheter aortic valve replacement (TAVR), with a marked decrease in procedure volumes during the first two waves of the pandemic.
- The study analyzed TAVR case data from 130 centers in 61 countries, finding a 15% drop in cases during the first wave and 7% in the second, particularly affecting regions like Africa, Central-South America, and Asia.
- Factors such as hospital type (private vs public), urban vs rural location, low procedure volumes, a country's socioeconomic status, and stringent public health measures contributed to these reductions, highlighting the need for improved public health policies for future health crises.
Background: Transcatheter aortic valve implantation (TAVI) is an established treatment option for patients with severe aortic valve stenosis, but is still associated with relatively high rates of pacemaker implantation and paravalvular regurgitation. Routine preoperative computed tomography (CT) combined with patient-specific computer modelling can predict the interaction between the TAVI device and the patient's unique anatomy, allowing physicians to assess the risk for paravalvular regurgitation and conduction disorders in advance to the procedure. The aim of this trial is to assess potential improvement in the procedural outcome of TAVI by applying CT-based patient-specific computer simulations in patients with suitable anatomy for TAVI.
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- The study investigates a new technique called inward displacement (InD) to assess regional left ventricular (LV) function by measuring the movement of the LV endocardial border in healthy adults across 17 LV segments.
- A total of 120 healthy subjects underwent cardiac MRI to quantify InD, with the results revealing higher displacement percentages in the basal and mid-cavity segments compared to the apical segments.
- The findings establish normal reference ranges for InD, which can aid in using this technique as a valuable tool for screening and evaluating treatments in patients with heart failure with reduced ejection fraction (HFrEF).
This study evaluates the early and long-term clinical and echocardiographic outcome of edge-to-edge (E2E) mitral valve repair (MVr) concomitant to septal myectomy (SM) in patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM). A retrospective single-center analysis was performed of patients who underwent isolated SM or SM with E2E MVr from 2011 to 2022. Exclusion criteria were primary mitral valve (MV) disease or concomitant valve surgery.
View Article and Find Full Text PDFBackground: Preprocedural computed tomography planning improves procedural safety and efficacy of transcatheter aortic valve implantation (TAVI). However, contemporary imaging modalities do not account for device-host interactions.
Aims: This study evaluates the value of preprocedural computer simulation with FEops HEARTguide on overall device success in patients with challenging anatomies undergoing TAVI with a contemporary self-expanding supra-annular transcatheter heart valve.
Article Synopsis
- There has been a significant increase in the use of transcatheter aortic valve implantation (TAVI) to treat symptomatic severe aortic stenosis, prompting the need for streamlined procedures in specialized Heart Valve Centres.
- The 2022 European TAVI Pathway Survey collected input from 147 TAVI centres in 26 countries, revealing details about their procedural practices and patient management.
- Findings indicate that while minimalist TAVI methods are widely adopted, many patients still experience longer hospital stays, suggesting room for improvement in discharge processes.
Periprocedural continuation versus interruption of oral anticoagulant drugs during transcatheter aortic valve implantation: rationale and design of the POPular PAUSE TAVI trial.
EuroIntervention
November 2023
About one-third of patients undergoing transcatheter aortic valve implantation (TAVI) use oral anticoagulants (OAC), mainly due to atrial fibrillation. General guidelines advise interrupting OAC in patients with a high risk of bleeding undergoing interventions. However, preliminary observational data suggest that the continuation of OAC during TAVI is safe and may reduce the risk of periprocedural thromboembolic events.
View Article and Find Full Text PDFBackground: Left atrial appendage occlusion (LAAO) procedures are widely guided by standard transesophageal echocardiography (TEE) probes, requiring general anesthesia in most patients. The use of miniaturized TEE probes allows for LAAO guidance under local anesthesia and offers an attractive imaging alternative to standard TEE probes.
Objectives: The aim of this study was to assess the safety and efficacy of miniaturized TEE probes for procedural guidance of LAAO.