Author + information
- Received April 17, 2018
- Revision received May 15, 2018
- Accepted May 22, 2018
- Published online September 3, 2018.
- Flavien Vincent, MDa,b,c,∗,
- Antoine Rauch, MD, PhDb,c,d,∗,
- Hugues Spillemaeker, MDa,
- André Vincentelli, MD. PhDb,c,e,
- Camille Paris, MDb,c,d,
- Mickael Rosa, PhDb,c,
- Annabelle Dupont, PharmD, PhDb,c,d,
- Cedric Delhaye, MDa,
- Basile Verdier, MDa,
- Emmanuel Robin, MD, PhDb,c,f,
- Peter J. Lenting, PhDg,
- Sophie Susen, MD,PhDb,c,d,∗∗∗ ( and )
- Eric Van Belle, MD, PhDa,b,c,∗∗ ()
- aCHU Lille, Institut Coeur-Poumon, Cardiology, Lille, France
- bUniversity Lille, Inserm U1011 - EGID, Lille, France
- cInstitut Pasteur de Lille, Lille, France
- dCHU Lille, Hematology Transfusion, Lille, France
- eCHU Lille, Cardiac surgery, Lille, France
- fCHU Lille, Anesthesia and Intensive Care, Lille, France
- gInserm, UMR_S 1176, University Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- ↵∗∗Address for correspondence:
Prof. Sophie Susen, Department of Hematology and Transfusion, Institut Cœur-Poumon, Centre Hospitalier, Universitaire de Lille, 59037 Lille Cedex, France.
- ↵∗Prof. Eric Van Belle, Department of Cardiology, Centre Hospitalier Universitaire de Lille, Institut Coeur-Poumon, 3ème Étage, Aile Est, Boulevard du Professeur Jules Leclercq, 59037 Lille Cedex, France.
Significant paravalvular regurgitation (PVR) remains a relatively frequent (4% to 9%) and deleterious complication of transcatheter aortic valve replacement (TAVR), even with the latest generation of bioprosthesis. Although mini-invasive TAVR without general anesthesia or transesophageal echocardiography (TEE) is progressively becoming the predominant approach, identification and grading of PVR in the catheterization laboratory remain an important and challenging clinical issue. The authors discuss how a recently reported blood biomarker reflecting the von Willebrand factor activity, that is, the closure time with adenosine diphosphate, can be successfully applied during the TAVR procedure to detect and monitor PVR in real time, with an excellent negative predictive value. This point-of-care testing performed directly in the catheterization laboratory may improve the diagnosis of PVR and rationalize the decision of whether or not to perform corrective measures. They further discuss how such a test could be a substitute for the multimodal approach combining TEE, hemodynamics, and cine-angiography, and help to secure the transition to the mini-invasive approach and facilitate the expanding indications of less invasive procedures to lower-risk patients without jeopardizing procedural and clinical outcomes.
- paravalvular regurgitation
- point-of-care testing
- transcatheter aortic valve replacement
- transesophageal echocardiogram
- von Willebrand factor
↵∗ Drs. Vincent, Rauch, Susen, and Van Belle contributed equally to this work.
This work was supported by Lille-II University and by the National Research Agency (Programme d’Investissement d’Avenir) with the Hospital-University Research in Health program (Recherche Hospitalo-Universitaire, WILL-ASSIST HEART ANR-17-RHUS-0011). Dr. Vincent has received a research grant from the Fédération Française de Cardiologie. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 17, 2018.
- Revision received May 15, 2018.
- Accepted May 22, 2018.