Sabine Bleiziffer

• Head of Structural Heart at Herz- und Diabeteszentrum Nordrhein-Westfalen

Background Heavy calcifications in severe aortic stenosis (AS) pose a major challenge in patients undergoing transcatheter aortic valve replacement (TAVR). Only a few studies have addressed the performance of different transcatheter heart valves (THV) in this subgroup of patients. Objectives We aimed to investigate the outcomes of the self-expandi...

Background The mortality risk attributable to moderate aortic stenosis (AS) remains incompletely characterized and has historically been underestimated. We aim to evaluate the association between moderate AS and all‐cause death, comparing it with no/mild AS (in a general referral population and in patients with heart failure with reduced ejection f...

Background Permanent pacemaker implantation (PMI) is associated with increased morbidity after transcatheter aortic valve replacement (TAVR). Cardiac resynchronization-therapy (CRT) is recommended for patients if left ventricular ejection fraction (LVEF) is ≤ 40% and ventricular pacing is expected in favor to sole right ventricular (RV) pacing. Mea...

Background: Among low-risk patients with severe, symptomatic aortic stenosis who are eligible for both transcatheter aortic-valve implantation (TAVI) and surgical aortic-valve replacement (SAVR), data are lacking on the appropriate treatment strategy in routine clinical practice. Methods: In this randomized noninferiority trial conducted at 38 s...

Background: Patients with severe aortic stenosis and a small aortic annulus are at risk for impaired valvular hemodynamic performance and associated adverse cardiovascular clinical outcomes after transcatheter aortic-valve replacement (TAVR). Methods: We randomly assigned patients with symptomatic severe aortic stenosis and an aortic-valve annul...

Background In patients not suitable for transfemoral transcatheter aortic valve implantation (TAVI), several access strategies can be chosen. Aim To evaluate the use and patient outcomes of transaxillary (TAx), transapical (TA), and transaortic (TAo) as alternative access for TAVI in Germany; to further evaluate surgical cutdown vs. percutaneous T...

Background: Surgical mitral valve repair is the gold standard treatment of severe primary mitral valve regurgitation (MR). In the light of rapidly evolving percutaneous technologies, current surgical outcome data is essential to support heart team-based decision making. Methods: This retrospective, high-volume, single-center study analyzed in 17...

Background and aims Prosthetic valve endocarditis (PVE) is the prognostically most unfavourable complication after aortic valve replacement. This study aims to contribute to a better understanding of the different pathological and therapeutical aspects between PVE following surgical (SAVR) and transcatheter aortic valve replacement (TAVI). Methods...

Background In more than 90% transcatheter aortic valve implantation is performed via transfemoral access. Alternative access routes are necessary for patients with unfavourable femoral arteries. Case summary We report of a 68-year-old female with symptomatic severe aortic stenosis who in whom surgical aortic valve replacement was prohibited due to...

Background Transcatheter aortic valve implantation (TAVI) has developed to the therapy of choice for patients with symptomatic severe aortic stenosis who are inoperable or at high or intermediate operative risk for surgical aortic valve replacement. However, the optimal anticoagulant therapy post-TAVI still remains a matter of debate and individual...

Valvular heart disease (VHD) is one of the most frequent causes of heart failure (HF) and is associated with poor prognosis, particularly among patients with conservative management. The development and improvement of catheter-based VHD interventions have broadened the indications for transcatheter valve interventions from inoperable/high-risk pati...

Introduction: The management of patients with severe aortic stenosis (AS) may differ according to patient age. The aim of this analysis was to describe patterns of aortic valve replacement (AVR) use in European countries stratified by age. Methods: Procedure volume data for AVR, including surgical aortic valve replacement (sAVR) and transcathete...

Background A steep rise in the use of transcatheter aortic valve implantation (TAVI) for the management of symptomatic severe aortic stenosis occurred. Minimalist TAVI procedures and streamlined patient pathways within experienced Heart Valve Centres are designed to overcome the challenges of ever-increasing procedural volume. Aims The 2022 Europe...

Objectives: Multidisciplinary approach is well established in various disciplines, with evidence highlighting improved patient outcomes. The objective of this survey was to determine the real world practice of heart teams across Europe. Methods: The survey was drafted after a consensus opinion from the authors. The survey was sent to cardiac sur...

Background: Aortic valve (AV) repair is an evolving surgical strategy in the treatment of non-elderly adults with aortic regurgitation. We aimed to determine the 1-year outcome following AV repair vs. surgical aortic valve replacement (sAVR) using real-world data from the German Aortic Valve Registry. Methods: A total of 8.076 aortic regurgitati...

Background: Patients with severe aortic regurgitation (AR) are often not considered for surgery because of increased surgical risk. Because of unique anatomical characteristics among patients with AR, interventional treatment options are limited, and implantation results are inconsistent compared with those among patients with aortic stenosis. Ob...

Background Many patients in need for transcatheter aortic valve implantation (TAVI) present with an aortic annulus size larger than recommended by the manufacturer’s instructions for use (IFU). Aims To investigate procedural and short-term safety and efficacy of TAVI in patients with extra-large annuli (ELA). Methods 30-day clinical outcome and v...

Background Various second-generation transcatheter heart valve (THV) prostheses with high clinical efficacy and safety are available, but there is limited large-scale data available comparing their hemodynamic performance and clinical implications. Objective To compare the hemodynamic performance and short-term clinical outcome of four second-gene...

Objective After transcatheter aortic valve implantation (TAVI), the optimal regimen of anticoagulant therapy in patients with an additional indication for oral anticoagulation remains a matter of debate. This study investigates the efficacy of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in patients after TAVI in a real-wo...

Background Up to 30% of patients with the left ventricular assist device (LVAD) develop moderate to severe aortic regurgitation (AR) within the first year. Surgical aortic valve replacement (SAVR) is the treatment of choice in patients with native AR. However, the high perioperative risk in patients with LVAD might prohibit surgery and choice of th...

Background: Transcatheter mitral valve replacement (TMVR) using dedicated devices is an alternative therapy for high-risk patients with symptomatic mitral regurgitation (MR). Aims: This study aimed to assess the 2-year outcomes and predictors of mortality in patients undergoing TMVR from the multicentre CHOICE-MI Registry. Methods: The CHOICE-...

Background New-generation self-expanding transcatheter aortic heart valves (THV) were designed to overcome technical constraints of their preceding generations. We sought to compare the efficacy and safety of the self-expanding ACURATE neo2 (Neo2) versus Evolut PRO (PRO) devices. Methods Seven hundred nine patients undergoing transfemoral transcat...

Background: Reducing rates of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) is important for achieving the best procedural outcomes. The cusp overlap technique (COT) implements procedural steps including an overlap angulation of the right and left coronary cusp to mitigate this complication. Aims: We...

Background The majority of medical students in Germany are female but contrarily the vast majority of leading positions in cardiac surgery are held by men. Despite its current relevancy, little is known about the status quo and the career challenges experienced by female cardiac surgeons (FCS).Objective This study analyzed the current situation of...

Background Identification of high-risk patients and individualized decision support based on objective criteria for rapid discharge after transcatheter aortic valve implantation (TAVI) are key requirements in the context of contemporary TAVI treatment. This study aimed to predict 30-day mortality following TAVI based on machine learning (ML) using...

Background: Isolated tricuspid valve surgery has been associated with early mortality rates of up to 10%. With rapidly emerging interventional catheter-based options, the question arises of whether current technical and perioperative protocols in cardiac surgery might translate into lower than previously expected mortality rates, especially when l...

Background Several supra-annular self-expanding transcatheter systems are commercially available for transcatheter aortic valve implantation (TAVI). Comparative data in large scale multicenter studies are scant. Methods This study included a total of 5175 patients with severe aortic stenosis undergoing TAVI with the ACURATE neo (n=1095), Evolut R...

Background and aims: Currently, it is unclear whether transcatheter aortic valve implantation (TAVI) without predilation (direct TAVI; d-TAVI) or with preimplantation balloon valvuloplasty (b-TAVI) provides similar clinical safety and efficacy. Therefore, we analyzed patients undergoing d-TAVI or b-TAVI for severe aortic stenosis (AS) with either...

Background Due to its close anatomical proximity to the annular plane of the tricuspid valve (TV), the right coronary artery (RCA) is at risk of injury and distortion during surgical and interventional repair. Recently, reversible, non-flow limiting, purse-string like deformations of the RCA following percutaneous TV annuloplasty have been describe...

Introduction Prosthetic valve endocarditis (PVE) is the most unfavourable complication after any aortic valve replacement. Purpose The aim of this study was to analyse the impact of antibiotic-only and additional surgical therapy in patients with TAVI-PVE and to compare it with the results of patients with PVE after surgical aortic valve replaceme...

Objectives: We aimed to develop and validate an effective prediction model for 1-year mortality risk in elective transfemoral transcatheter aortic valve replacement (TAVR), ie, the TAVR-Risk (TARI) model. Background: TAVR is the primary treatment for patients with symptomatic severe aortic valve stenosis; however, risk assessment tools for longe...

Background According to American and recent European guidelines, both transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) may be used to treat severe aortic stenosis in a subgroup of patients with intermediate surgical risk, in spite of slight differences in recommended age limits (ACC/AHA: 65–80 years and ES...

Background Coronary artery disease (CAD) in female patients undergoing a Transcatheter Aortic Valve Implantation (TAVI) is accompanied with a worse outcome compared to those without CAD. Nevertheless, it is still unclear whether a complete revascularization and outcome are achieved similarly in women treated with an interventional (PCI plus TAVI) o...

Background: No detailed data on left bundle branch block (LBBB) and permanent pacemaker implantation (PPI) exist from randomised clinical trials comparing the ACURATE neo and CoreValve Evolut devices. Aims: Our aim was to assess the incidence and impact of new LBBB and PPI with self-expanding prostheses from a powered randomised comparison. Met...

Objective We compared TAVI vs. SAVR in patients with moderate-to-severe chronic kidney disease (eGFR 15–60 ml/min/1.73 m ² ) for whom both procedures could possibly be considered (age ≤ 80 years, STS-score 4–8). Background According to both ACC/AHA and ESC/EACTS recent guidelines, aortic stenosis may be treated with either transcatheter (TAVI) or...

Importance: In patients with severe aortic valve stenosis at intermediate surgical risk, transcatheter aortic valve replacement (TAVR) with a self-expanding supra-annular valve was noninferior to surgery for all-cause mortality or disabling stroke at 2 years. Comparisons of longer-term clinical and hemodynamic outcomes in these patients are limite...

Background Patients with severe aortic stenosis (AS) frequently presented mitral regurgitation (MR), which may interfere with the standard echocardiographic measurements of mean pressure gradient (MPG), flow velocity, and aortic valve area (AVA). Aims Herein we investigated the prevalence and severity of MR in patients with severe AS and its role...

This article summarizes the results of AV repair surgery in a large prospective multicenter GARY registry

OBJECTIVES Aortic valve (AV) repair is an evolving surgical strategy in the treatment of young patients with aortic regurgitation (AR) and/or aortic root aneurysm. We aimed to determine the clinical outcome following AV repair/AV sparing root surgery using real-world data from the German Aortic Valve Registry (GARY). METHODS A total of 2327 patien...

Background: Treatment of severely calcified aortic valve stenosis is associated with a higher rate of paravalvular leakage (PVL) and permanent pacemaker implantation (PPI). We hypothesized that the self-expanding transcatheter heart valve (THV) prostheses Evolut Pro (EPro) is comparable to the balloon-expandable Sapien 3 (S3) regarding hemodynamic...

Objective To assess temporal trends of patient baseline characteristics, risk profile and outcome of transcatheter aortic valve implantation (TAVI) between 2013 and 2020. Background Guideline recommendations and increasing confidence in TAVI therapy may have changed the selection of TAVI patients. Methods Baseline risk profile and VARC-2 outcome...

Bioprosthetic valve dysfunction (BVD) and bioprosthetic valve failure (BVF) may be caused by structural or nonstructural valve dysfunction. Both surgical and transcatheter bioprosthetic valves have limited durability because of structural valve deterioration. The main objective of this summary of experts participating in a virtual workshop was to p...

The ESC/EACTS guidelines for the management of valvular heart disease, as published by the European Society of Cardiology and European Association for Cardio-Thoracic Surgery, underwent renewal in 2021. The current guidelines focus on early surgical treatment in patients with asymptomatic valvular heart disease, in particular aortic stenosis, aorti...

The ESC/EACTS guidelines for the management of valvular heart disease, as published by the European Society of Cardiology and European Association for Cardio-Thoracic Surgery, underwent renewal in 2021. The current guidelines focus on early surgical treatment in patients with asymptomatic valvular heart disease, in particular aortic stenosis, aorti...

Objectives This study aimed to compare hemodynamic characteristics of different self-expanding (SE) and balloon-expandable (BE) transcatheter heart valves (THV) in relation to native aortic annulus anatomy. Background A patient centered THV selection becomes increasingly important as indications for transcatheter aortic valve replacement (TAVR) ar...

Objective The aim of this study was to analyze the outcome of patients between 50 and 69 years of age undergoing biological or mechanical aortic valve replacement. Methods Data was collected from the German Aortic Valve Registry (GARY). Data was analyzed regarding baseline characteristics and outcome parameters such as 5-year survival, stroke and...

Background: The Academic Research Consortium - High Bleeding Risk (ARC-HBR) initiative defined conditions associated with percutaneous coronary intervention (PCI)-related bleeding. Aims: We sought to further explore these HBR conditions in the setting of transcatheter aortic valve replacement (TAVR). Methods: Patients from the SCOPE 2 trial we...

The course of COVID-19 patients may be complicated by thromboembolic events. We report on a 48-year-old female COVID-19 patient who underwent surgical removal of a large intracardiac thrombus. As per our centre protocol, critically ill COVID-19 patients are anticoagulated by the direct thrombin inhibitor Argatroban with close monitoring of anti-IIa...

Patient-prosthesis mismatch (PPM) remains one out of many factors to be considered during decision-making for the treatment of aortic valve pathologies. The idea of adequate sizing of a prosthetic heart valve was established by Rahimtoola already in 1978. In this article, the author described the phenomenon that the orifice area of a prosthetic hea...

Objectives: We aimed to describe stroke and transient ischemic attacks (TIAs) after transcatheter aortic valve replacement (TAVR) and to identify associated risk factors. Background: Stroke/TIA after TAVR is a major complication. Methods: A total of 1919 concomitant patients underwent TAVR in a single center from 2007 to 2017. Pre-, intra-, an...

Background Direct comparisons of latest-generation balloon-expandable versus self-expanding transcatheter heart valves (THV) are scarce. To compare outcomes after transcatheter aortic valve replacement (TAVR) with SAPIEN 3 Ultra (Ultra) versus Evolut R or Pro (Evolut) THVs. Methods 1612 consecutive patients undergoing TAVR with either Ultra (n = 6...

Aims: Transcatheter mitral valve implantation (TMVI) represents a novel treatment option for patients with mitral regurgitation (MR) unsuitable for established therapies. The CHOICE-MI registry aimed to investigate outcomes of patients undergoing screening for TMVI. Methods and results: From 05/2014 to 03/2021, patients with MR considered subopt...

Aims: Transcatheter mitral valve implantation (TMVI) is a new treatment option for patients with symptomatic mitral valve (MV) disease. Real-world data have not yet been reported. This study aimed to assess procedural and 30-day outcomes of TMVI in a real-world patient cohort. Method and results: All consecutive patients undergoing implantation...

Objectives Using a novel glycoprotein IIb/IIIa receptor radiotracer 18F-GP1, we investigated whether positron emission tomography (PET)-computed tomography (CT) could detect thrombus formation on bioprosthetic aortic valves. Background Bioprosthetic valve thrombosis may have implications for valve function and durability. Methods Ex vivo experime...

Background: Right ventricular (RV) dysfunction has been linked to worse outcomes in patients undergoing TAVI. Assessment of RV function is challenging due to its complex morphology. RV longitudinal strain (LS) assessed by speckle-tracking echocardiography (STE) is a novel measure that may overcome most of the limitations of conventional echocardio...

Patients presenting with severe aortic stenosis and large aortic annuli are challenging to treat because of the size limitations of available transcatheter heart valves. In this study, we aimed to determine clinical and hemodynamic outcomes in patients presenting with large aortic annuli who underwent transcatheter aortic valve implantation (TAVI)....

Coronary artery bypass grafting (CABG) is the recommended type of revascularization procedure in patients with left main or three-vessel disease and is considered an alternative when percutaneous coronary intervention is not feasible. We evaluated registry data to obtain long-term outcome data. All patients ≤45 years in whom CABG was performed betw...

TCT 2021

Background Patients with isolated aortic valve stenosis (AS) at intermediate and even low-risk benefit from an interventional treatment with TAVI as compared to surgical aortic valve replacement. Whether patients with concomitant coronary artery disease have a better outcome with an interventional (PCI plus TAVI) or surgical (CABG plus SAVR) treatm...

Background Given the recent option for treatment using TAVI irrespective of surgical risk, general surgical risk scores have become less relevant, while TAVI-specific scores require refinement. Additionally, post-TAVI risk models are lacking; however, such risk models can support decision between post-TAVI treatment approaches, such as early discha...

Background/Introduction Bioprosthetic valve thrombosis (BPVT) is an important clinical entity eventually following both bioprosthetic surgical and transcatheter aortic valve replacement. Although dynamic contrast-enhanced 4D-MDCT has improved the diagnosis of BPVT, more sensitive and pathology-specific non-invasive imaging tools are lacking. Recent...

Background: The SMall Annuli Randomized To Evolut or SAPIEN (SMART) Trial was designed to compare the performance of the two most widely available commercial transcatheter aortic valve replacement (TAVR) devices in patients with symptomatic severe native aortic stenosis with a small aortic valve annulus undergoing transfemoral TAVR. Patients with...

Objectives The Evolut R FORWARD study confirmed safety and effectivenesss of the Evolut R THV in routine clinical practice out to 1 year. Herein, we report the final 3-year clinical follow up of the FORWARD study. Background Transcatheter aortic valve replacement (TAVR) is a proven alternative to surgery in elderly patients with symptomatic severe...

OBJECTIVES To determine the 5-year outcome in patients treated by isolated transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (sAVR)—a prospective observational cohort study. METHODS A total of 18 010 patients were included (n = 8942 TAVI and n = 9068 sAVR) in the German Aortic Valve Registry (GARY) who were treate...

Background Permanent pacemaker implantation (PPI) remains one of the main drawbacks of transcatheter aortic valve replacement (TAVR), but scarce data exist on PPI after valve-in-valve (ViV) TAVR, particularly with the use of newer-generation transcatheter heart valves (THVs). Objectives The goal of this study was to determine the incidence, factor...

We performed “Papillary muscle heads focalization” for three patients with severe functional mitral regurgitation with severe leaflet tethering (coaptation distance ≥1 cm and/or posterior leaflet angle ≥45 degrees). All separated papillary muscle heads were sutured together and both the anterolateral and posteromedial papillary muscles were reconst...

Objectives: The aim of this study was to compare outcomes of transcatheter and surgical aortic valve implantation in chronic dialysis patients with aortic valve stenosis (AS). Background: Chronic dialysis patients undergoing heart valve surgery are at higher risk for morbidity and mortality. Whether interventional techniques can reduce this risk...

Purpose The Sentinel Cerebral Protection System (Sentinel‐CPS) is increasingly used in transcatheter aortic valve replacement (TAVR). However, the impact of inserting the Sentinel‐CPS inside the brain‐supplying arteries on cerebral perfusion and oxygenation is unknown. Methods Twenty patients undergoing transfemoral TAVR with (n = 10) and without...

Background Since the introduction of transcatheter aortic valve implantation (TAVI) for the treatment of aortic valve lesions, there has been an immense evolution of the indications, implantation techniques and the types of prostheses available.Objective The aim of this article is to characterize the currently available and approved TAVI prostheses...

OBJECTIVES Chronic kidney disease (CKD) is a key risk factor in patients undergoing transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). We analysed the impact of estimated glomerular filtration rate (eGFR) and CKD stages on their mid-term survival. METHODS Data from 29 893 patients enrolled in the German Aor...

Objectives This study sought to compare patient characteristics, procedural outcomes, and valve hemodynamics of surgical aortic valve replacement (SAVR) with current-generation rapid-deployment valves (RDVs) versus transcatheter aortic valve replacement (TAVR) with current-generation transcatheter heart valves (THVs). Background The patient popula...

Background Chronic kidney disease (CKD) is a key risk factor in patients undergoing transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). Purpose We analyzed the impact of eGFR and different stages of chronic kidney disease (CKD), on short- and mid-term survival in patients undergoing TAVI or SAVR. Methods Da...

Background: A greater number of patients with bicuspid aortic valves (BAV) may be identified and treated as indications for transcatheter aortic valve implantation (TAVI) are expected to expand to younger patients. We evaluated the contemporary frequency and management of symptomatic patients with stenotic BAV in a multicenter European registry....