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Butt JH, Yafasova A, Thein D, Begun X, Havers-Borgersen E, Bække PS, Smerup MH, De Backer O, Køber L, Fosbøl EL. Burden of hospitalization during the first year following transcatheter and surgical aortic valve replacement. Am Heart J 2024; 276:12-21. [PMID: 39084484 DOI: 10.1016/j.ahj.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/25/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Hospitalizations are a major burden for both patients and society but are potentially preventable. We examined the one-year hospitalization burden in patients undergoing transcatheter aortic valve replacement (TAVR) and compared hospitalization rates and patterns with those undergoing isolated surgical aortic valve replacement (SAVR). METHODS Using Danish nationwide registries, we identified patients who underwent first-time TAVR and isolated SAVR (2008-2019), respectively. Subsequent hospitalizations were classified as cardiovascular or noncardiovascular according to discharge diagnosis codes. RESULTS Patients undergoing TAVR (N = 4,921) were older and had more comorbidities than those undergoing SAVR (N = 5,220). There were 5,725 and 4,426 hospitalizations within the first year after discharge in the TAVR and SAVR group, respectively. During the one-year follow-up period post-TAVR, 46.6% were not admitted, 25.4% were admitted once, 12.6% twice, and 15.4% 3 times or more. The corresponding proportions in patients undergoing SAVR were 55.3%, 25.1%, 10.0%, and 9.5%, respectively. Among patients with ≥1 hospitalization following TAVR, 50.3% had a total length of all hospital stays between 1 and 7days, 19.0% 8-14days, 18.0% 15-30days, 9.9% 31-60days, and 2.8% ≥61days. The corresponding proportions for patients undergoing SAVR were 58.6%, 17.2%, 13.1%, 7.4%, and 3.7%, respectively. Compared with patients undergoing SAVR, those undergoing TAVR had a lower early (day0-30: HR 0.89 [95% CI, 0.80-0.98]), but a higher late hospitalization rate (day 31-365: 1.46 [1.32-1.60]). CONCLUSIONS The 1-year hospitalization burden following TAVR is substantial. Compared with patients undergoing isolated SAVR, those undergoing TAVR had a lower early, but a higher late hospitalization rate - a difference that likely reflects unmeasured differences in the patient cohorts.
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Affiliation(s)
- Jawad H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
| | - Adelina Yafasova
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David Thein
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Xenia Begun
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eva Havers-Borgersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Pernille S Bække
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten H Smerup
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Ellfors E, Dismorr M, Rück A, Settergren M, Sartipy U, Glaser N. Predicted prosthesis-patient mismatch and long-term clinical outcomes after transcatheter aortic valve replacement: A SWEDEHEART study. Am Heart J 2024; 276:70-82. [PMID: 39032585 DOI: 10.1016/j.ahj.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/07/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND The impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) is uncertain. This study was performed to investigate the risk of all-cause mortality, heart failure hospitalization, and aortic valve reintervention in patients with and without predicted PPM after TAVR. METHODS This nationwide, population-based cohort study included all patients who underwent transfemoral primary TAVR in Sweden from 2008 to 2022 in the SWEDEHEART register. PPM was defined according to published effective orifice areas for each valve model and size. The patients were divided into those with and without PPM. Additional baseline characteristics and outcome data were obtained from other national health data registers. Regression standardization was used to adjust for intergroup differences. RESULTS Of 8485 patients, 7879 (93%) had no PPM and 606 (7%) had PPM. The crude cumulative incidence of all-cause mortality at 1, 5, and 10 years in patients with versus without PPM was 7% versus 9%, 40% versus 44%, and 80% versus 85%, respectively. After regression standardization, there was no between-group difference in long-term mortality, and the absolute difference at 10 years was 1.5% (95% confidence interval, -2.9%-6.0%). The mean follow-up was 3.0 years (maximum, 14 years). There was no difference in the risk of heart failure hospitalization or aortic valve reintervention. CONCLUSIONS The risk of all-cause mortality, heart failure hospitalization, or aortic valve reintervention was not higher in patients with than without predicted PPM following TAVR. Furthermore, PPM was present in only 7% of patients, and severe PPM was almost nonexistent.
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Affiliation(s)
- Emma Ellfors
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Michael Dismorr
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Rück
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Settergren
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Natalie Glaser
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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3
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Ahmad D, Sá MP, Makani A, Kliner D, Toma C, Christensen E, Wang Y, Thoma F, West D, Serna-Gallegos D, Sultan I. Transcatheter Aortic Valve Replacement in Patients With Small Aortic Annuli: A Propensity-Matched Analysis of Gender-Based Outcomes. Am J Cardiol 2024; 227:75-82. [PMID: 39059705 DOI: 10.1016/j.amjcard.2024.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 07/20/2024] [Indexed: 07/28/2024]
Abstract
Patients with small aortic annuli (SAAs) are predominantly women. We sought to compare gender-based and propensity-matched outcomes of index transcatheter aortic valve replacement (TAVR) in patients with SAAs. In this retrospective institutional analysis (2012 to 2023), primary stratification was by gender. SAA was defined as an aortic valve annulus diameter <23 mm and the 30-day and 1-year outcomes were compared between the groups. A total of 3,911 patients underwent TAVR. Of those, 661 patients had an SAA, of whom 23.8% were men and 76.2% were women. Propensity matching (1:1) identified 152 pairs. The mean age was 81 years. History of surgical or percutaneous coronary intervention was more prevalent in men (72.4% vs 48%, p <0.001). Men had a higher incidence of postoperative pacemaker implantation (8.6% vs 3.3%, p = 0.05), whereas only women had iliofemoral dissections (4.6% vs 0%, p = 0.007). The rates of moderate (23.0% vs 25.7%) and severe (2.6% vs 0.7%) prosthesis-patient mismatch was not statistically significantly different between the groups (p = 0.364). The 30-day mortality was 0%, whereas the 1-year mortality was 4.3%, with no difference between the groups. An increase in preoperative creatinine was associated with higher risk of death (hazard ratio 1.206, 95% confidence interval 1.025 to 1.418, p = 0.02), whereas gender was not. Kaplan-Meier survival estimates (Log rank, p = 0.768) and cumulative incidence of stroke readmission (p = 0.842) were similar in both groups. In conclusion, the outcomes of TAVR in SAAs do not differ by gender, with safety and efficacy evident in men and women.
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Affiliation(s)
- Danial Ahmad
- Department of Cardiothoracic Surgery; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michel Pompeu Sá
- Department of Cardiothoracic Surgery; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amber Makani
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Interventional Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dustin Kliner
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Interventional Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Catalin Toma
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Interventional Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth Christensen
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Yisi Wang
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd Thoma
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David West
- Department of Cardiothoracic Surgery; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Derek Serna-Gallegos
- Department of Cardiothoracic Surgery; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Hengstenberg C, Unverdorben M, Möllmann H, Van Mieghem NM, Thiele H, Nordbeck P, Rassaf T, Moreno R, Mehran R, Jin J, Lang I, Veltkamp R, Dangas GD. Risk Factors of Ischemic Stroke in Patients With Atrial Fibrillation After Transcatheter Aortic Valve Implantation from the Randomized ENVISAGE-TAVI AF Trial. Am J Cardiol 2024; 227:98-104. [PMID: 39032588 DOI: 10.1016/j.amjcard.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/08/2024] [Accepted: 07/14/2024] [Indexed: 07/23/2024]
Abstract
In patients with prevalent or incident atrial fibrillation (AF) after successful transcatheter aortic valve implantation (TAVI) enrolled in the EdoxabaN Versus standard of care and theIr effectS on clinical outcomes in pAtients havinG undergonE Transcatheter Aortic Valve Implantation - in Atrial Fibrillation (ENVISAGE-TAVI AF) trial, the incidence of ischemic stroke (IS) and any stroke was numerically less in the edoxaban group than in the vitamin K antagonist (VKA) group. The present study aimed to identify risk factors associated with IS in an on-treatment subanalysis in patients from ENVISAGE-TAVI AF who received ≥1 dose of edoxaban or VKA. Baseline patient characteristics were compared in patients with and those without IS. Numerical variables were compared using a 1-way analysis of variance; categorical variables were compared using Fisher's exact test. Stepwise Cox regression determined patient characteristics associated with the first IS event. Of 1,377 patients, 41 (3.0%) experienced an IS, and 1,336 (97.0%) did not; baseline demographics and clinical characteristics were well balanced between groups. Most ISs occurred within 180 days of TAVI for edoxaban (57.9%) and VKA (68.2%). The rate of IS was 2.0/100 person-years for edoxaban versus 2.7/100 person-years for VKA. Independently associated with IS were history of systemic embolic events (hazard ratio 2.96, 95% confidence interval 1.26 to 7.00, p = 0.01) and pre-TAVI use of VKAs (hazard ratio 2.17, 95% confidence interval 1.12 to 4.20, p = 0.02). In conclusion, although the overall incidence of IS was small for patients with AF on edoxaban or VKA after successful TAVI, patients with a history of systemic embolic events or pre-TAVI use of VKAs may be at greater risk of IS after TAVI.
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Affiliation(s)
- Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University, Vienna, Austria.
| | | | - Helge Möllmann
- Department of Internal Medicine, St. Johannes Hospital, Dortmund, Germany
| | - Nicolas M Van Mieghem
- Department of Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Tienush Rassaf
- Clinic for Cardiology and Vascular Medicine, Westgerman Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Raul Moreno
- Department of Cardiology, University Hospital La Paz, Madrid, Spain
| | - Roxana Mehran
- Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York
| | - James Jin
- Daiichi Sankyo, Inc., Basking Ridge, New Jersey
| | - Irene Lang
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University, Vienna, Austria
| | - Roland Veltkamp
- Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany; Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany; Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - George D Dangas
- Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York; School of Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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5
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Le Ruz R, Leroux L, Lhermusier T, Cuisset T, Van Belle E, Dibie A, Palermo V, Champagnac D, Obadia JF, Teiger E, Ohlman P, Tchétché D, Le Breton H, Saint-Etienne C, Piriou PG, Plessis J, Beurtheret S, Du Chayla F, Leclère M, Lefèvre T, Collet JP, Eltchaninoff H, Gilard M, Iung B, Manigold T, Letocart V, Of Stop-As And France-Tavi Investigators OB. Outcomes of transcatheter aortic valve implantation for native aortic valve regurgitation. EUROINTERVENTION 2024; 20:e1076-e1085. [PMID: 39219361 PMCID: PMC11363660 DOI: 10.4244/eij-d-24-00339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/25/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Large datasets of transcatheter aortic valve implantation (TAVI) for pure aortic valve regurgitation (PAVR) are scarce. AIMS We aimed to report procedural safety and long-term clinical events (CE) in a contemporary cohort of PAVR patients treated with new-generation devices (NGD). METHODS Patients with grade III/IV PAVR enrolled in the FRANCE-TAVI Registry were selected. The primary safety endpoint was technical success (TS) according to Valve Academic Research Consortium 3 criteria. The co-primary endpoint was defined as a composite of mortality, heart failure hospitalisation and valve reintervention at last follow-up. RESULTS From 2015 to 2021, 227 individuals (64.3% males, median age 81.0 [interquartile range {IQR} 73.5-85.0] years, with EuroSCORE II 6.0% [IQR 4.0-10.9]) from 41 centres underwent TAVI with NGD, using either self-expanding (55.1%) or balloon-expandable valves (44.9%; p=0.50). TS was 85.5%, with a non-significant trend towards increased TS in high-volume activity centres. A second valve implantation (SVI) was needed in 8.8% of patients, independent of valve type (p=0.82). Device size was ≥29 mm in 73.0% of patients, post-procedure grade ≥III residual aortic regurgitation was rare (1.2%), and the permanent pacemaker implantation (PPI) rate was 36.0%. At 30 days, the incidences of mortality and reintervention were 8.4% and 3.5%, respectively. The co-primary endpoint reached 41.6% (IQR 34.4-49.6) at 1 year, increased up to 61.8% (IQR 52.4-71.2) at 4 years, and was independently predicted by TS, with a hazard ratio of 0.45 (95% confidence interval: 0.27-0.76); p=0.003. CONCLUSIONS TAVI with NGD in PAVR patients is efficient and reasonably safe. Preventing the need for an SVI embodies the major technical challenge. Larger implanted valves may have limited this complication, outweighing the increased risk of PPI. Despite successful TAVI, PAVR patients experience frequent CE at long-term follow-up.
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Affiliation(s)
- Robin Le Ruz
- Interventional Cardiology Department, Nantes Université, CHU Nantes, L'institut du thorax, Nantes, France
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du thorax, Nantes, France
| | - Lionel Leroux
- Department of Cardiology and Cardiovascular Surgery, Hôpital Cardiologique de Haut-Lévêque, Pessac, France
| | | | - Thomas Cuisset
- Centre for Cardiovascular and Nutrition Research, Aix Marseille Université, Marseille, France
| | - Eric Van Belle
- University of Lille, INSERM, Centre Hospitalier Universitaire Lille, Institut Pasteur de Lille, Lille, France
| | - Alain Dibie
- Institut Mutualiste Montsouris, Paris, France
| | - Vincenzo Palermo
- Hôpital Marie-Lannelongue (groupe hospitalier Paris Saint-Joseph), Le Plessis-Robinson, France
| | | | - Jean-François Obadia
- Clinical Investigation Center & Heart Failure Department, Hôpital Cardiovasculaire Louis Pradel, INSERM 1407, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | - Emmanuel Teiger
- Department of Cardiology, APHP, Henri-Mondor University Hospital, Créteil, France
| | - Patrick Ohlman
- Department of Cardiology, University Hospital of Strasbourg, Strasbourg, France
| | | | - Hervé Le Breton
- Department of Cardiology, University of Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | | | - Pierre-Guillaume Piriou
- Interventional Cardiology Department, Nantes Université, CHU Nantes, L'institut du thorax, Nantes, France
| | - Julien Plessis
- Interventional Cardiology Department, Nantes Université, CHU Nantes, L'institut du thorax, Nantes, France
| | | | | | | | - Thierry Lefèvre
- Institut Cardiovasculaire Paris Sud, Hôpital privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Jean-Philippe Collet
- ACTION Study Group, Sorbonne Université, UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Hélène Eltchaninoff
- Department of Cardiology, University Rouen Normandie, INSERM U1096, CHU Rouen, Rouen, France
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, Brest, France
| | - Bernard Iung
- Department of Cardiology, Université Paris-Cité, Paris, France and Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, Paris, France
| | - Thibaut Manigold
- Interventional Cardiology Department, Nantes Université, CHU Nantes, L'institut du thorax, Nantes, France
| | - Vincent Letocart
- Interventional Cardiology Department, Nantes Université, CHU Nantes, L'institut du thorax, Nantes, France
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Krittanawong C, Wang Y, Qadeer YK, Chen B, Wang Z, Al-Azzam F, Alam M, Sharma S, Jneid H. Trends in Transcatheter Aortic Valve Implantation Utilization, Outcomes, and Healthcare Resource Use in Patients With Liver Cirrhosis: A Decade of Insights (2011-2020). Crit Pathw Cardiol 2024; 23:166-173. [PMID: 38598544 DOI: 10.1097/hpc.0000000000000361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
It is well known that individuals with liver cirrhosis are considered at high risk for cardiac surgery, with an increased risk for morbidity and mortality as the liver disease progresses. In the last decade, there have been considerable advances in transcatheter aortic valve implantation (TAVI) as an alternative to surgical aortic valve replacement (SAVR) in individuals deemed to be at high risk for surgery. However, research surrounding TAVI in the setting of liver cirrhosis has not been as widely studied. In this national population-based cohort study, we evaluated the trends of mortality, complications, and healthcare utilization in liver cirrhotic patients undergoing TAVI, as well as analyzed the basic demographics of these individuals. We found that from 2011 to 2020, the amount of TAVI procedures conducted in cirrhotic patients was increasing annually, while mortality, procedural complications, and healthcare utilization trends in these cirrhotic patients undergoing TAVI decreased. Overall, TAVI does seem to be reasonable management for aortic stenosis patients with liver cirrhosis who need aortic valve replacement.
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Affiliation(s)
- Chayakrit Krittanawong
- From the Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY
| | - Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, MA
| | | | - Bing Chen
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Fu'ad Al-Azzam
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mahboob Alam
- The Texas Heart Institute, Baylor College of Medicine, Houston, TX
| | - Samin Sharma
- Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, New York, NY
| | - Hani Jneid
- John Sealy Distinguished Centennial Chair in Cardiology, Chief, Division of Cardiology, University of Texas Medical Branch, Houston, TX
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7
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Aurigemma C, Busco M, Bianchini F, Bianchini E, Di Brango C, Marchetta M, Bruno P, Nesta M, Romagnoli E, Burzotta F, Trani C. Clinical impact of multiple resheathing during transcatheter aortic valve implantation with Evolut self-expanding valves. Int J Cardiol 2024; 410:132218. [PMID: 38815673 DOI: 10.1016/j.ijcard.2024.132218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 05/02/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The possibility to resheath some transcatheter heart valves (THV) facilitates the optimization of self-expandable devices implantation. However, resheating manoeuvres (expecially when repeated) increase the interaction between the transcatheter prosthesis and the patient's tissues potentially causing side-effects. AIMS To assess the clinical outcomes of resheathing at midterm follow-up with a focus on the safety of multiple resheathing. METHODS This retrospective observational study included all consecutive patients who underwent TAVI with a self-expandable supra-annular THV between December 2018 and December 2022. Primary endpoint was a composite of cardiovascular (CV) mortality, neurological events, non-fatal acute myocardial infarction and CV rehospitalizations. All clinical endpoints were assessed according to VARC-3 criteria. RESULTS 469 TAVI procedures with self-expandable supra-annular THV were included in the study. The attempt to resheath and the resheath manoeuvres number was prospectively recorded into an electronic database. Resheating was attempted in 253 (53.9%) cases; 1, 2 and ≥ 3 resheathing were performed in respectively 122 (26.0%), 63 (13.4%) and 68 (14.5%) procedures. At a median follow-up of 640 days (interquartile range 340-1033 days), the incidence of the primary endpoint did not differ between 0 vs. ≥1 (22.7 vs. 26.1%, LogRank p = 0.584) and < 3 vs. ≥3 resheathing groups (24.2 vs. 26.5% LogRank p = 0.963). Furthermore, no significant differences in the primary endpoint were observed between 0, 1-2 and ≥ 3 resheathing (p = 0.84). CONCLUSIONS Our study found that resheathing of self-expandable THVs during TAVI did not result in worse clinical outcomes compared with no resheathing at mid-term follow-up. These results are independent from the number of resheathing, underling the safety of multiple resheathing in terms of peri-procedural and mid-term outcome. CONDENSED ABSTRACT In this retrospective observational study of 469 patients undergoing transcatheter aortic valve implantation (TAVI) for symptomatic severe aortic stenosis with self-expanding valves, we investigated the influence of resheathing on mid-term clinical outcomes. Specifically, we focused on the safety of multiple resheathing procedures. Our findings revealed no significant impact of resheathing on medium-term outcomes. The primary endpoint, a composite of cardiovascular mortality, neurological events, non-fatal acute myocardial infarction, and cardiovascular rehospitalizations, did not show statistically significant differences between no resheathing, single resheathing and multiple resheathing groups. Our study suggests that resheathing, even when performed multiple times, does not appear to significantly affect clinical outcomes at mid-term follow-up.
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Affiliation(s)
- Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Busco
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Bianchini
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emiliano Bianchini
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Di Brango
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michele Marchetta
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marialisa Nesta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Carlo Trani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
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8
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Rivera FB, Cha SW, Redula SC, Liston MBO, Ong EP, Bantayan NRB, Kaur G, Volgman AS, Mamas MA. Sex differences in transcatheter aortic valve replacement outcomes among patients with bicuspid aortic stenosis. Heart Lung 2024; 67:144-151. [PMID: 38762962 DOI: 10.1016/j.hrtlng.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/22/2024] [Accepted: 05/06/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Despite comprising almost half of all patients undergoing valvular repair, data on transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (BAS) are limited. OBJECTIVE We aimed to evaluate whether there are any sex differences in trends and outcomes of TAVR in this population. METHODS We utilized the National Inpatient Sample from 2012 to 2020 to identify admissions with BAS who underwent TAVR and analyzed trends and outcomes. Our primary outcome was in-hospital mortality and secondary outcomes were in-hospital complications. We used two models to adjust for demographics (A) and interventions (B). RESULTS Between 2012 to 2020, there were 76,540 hospitalizations for BAS patients who underwent AVR, among which 6,010 (7.9 %) underwent TAVR. There was an overall increasing trend in number of TAVR cases with a decreasing trend in mortality (2013: 8.7 %, 2020: 1.3 %). TAVR was performed more in males (61.1% vs 38.9 %). Despite the worse baseline characteristics in males, in-hospital mortality (2.4% vs. 1.5 %; OR: 1.584; 95 % CI: 0.621-4.038; p = 0.335) and secondary outcomes were similar across both sexes, even after adjusting for demographics and interventions. CONCLUSION TAVR in BAS has grown rapidly in the last decade. Males comprised the majority and had more comorbidities, but mortality and complications were similar in both sexes. Despite the increasing number of cases, a decreasing trend in mortality was observed for both sexes ultimately approaching that of SAVR, suggesting that TAVR may be a safe alternative among eligible males and females with bicuspid AS.
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Affiliation(s)
| | | | | | | | - Erika P Ong
- University of the Philippines Manila, Manila City, Philippines
| | | | - Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke-on-Trent, UK
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9
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Giuliani C, Zanuttini A, Salaun E, Côté N, Clavel MA, Pibarot P. Subclinical valve leaflet thrombosis following bioprosthetic aortic valve replacement. Curr Opin Cardiol 2024; 39:457-464. [PMID: 38899782 DOI: 10.1097/hco.0000000000001161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
PURPOSE OF REVIEW Subclinical leaflet thrombosis (SLT) is often an incidental finding characterized by a thin layer of thrombus involving one, two or three leaflets, with typical appearance on multi-detector computed tomography (MDCT) of hypo-attenuating defect at the aortic side of the leaflet, also called hypo-attenuating leaflet thickening (HALT). SLT may occur following both transcatheter aortic replacement (TAVR) or biological surgical aortic valve replacement (SAVR). The aim of this review is to present an overview of the current state of knowledge on the incidence, diagnosis, clinical impact, and management of SLT following TAVR or SAVR. RECENT FINDINGS SLT occurs in 10-20% of patients following TAVR and is somewhat more frequent than following SAVR (5-15%). SLT may regress spontaneously without treatment in about 50% of the cases but may also progress to clinically significant valve thrombosis in some cases. Oral anticoagulation with vitamin K antagonist is reasonable if SLT is detected by echocardiography and/or MDCT during follow-up and is generally efficient to reverse SLT. SLT is associated with mild increase in the risk of stroke but has no impact on survival. SLT has been linked with accelerated structural valve deterioration and may thus impact valve durability and long-term outcomes. SUMMARY SLT is often an incidental finding on echocardiography or MDCT that occurs in 10-20% of patients following TAVR or 5-15% following biological SAVR and is associated with a mild increase in the risk of thrombo-embolic event with no significant impact on mortality but may be associated with reduced valve durability.
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Affiliation(s)
- Carlos Giuliani
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada
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10
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Gómez-Herrero J, Fernandez-Cordón C, Gonzalez JC, García-Gómez M, Turrión SB, Serrador A, Gutiérrez H, Campo A, Cortés C, Sevilla T, Aristizabal C, Ruiz J, Campillo S, Baladrón C, Carrasco-Moraleja M, Román JAS, Amat-Santos IJ. TAV-in-TAV in patients with prosthesis embolization: Impact of commissural alignment and global outcomes. Int J Cardiol 2024; 410:132179. [PMID: 38761972 DOI: 10.1016/j.ijcard.2024.132179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/02/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Optimal strategies to manage embolization of transcatheter aortic valve implantation (TAVI) devices are unclear; valve-in-valve (ViV) is often used. We aimed to describe through one-single center experience its rate, causes, consequences, and management as well as the rate and relevance of commissural alignment (CA) in this context. METHODS We identified across 1038 TAVI cases, those cases requiring ViV for the management of first device embolization. CA (absence or mild misalignment) after first and second device was assessed by CT or fluoroscopy. RESULTS A total of 23 cases (2.2%) were identified, 52.3% embolized towards the aorta and 47.7% towards the ventricle. Suboptimal implant height (38%) and embolization at the time of post-dilation (23%) were the most frequent mechanisms together with greater rate of bicuspid valve (p < 0.001) and a trend to greater annular eccentricity. Procedural and 1-year death occurred in 13% and 34%, respectively (vs. 1.1% and 7.8% in the global cohort, p < 0.001). CA was present in 76.9% of the prostheses initially implanted but was only spontaneously achieved in 30.8% of the second ViV device. Adequate CA of both prostheses was identified in only two cases (8.7%). There were no cases of coronary obstruction. CONCLUSIONS TAVI device embolization mechanisms can often be predicted and prevented. Mortality following bail-out ViV is higher than in regular TAVI procedures but 2/3 of these patients survived beyond 1-year follow-up. In them, valve degeneration or coronary re-access might be particularly challenging since CA was rarely achieved with both devices suggesting that greater efforts should be made in this regard.
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Affiliation(s)
| | | | | | | | | | - Ana Serrador
- Cardiology Department, University Clinic Hospital, Valladolid, Spain; Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | | | - Alberto Campo
- Cardiology Department, University Clinic Hospital, Valladolid, Spain
| | - Carlos Cortés
- Cardiology Department, University Clinic Hospital, Valladolid, Spain
| | - Teresa Sevilla
- Cardiology Department, University Clinic Hospital, Valladolid, Spain; Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | | | - Julio Ruiz
- Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - Sofía Campillo
- Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - Carlos Baladrón
- Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - Manuel Carrasco-Moraleja
- Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - J Alberto San Román
- Cardiology Department, University Clinic Hospital, Valladolid, Spain; Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - Ignacio J Amat-Santos
- Cardiology Department, University Clinic Hospital, Valladolid, Spain; Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain.
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11
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Decotto S, Villar GF, Knorre ME, Bergier M, Orellano A, Vega BS, Busnelli G, Rossi E, Castillo SD, Falconi M, Oberti P, Kotowicz V, Pizarro R. Surgical aortic valve replacement in patients with reduced ejection fraction. Prevalence and follow-up. Curr Probl Cardiol 2024; 49:102725. [PMID: 38925204 DOI: 10.1016/j.cpcardiol.2024.102725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Limited information exists on the prevalence and outcomes of patients undergoing surgical aortic valve replacement (SAVR) for aortic stenosis (AS) with reduced left ventricular ejection fraction (LVEF). This study aims to describe the number of AS patients undergoing SAVR with LVEF less than 55 % and quantify LVEF improvement at follow-up. MATERIAL AND METHODS We analyzed patients undergoing SAVR with LVEF less than 55 % and the number of patients that improved the LVEF at 6 months. We defined 'improved LVEF' as a 10 % increase of LVEF compared to baseline. RESULTS Out of 685 patients, 11.4 % (n = 78) had SAVR with LVEF <55 %. The median pre-surgery LVEF was 45 % [IQR 37-51]. In-hospital mortality was 5.1 % (n = 4). Follow-up data for 69 patients showed 50.7 % (n = 35) had improved LVEF. CONCLUSIONS In our cohort, 10 % of severe AS patients underwent SAVR with LVEF <55 %, with half showing LVEF improvement at follow-up.
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Affiliation(s)
- Santiago Decotto
- Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
| | | | | | - Mariano Bergier
- Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
| | | | - Brian Soria Vega
- Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
| | - Guido Busnelli
- Cardiovascular Surgery Department, Hospital Italiano de Buenos Aires, Argentina
| | - Emiliano Rossi
- Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
| | | | - Mariano Falconi
- Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
| | - Pablo Oberti
- Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
| | - Vadim Kotowicz
- Cardiovascular Surgery Department, Hospital Italiano de Buenos Aires, Argentina
| | - Rodolfo Pizarro
- Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
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12
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Elbasha K, Kaur J, Abdelghani M, Landt M, Alotaibi S, Abdelaziz A, Abdel-Wahab M, Toelg R, Geist V, Richardt G, Allali A. Ten-year Durability, Hemodynamic Performance, and Clinical Outcomes after Transcatheter Aortic Valve Implantation Using a Self-expanding Device. Cardiol Ther 2024; 13:529-540. [PMID: 38734999 PMCID: PMC11333656 DOI: 10.1007/s40119-024-00369-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 04/16/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION The expansion of transcatheter aortic valve implantation (TAVI) to low-risk and younger patients has increased the relevance of the long-term durability of transcatheter heart valves (THV). The present study aims to assess the 10-year durability, hemodynamic performance, and clinical outcomes after TAVI using the CoreValve system. METHODS An analysis from a prospective registry with predefined clinical and echocardiographic follow-up included 302 patients who underwent TAVI with the CoreValve system between 2007 and 2015. Bioprosthetic valve failure (BVF) was defined as any bioprosthetic valve dysfunction-related death, re-intervention, or severe hemodynamic valve deterioration. RESULTS At the time of TAVI, the mean age was 80.41 ± 7.01 years, and the Society of Thoracic Surgeons (STS) score was 6.13 ± 5.23%. At latest follow-up (median [IQR]: 5 [2-7] years), cumulative all-cause mortality rates at 3, 5, 7, and 10 years was 23.7%, 40%, 65.8%, and 89.8%, respectively. Mean aortic valve area and transvalvular gradient post-TAVI and at 5, 7, and 10 years were 1.94, 1.87, 1.69, and 1.98 cm2 (p = 0.236) and 8.3, 9.0, 8.2, and 10.1 mmHg (p = 0.796), respectively. Overall, 11 patients had BVF, of whom six had structural valve deterioration (SVD). The 10-year actual and actuarial freedom from BVF was 96.1% and 78.8%, and from SVD was 97.9% and 80.9%, respectively. Three patients developed significant non-SVD due to severe paravalvular leakage, and two patients were diagnosed with infective endocarditis. CONCLUSION Using an early-generation self-expanding bioprosthesis, we documented durable hemodynamic performance and low rates of BVF and SVD up to 10 years after TAVI.
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Affiliation(s)
- Karim Elbasha
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany.
- Cardiology Department, Zagazig University, Sharkia, Egypt.
| | - Jatinderjit Kaur
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Mohammad Abdelghani
- Department of Cardiology, Al-Azhar University, Cairo, Egypt
- Cardiology Unit, Department of Internal Medicine, Sohar Hospital, Sohar, Oman
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Martin Landt
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Sultan Alotaibi
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- Cardiac Centre, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | | | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Centre Leipzig at the University of Leipzig, Leipzig, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Volker Geist
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Gert Richardt
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Abdelhakim Allali
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- University Heart Centre Lübeck, Medical Clinic II, Lübeck, Germany
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13
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Silva I, Ternacle J, Hahn RT, Salah-Annabi M, Dahou A, Krapf L, Salaun E, Guzzetti E, Xu K, Clavel MA, Bernier M, Beaudoin J, Cremer PC, Jaber W, Rodriguez L, Asch FM, Weismann NJ, Bax J, Ajmone N, Alu MC, Kallel F, Mack MJ, Webb JG, Kapadia S, Makkar R, Kodali S, Herrmann HC, Thourani V, Leon MB, Pibarot P. Left and right ventricular longitudinal systolic function following aortic valve replacement in the PARTNER 2 trial and registry. Eur Heart J Cardiovasc Imaging 2024; 25:1276-1286. [PMID: 38693866 DOI: 10.1093/ehjci/jeae114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024] Open
Abstract
AIMS Evaluation of left and right ventricular (RV) longitudinal systolic function may enhance risk stratification following aortic valve replacement (AVR). The study objective was to evaluate the changes in left and RV longitudinal systolic function and RV-pulmonary artery (RV-PA) coupling from baseline to 30 days and 1 year after AVR. METHODS AND RESULTS Left ventricular (LV) longitudinal strain (LS), tricuspid annulus plane systolic excursion (TAPSE), and RV-PA coupling were evaluated in patients from the PARTNER 2A surgical AVR (SAVR) arm (n = 985) and from the PARTNER 2 SAPIEN 3 registry (n = 719). TAPSE and RV-PA coupling decreased significantly following SAVR, but remained stable following TAVR. Lower LV LS, TAPSE, or RV-PA coupling at baseline was associated with increased risk of the composite of death, hospitalization, and stroke at 5 years [adjusted hazard ratios (HRs) for LV LS < 15%: 1.24, 95% confidence interval (CI) 1.05-1.45, P = 0.001; TAPSE < 14 mm: 1.44, 95% CI 1.21-1.73, P < 0.001; RV-PA coupling < 0.55 mm/mmHg: 1.32, 95% CI 1.07-1.63, P = 0.011]. Reduced TAPSE at baseline was the most powerful predictor of the composite endpoint at 5 years. Patients with LV ejection fraction <50% at baseline had increased risk of the primary endpoint with SAVR (HR: 1.34, 95% CI 1.08-1.68, P = 0.009) but not with TAVR (HR: 1.12, 95% CI 0.88-1.42). Lower RV-PA coupling at 30 days showed the strongest association with cardiac mortality. CONCLUSION SAVR but not TAVR was associated with a marked deterioration in RV longitudinal systolic function and RV-PA coupling. Lower TAPSE and RV-PA coupling at 30 days were associated with inferior clinical outcomes at 5 years. In patients with LVEF < 50%, TAVR was associated with superior 5-year outcomes.
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Affiliation(s)
- Iria Silva
- Department of Cardiology, Québec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Québec G1V-4G5, Canada
- Department of Cardiology, Central University Hospital of Asturias, Oviedo, Spain
| | - Julien Ternacle
- Haut-Leveque Cardiology Hospital, Bordeaux University, Pessac, France
| | - Rebecca T Hahn
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | | | | | - Laura Krapf
- Haut-Leveque Cardiology Hospital, Bordeaux University, Pessac, France
| | - Erwan Salaun
- Department of Cardiology, Québec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Québec G1V-4G5, Canada
| | - Ezequiel Guzzetti
- Département de cardiologie, Centre Hospitalier Affilié Universitaire Régional, Trois-Rivières, Québec, Canada
| | - Ke Xu
- Edwards Lifesciences, Irvine, CA, USA
| | - Marie-Annick Clavel
- Department of Cardiology, Québec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Québec G1V-4G5, Canada
| | - Mathieu Bernier
- Department of Cardiology, Québec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Québec G1V-4G5, Canada
| | - Jonathan Beaudoin
- Department of Cardiology, Québec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Québec G1V-4G5, Canada
| | - Paul C Cremer
- Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - Wael Jaber
- Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Federico M Asch
- Cardiovascular Core Laboratories, MedStar Heart and Vascular Institute and Georgetown University, Washington, DC, USA
| | - Neil J Weismann
- Cardiovascular Core Laboratories, MedStar Heart and Vascular Institute and Georgetown University, Washington, DC, USA
| | - Jeroen Bax
- Hart Long Centrum Leiden, Leiden University, Leiden, The Netherlands
| | - Nina Ajmone
- Hart Long Centrum Leiden, Leiden University, Leiden, The Netherlands
| | - Maria C Alu
- Division of Cardiology, Columbia University Irving Medical Center; Presbyterian Hospital; Cardiovascular Research Foundation, New York, NY, USA
| | | | - Michael J Mack
- Department of Cardiovascular and Thoracic Surgery, Baylor Scott & White Cardiac Surgery Specialists, Plano, TX, USA
| | - John G Webb
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, Canada
| | - Samir Kapadia
- Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Susheel Kodali
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Howard C Herrmann
- Division of Cardiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Vinod Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Martin B Leon
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Philippe Pibarot
- Department of Cardiology, Québec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Québec G1V-4G5, Canada
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14
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Li W, Li H, Peng S, Li J, Feng Y, Peng Y, Wei J, Zhao Z, Xiong T, Yang H, Song C, Bai L, Yao Y, Chen F, Yin Y, Chen M. Prognostic effect of the TyG index on patients with severe aortic stenosis following transcatheter aortic valve replacement: a retrospective cohort study. Cardiovasc Diabetol 2024; 23:312. [PMID: 39182080 PMCID: PMC11344917 DOI: 10.1186/s12933-024-02414-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 08/19/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND The triglyceride glucose (TyG) index, as a reliable marker of insulin resistance, is associated with the incidence and poor prognosis of various cardiovascular diseases. However, the relationship between the TyG index and clinical outcomes in patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve replacement (TAVR) remains unclear. METHODS This study consecutively enrolled 1569 patients with AS underwent TAVR at West China Hospital of Sichuan University between April 2014 and August 2023. The outcomes of interest included all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACE). Multivariate adjusted Cox regression and restricted cubic splines (RCS) regression analyses were used to assess the associations between the TyG index and the clinical outcomes. The incremental prognostic value of the TyG index was further assessed by the time-dependent Harrell's C-index, integrated discrimination improvement (IDI) and the net reclassification improvement (NRI). RESULTS During a median follow-up of 1.09 years, there were 146, 70, and 196 patients experienced all-cause death, cardiovascular death, and MACE, respectively. After fully adjusting for confounders, a per-unit increase of TyG index was associated with a 441% (adjusted HR: 5.41, 95% CI: 4.01-7.32), 385% (adjusted HR: 4.85, 95% CI: 3.16-7.43), and 347% (adjusted HR: 4.47, 95% CI: 3.42-5.85) higher risk of all-cause mortality, cardiovascular mortality and MACE, respectively. The RCS regression analyses revealed a linear association between TyG index and endpoints (all P for non-linearity > 0.05) with 8.40 as the optimal binary cutoff point. Furthermore, adding TyG index to the basic risk model provided a significant incremental value in predicting poor prognosis (Time-dependent Harrell's C-index increased for all the endpoints; All-cause mortality, IDI: 0.11, P < 0.001; NRI: 0.32, P < 0.001; Cardiovascular mortality, IDI: 0.043, P < 0.001; NRI: 0.37, P < 0.001; MACE, IDI: 0.092, P < 0.001; NRI: 0.32, P < 0.001). CONCLUSIONS In patients with severe AS receiving TAVR, there was a positive linear relationship between TyG index and poor prognosis, with 8.4 as the optimal bivariate cutoff value. Our findings suggest TyG index holds potential value for risk stratification and guiding therapeutic decisions in patients after TAVR.
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Affiliation(s)
- Weiya Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
- Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, No.37 Guoxue Street, Chengdu, 610041, P.R. China
| | - Hongde Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
- Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, No.37 Guoxue Street, Chengdu, 610041, P.R. China
| | - Shiqin Peng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
- Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, No.37 Guoxue Street, Chengdu, 610041, P.R. China
| | - Junli Li
- Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
- Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, No.37 Guoxue Street, Chengdu, 610041, P.R. China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiafu Wei
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhengang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
- Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, No.37 Guoxue Street, Chengdu, 610041, P.R. China
| | - Tianyuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
- Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, No.37 Guoxue Street, Chengdu, 610041, P.R. China
| | - Haoran Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
- Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, No.37 Guoxue Street, Chengdu, 610041, P.R. China
| | - Chengxiang Song
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
- Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, No.37 Guoxue Street, Chengdu, 610041, P.R. China
| | - Lin Bai
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
- Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, No.37 Guoxue Street, Chengdu, 610041, P.R. China
| | - Yijun Yao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
- Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, No.37 Guoxue Street, Chengdu, 610041, P.R. China
| | - Fei Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
- Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, No.37 Guoxue Street, Chengdu, 610041, P.R. China
| | - Yue Yin
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
- Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, No.37 Guoxue Street, Chengdu, 610041, P.R. China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
- Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, China.
- Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, No.37 Guoxue Street, Chengdu, 610041, P.R. China.
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15
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Caminiti R, Ielasi A, Vetta G, Parlavecchio A, Rocca DGD, Glauber M, Tespili M, Vizzari G, Micari A. Long-Term Results Following Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Severe Aortic Stenosis: A Systematic Review and Meta-Analysis of Randomized Trials. Am J Cardiol 2024:S0002-9149(24)00603-9. [PMID: 39173988 DOI: 10.1016/j.amjcard.2024.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 07/30/2024] [Accepted: 08/14/2024] [Indexed: 08/24/2024]
Abstract
Transcatheter aortic valve replacement (TAVR) is a safe and effective treatment option for patients with severe aortic stenosis at intermediate or high surgical risk. Results after TAVR in low-risk patients are very encouraging at midterm follow-up, whereas limited long-term (≥3 year) data are available in this subset of patients. This meta-analysis aims to compare the long-term follow-up after TAVR versus surgical aortic valve replacement (SAVR) in low-risk patients. We searched databases up to July 7, 2024 for randomized clinical trials comparing TAVR versus SAVR in low-risk patients (defined as Society of Thoracic Surgeons Predicted Risk of Mortality score <4%) (PROSPERO ID: CRD42023480495). Primary outcome analyzed was all-cause death at a minimum of 3 years of follow-up. The secondary outcomes were cardiovascular death, disabling stroke, myocardial infarction, aortic valve reintervention, endocarditis, new-onset atrial fibrillation, permanent pacemaker implantation, and bioprosthetic valve failure. A total of 3 randomized clinical trials with 2,644 patients (TAVR n = 1,371 patients; SAVR n = 1,273 patients) were included. The follow-up time was 6 ± 2.9 years. TAVR resulted noninferior to SAVR for all-cause death (risk ratio [RR] 0.99, 95% confidence interval [CI] 0.84 to 1.17, p = 0.89, I2 = 28%), cardiovascular death (RR 0.94, 95% CI 0.76 to 1.15, p = 0.54, I2 = 0%), myocardial infarction (RR 1.06, 95% CI 0.71 to 1.57, p = 0.79, I2 = 61%), aortic valve reintervention, endocarditis, and bioprosthetic valve failure. New-onset atrial fibrillation was more common in the SAVR group, whereas permanent pacemaker implantation was more common in the TAVR group. In conclusion, our meta-analysis showed that TAVR is associated with similar long-term outcomes compared with SAVR in selected low-risk patients.
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Affiliation(s)
- Rodolfo Caminiti
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Alfonso Ielasi
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy.
| | - Giampaolo Vetta
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, UniversitairZiekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Antonio Parlavecchio
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, UniversitairZiekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Mattia Glauber
- Mini-Invasive Cardiac Surgery Unit, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Maurizio Tespili
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Giampiero Vizzari
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Micari
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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16
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Riaz S, Kasam Shiva PK, Manimekalai Krishnamurthi JS, Shah RS, Cherukuri AMK, Bhatia P, Arul S, Multani M, Singh A, Suyambu J, Asif K, Al-Tawil M. Percutaneous Versus Surgical Cutdown Access for Transfemoral Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis Focusing on Propensity-Score Matched Studies. Heart Lung Circ 2024:S1443-9506(24)00660-7. [PMID: 39179438 DOI: 10.1016/j.hlc.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 05/03/2024] [Accepted: 05/28/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has emerged as a potential alternative for aortic valve surgery to treat aortic valve stenosis. There is limited evidence on the comparative outcomes of TAVI access approaches, specifically the percutaneous (PC) vs surgical cutdown (SC) approach. This study aimed to assess the short-term outcomes in patients undergoing PC vs SC access for transfemoral transcatheter aortic valve replacement. METHODS PubMed, SCOPUS, and EMBASE were searched to identify relevant studies. The primary outcomes were short-term all-cause mortality, bleeding, vascular complications, and length of in-hospital stay for patients who underwent transfemoral TAVI. Both matched and unmatched observational studies were included and subgroup analyses were performed. This systematic review and meta-analysis was performed in line with the PRISMA guidelines. RESULTS Fifteen observational studies involving 7,545 patients (3,033 underwent the PC approach and 2,466 underwent the SC approach) were included. There were no clinically significant between-group differences in short-term mortality, bleeding, length of in-hospital stay, or major vascular complications. However, minor vascular complications were significantly higher in patients who underwent PC-TAVI (p=0.007). In the matched subgroup, all outcomes were comparable between both groups, with the largest difference being observed in minor vascular complications more frequently occurring in the PC group (p=0.08). CONCLUSION The evidence shows that outcomes were comparable between the two methods of access, rendering both the PC and SC approaches equally effective for transfemoral TAVI. However, it is worth noting that minor vascular complications were more pronounced in the PC group.
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Affiliation(s)
- Sania Riaz
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | | | | | | | | | - Pranav Bhatia
- Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Subiksha Arul
- University of Perpetual Help System DALTA Jonelta Foundation School of Medicine, Manila, Philippines
| | - Monika Multani
- Adesh Institute of Medical Sciences and Research, Punjab, India
| | - Adishwar Singh
- Government Medical College and Hospital, Chandigarh, India
| | - Jenisha Suyambu
- University of Perpetual Help System DALTA Jonelta Foundation School of Medicine, Manila, Philippines
| | - Kainat Asif
- Department of Medicine, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Karachi, Pakistan
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17
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Adrichem R, Mattace-Raso AM, Hokken TW, van den Dorpel MMP, de Ronde MJAG, Lenzen MJ, Cummins PA, Kardys I, Nuis RJ, Daemen J, Bekkers JA, Van Mieghem NM. Demographics and outcomes of patients younger than 75 years undergoing aortic valve interventions in Rotterdam. Neth Heart J 2024:10.1007/s12471-024-01888-2. [PMID: 39164507 DOI: 10.1007/s12471-024-01888-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is considered a safe and effective alternative to surgical aortic valve replacement (SAVR) for elderly patients across the operative risk spectrum. In the Netherlands, TAVI is reimbursed only for patients with a high operative risk. Despite this, one fifth of TAVI patients are < 75 years of age. We aim to compare patient characteristics and outcomes of TAVI and SAVR patients < 75 years. METHODS This study included all patients < 75 years without active endocarditis undergoing TAVI or SAVR for severe aortic stenosis, mixed aortic valve disease or degenerated aortic bioprosthesis between 2015 and 2020 at the Erasmus University Medical Centre. Dutch authority guidelines were used to classify operative risk. RESULTS TAVI was performed in 292 patients, SAVR in 386 patients. Based on the Dutch risk algorithm, 59.6% of TAVI patients and 19.4% of SAVR patients were at high operative risk. There was no difference in 30-day all-cause mortality between TAVI and SAVR (2.4% vs 0.8%, p = 0.083). One-year and 5‑year mortality was higher after TAVI than after SAVR (1-year: 12.5% vs 4.3%, p < 0.001; 5‑year: 36.8% vs 12.0%, p < 0.001). Within risk categories we found no difference between treatment strategies. Independent predictors of mortality were cardiovascular comorbidities (left ventricular ejection fraction < 30%, atrial fibrillation, pulmonary hypertension) and the presence of malignancies, liver cirrhosis or immunomodulatory drug use. CONCLUSION At the Erasmus University Medical Centre, in patients < 75 years, TAVI is selected for higher-risk phenotypes and overall has higher long-term mortality than SAVR. We found no evidence for worse outcome within risk categories.
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Affiliation(s)
- Rik Adrichem
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Thijmen W Hokken
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Marjo J A G de Ronde
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Mattie J Lenzen
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Paul A Cummins
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Rutger-Jan Nuis
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jos A Bekkers
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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18
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Wilderman M, Tateishi K, O'Connor D, Simonian S, Ratnathicam A, Cook K, De Gregorio L, Hmoud H, De Gregorio J. Safety and efficacy of covered stent grafts in the treatment of emergent access related complications. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00628-6. [PMID: 39168761 DOI: 10.1016/j.carrev.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 08/06/2024] [Accepted: 08/14/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Large bore percutaneous access is becoming increasingly common. Parallel to this, we observe an increase in vascular access site complications such as bleeding, dissection, thrombosis or pseudo-aneurysms. This study was aimed to evaluate safety and efficacy of covered stent grafts for fixing large bore vascular access injuries. METHODS A total of 147 Viabahn or Viabahn VBX (WL Gore) stent grafts which were placed across the inguinal ligament in emergent settings in 136 patients, were retrospectively analyzed. The two endpoints were the technical success rate, defined by complete arterial repair, and long-term stent graft patency. We also looked at the need for open conversion, wound infections, and in hospital and 30-day mortality. We followed the patients using duplex ultrasound and computed tomography angiogram to assess for arterial patency, freedom from intervention, stent kinking and clinical symptoms. RESULTS 30 Viabahn and 117 Viabahn VBX (WL Gore) stent grafts were placed in the distal external iliac artery and into the proximal common femoral artery of 136 patients. Indications for intervention were bleeding in 92 patients (68 %), flow limiting dissection in 41 patients (30 %) and symptomatic AVF in 3 patients (2 %). Primary technical success rate was 100 %. Limited 3-year follow up (101/136 patients) showed 99 % patency with no evidence of stent fracture, stenosis or kinking except in one patient who needed target lesion revascularization due to neointimal hyperplasia. CONCLUSIONS Covered stent grafts can be placed safely, efficiently, and effectively in the distal external iliac and common femoral arteries across the inguinal ligament. These stent grafts can be used as an alternative therapeutic option to open surgery in patients with large bore vascular access injuries.
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Affiliation(s)
- Michael Wilderman
- Department of Vascular Surgery, Bergen Vascular Institute, Hackensack, NJ, USA.
| | - Kazuya Tateishi
- Department of Cardiovascular Services, Englewood Hospital and Medical Center, Englewood, NJ, USA
| | - David O'Connor
- Department of Vascular Surgery, Bergen Vascular Institute, Hackensack, NJ, USA
| | - Sophia Simonian
- Department of Vascular Surgery, Bergen Vascular Institute, Hackensack, NJ, USA
| | - Anjali Ratnathicam
- Department of Vascular Surgery, Bergen Vascular Institute, Hackensack, NJ, USA
| | - Kristen Cook
- Department of Vascular Surgery, Bergen Vascular Institute, Hackensack, NJ, USA
| | | | - Hosam Hmoud
- Department of Cardiology, Lenox Hill Hospital Northwell Health, New York, NY, USA
| | - Joseph De Gregorio
- Department of Cardiovascular Services, Englewood Hospital and Medical Center, Englewood, NJ, USA
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19
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Vriesendorp PA, Nanayakkara S, Heuts S, Ball J, Chandrasekar J, Dick R, Haji K, Htun NM, McGaw D, Noaman S, Palmer S, Cairo S, Shulman M, Lin E, Hastings S, Waldron B, Proimos G, Soon KH, Yudi MB, Zimmet A, Stub D, Walton AS. Routine Protamine Administration for Bleeding in Transcatheter Aortic Valve Implantation: The ACE-PROTAVI Randomized Clinical Trial. JAMA Cardiol 2024:2822233. [PMID: 39141396 PMCID: PMC11325237 DOI: 10.1001/jamacardio.2024.2454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Importance Vascular complications after transfemoral transcatheter aortic valve implantation (TAVI) remain an important cause of procedure-related morbidity. Routine reversal of anticoagulation with protamine at the conclusion of transfemoral TAVI could reduce complications, but data remain scarce. Objective To evaluate the efficacy and safety of routine protamine administration after transfemoral TAVI. Design, Setting, and Participants The ACE-PROTAVI trial was an investigator-initiated, double-blind, placebo-controlled randomized clinical trial performed at 3 Australian hospitals between December 2021 and June 2023 with a 1-year follow-up period. All patients accepted for transfemoral TAVI by a multidisciplinary heart team were eligible for enrollment. Interventions Eligible patients were randomized 1:1 between routine protamine administration and placebo. Main Outcomes and Measures The coprimary outcomes were the rate of hemostasis success and time to hemostasis (TTH), presented as categorical variables and compared with a χ2 test or as continuous variables as mean (SD) or median (IQR), depending on distribution. The major secondary outcome was a composite of all-cause death, major and minor bleeding complications, and major and minor vascular complications after 30 days, reported in odds ratios (ORs) with 95% CIs and P values. Results The study population consisted of 410 patients: 199 patients in the protamine group and 211 in the placebo group. The median (IQR) patient age in the protamine group was 82 (77-85) years, and 68 of 199 patients receiving protamine (34.2%) were female. The median (IQR) patient age in the placebo group was 80 (75-85) years, and 89 of 211 patients receiving the placebo (42.2%) were female. Patients receiving up-front protamine administration had a higher rate of hemostasis success (188 of 192 patients [97.9%]) than patients in the placebo group (186 of 203 patients [91.6%]; absolute risk difference, 6.3%; 95% CI, 2.0%-10.6%; P = .006); in addition, patients receiving up-front protamine had a shorter median (IQR) TTH (181 [120-420] seconds vs 279 [122-600] seconds; P = .002). Routine protamine administration resulted in a reduced risk of the composite outcome in the protamine group (10 of 192 [5.2%]) vs the placebo group (26 of 203 [12.8%]; OR, 0.37; 95% CI, 0.1-0.8; P = .01). This difference was predominantly driven by the difference in the prevalence of minor vascular complications. There were no adverse events associated with protamine use. Conclusions and Relevance In the ACE-PROTAVI randomized clinical trial, routine administration of protamine increased the rate of hemostasis success and decreased TTH. The beneficial effect of protamine was reflected in a reduction in minor vascular complications, procedural time, and postprocedural hospital stay duration in patients receiving routine protamine compared with patients receiving placebo. Trial Registration anzctr.org.au Identifier: ACTRN12621001261808.
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Affiliation(s)
- Pieter A Vriesendorp
- Heart Centre, The Alfred Hospital, Melbourne, Australia
- Heart+Vascular Center, Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Shane Nanayakkara
- Heart Centre, The Alfred Hospital, Melbourne, Australia
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Samuel Heuts
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jaya Chandrasekar
- Department of Cardiology, Epworth HealthCare, Melbourne, Australia
- Department of Cardiology, Eastern Health, Melbourne, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Ronald Dick
- Department of Cardiology, Epworth HealthCare, Melbourne, Australia
| | - Kawa Haji
- Heart Centre, The Alfred Hospital, Melbourne, Australia
- Department of Cardiology, Epworth HealthCare, Melbourne, Australia
| | - Nay Min Htun
- Heart Centre, The Alfred Hospital, Melbourne, Australia
| | - David McGaw
- Department of Cardiology, Cabrini Health, Melbourne, Australia
| | - Samer Noaman
- Heart Centre, The Alfred Hospital, Melbourne, Australia
- Department of Cardiology, Epworth HealthCare, Melbourne, Australia
| | - Sonny Palmer
- Heart Centre, The Alfred Hospital, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Sesto Cairo
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Cabrini Anaesthetics Department, Cabrini Health, Melbourne, Australia
| | - Mark Shulman
- Heart Centre, The Alfred Hospital, Melbourne, Australia
- Cabrini Anaesthetics Department, Cabrini Health, Melbourne, Australia
| | - Enjarn Lin
- Heart Centre, The Alfred Hospital, Melbourne, Australia
- Cabrini Anaesthetics Department, Cabrini Health, Melbourne, Australia
| | - Stuart Hastings
- Heart Centre, The Alfred Hospital, Melbourne, Australia
- Cabrini Anaesthetics Department, Cabrini Health, Melbourne, Australia
| | - Benedict Waldron
- Heart Centre, The Alfred Hospital, Melbourne, Australia
- Cabrini Anaesthetics Department, Cabrini Health, Melbourne, Australia
| | - George Proimos
- Department of Cardiology, Epworth HealthCare, Melbourne, Australia
| | - Kean H Soon
- Department of Cardiology, Epworth HealthCare, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Matias B Yudi
- Department of Cardiology, Epworth HealthCare, Melbourne, Australia
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Adam Zimmet
- Heart Centre, The Alfred Hospital, Melbourne, Australia
| | - Dion Stub
- Heart Centre, The Alfred Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Cardiology, Cabrini Health, Melbourne, Australia
| | - Antony S Walton
- Heart Centre, The Alfred Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Cardiology, Epworth HealthCare, Melbourne, Australia
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20
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Ueyama HA, Miyamoto Y, Hashimoto K, Watanabe A, Kolte D, Latib A, Kuno T, Tsugawa Y. Comparison of Patient Outcomes Between Leadless vs Transvenous Pacemakers Following Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2024; 17:1779-1791. [PMID: 39023453 DOI: 10.1016/j.jcin.2024.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/23/2024] [Accepted: 05/21/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Evidence is limited regarding the effectiveness of leadless pacemaker implantation for conduction disturbance following transcatheter aortic valve replacement (TAVR). OBJECTIVES This study sought to examine the national trends in the use of leadless pacemaker implantation following TAVR and compare its performance with transvenous pacemakers. METHODS Medicare fee-for-service beneficiaries aged ≥65 years who underwent leadless or transvenous pacemakers following TAVR between 2017 and 2020 were included. Outcomes included in-hospital overall complications as well as midterm (up to 2 years) all-cause death, heart failure hospitalization, infective endocarditis, and device-related complications. Propensity score overlap weighting analysis was used. RESULTS A total of 10,338 patients (730 leadless vs 9,608 transvenous) were included. Between 2017 and 2020, there was a 3.5-fold increase in the proportion of leadless pacemakers implanted following TAVR. Leadless pacemaker recipients had more comorbidities, including atrial fibrillation and end-stage renal disease. After adjusting for potential confounders, patients with leadless pacemakers experienced a lower rate of in-hospital overall complications compared with patients who received transvenous pacemakers (7.2% vs 10.1%; P = 0.014). In the midterm, we found no significant differences in all-cause death (adjusted HR: 1.13; 95% CI: 0.96-1.32; P = 0.15), heart failure hospitalization (subdistribution HR: 0.89; 95% CI: 0.74-1.08; P = 0.24), or infective endocarditis (subdistribution HR: 0.98; 95% CI: 0.44-2.17; P = 0.95) between the 2 groups, but leadless pacemakers were associated with a lower risk of device-related complications (subdistribution HR: 0.37; 95% CI: 0.21-0.64; P < 0.001). CONCLUSIONS Leadless pacemakers are increasingly being used for conduction disturbance following TAVR and were associated with a lower rate of in-hospital complications and midterm device-related complications compared to transvenous pacemakers without a difference in midterm mortality.
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Affiliation(s)
- Hiroki A Ueyama
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yoshihisa Miyamoto
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
| | - Kenji Hashimoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Atsuyuki Watanabe
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and West, New York, New York, USA
| | - Dhaval Kolte
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA; Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, USA; Department of Health Policy and Management, University of California-Los Angeles Fielding School of Public Health, Los Angeles, California, USA
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21
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Abdelnour MW, Patel V, Patel PM, Kasel AM, Frangieh AH. Alternative access in transcatheter aortic valve replacement-an updated focused review. Front Cardiovasc Med 2024; 11:1437626. [PMID: 39175626 PMCID: PMC11338806 DOI: 10.3389/fcvm.2024.1437626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/22/2024] [Indexed: 08/24/2024] Open
Abstract
Aortic Stenosis (AS) is a common condition with an estimated pooled prevalence of all AS in the elderly population at around 12.4%, with that of severe AS estimated to be around 3.4%. In the past, surgical aortic valve replacement was the primary treatment option for severe AS for decades. However, with the compelling evidence on the safety and efficacy of transcatheter aortic valve replacement (TAVR), it has become the gold standard treatment option for many patients with symptomatic severe AS. Transfemoral access has been the preferred method for transcatheter heart valve delivery. However, the prevalent use of TAVR on a diverse patient profile with different risk factors, such as peripheral artery disease, precluded the possibility of a transfemoral approach despite the improvement of valves and delivery systems technology. Therefore, alternative TAVR approaches have gained increasing utility in cases where transfemoral access is unfavorable. We review the journey, evolution, and techniques for different approaches of percutaneous TAVR, including transfemoral, transcarotid, transsubclavian/transaxillary, and transcaval approaches, in addition to the traditional "surgical" transaortic and transapical accesses. Consolidating these data highlights each approach's practicality and limitations, providing additional grounding for case-by-case utilization and future clinical research.
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Affiliation(s)
- Mark W. Abdelnour
- Division of Cardiology, Department of Medicine, University of California Irvine Medical Center, Orange, California, CA, United States
| | - Vishal Patel
- Division of Cardiology, Department of Medicine, University of California Irvine Medical Center, Orange, California, CA, United States
| | - Pranav M. Patel
- Division of Cardiology, Department of Medicine, University of California Irvine Medical Center, Orange, California, CA, United States
| | - A. M. Kasel
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Antonio H. Frangieh
- Division of Cardiology, Department of Medicine, University of California Irvine Medical Center, Orange, California, CA, United States
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22
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Costa J, El-Ali A, Morland D, Dejust S, Papathanassiou D, Nazeyrollas P, Metz D. Cardiac amyloidosis prevalence and 1-year outcome in patients with aortic stenosis undergoing transaortic valve implantation: Findings from the CAMPOS-TAVI study. Arch Cardiovasc Dis 2024:S1875-2136(24)00281-X. [PMID: 39153878 DOI: 10.1016/j.acvd.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Transthyretin amyloid cardiomyopathy (ATTR-CM) can manifest as rhythm disorders, heart failure, but also valvular degeneration. Despite aortic stenosis (AS) being prevalent among the elderly, data on ATTR-CM prevalence and outcome in patients with AS undergoing transaortic valve implantation (TAVI) remain scarce. AIM To determine ATTR-CM prevalence and evaluate 1-year survival in patients undergoing TAVI. METHODS Between December 2020 and September 2021, 100 consecutive patients underwent TAVI and were screened prospectively for ATTR-CM using bone scintigraphy (BS). Monoclonal gammopathy was ruled out in case of cardiac uptake on BS. All patients were followed prospectively for 1year after TAVI. RESULTS The proportion of patients aged≥75years or with a EuroSCORE II>8% and possible femoral access was 99%. The abnormal cardiac uptake rate on BS was 7% (95% confidence interval: 2-12%); 86% of these patients were male. The RAISE (remodelling, age, injury, system and electrical) score, indicative of ATTR-CM risk, was higher in case of positive BS (P=0.04). Patients with positive BS were older and exhibited wider QRS complexes on electrocardiography (P=0.003), a higher frequency of reduced LVEF (57% vs. 17%), impaired basal LV strain (P=0.02) and a lower voltage/mass ratio (P=0.01). History of pacemaker implantation before TAVI was higher in the positive BS group (P=0.0004) and remained the only statistically significant factor after adjustment using the Holm-Bonferroni method. One-year survival of patients with positive BS did not differ from that of patients with isolated AS. CONCLUSIONS Prevalence of ATTR-CM in patients treated with TAVI, underscoring the need for continued surveillance for potential development of ATTR-CM after TAVI. Caution is warranted regarding the 1-year survival because of the lack of study power. Further investigations are needed to define long-term prognosis of AS with ATTR-CM.
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Affiliation(s)
- Jérôme Costa
- Cardiology Department, University Hospital of Reims, rue du Général-Koenig, 51100 Reims, France.
| | - Ahmed El-Ali
- Cardiology Department, University Hospital of Reims, rue du Général-Koenig, 51100 Reims, France
| | - David Morland
- Service de Médecine Nucléaire, Institut Godinot, 51100 Reims, France; Laboratoire de Biophysique, UFR de Médecine, Université de Reims Champagne-Ardenne, 51100 Reims, France; CReSTIC UR 3804, Université de Reims Champagne-Ardenne, Reims, France
| | - Sebastien Dejust
- Service de Médecine Nucléaire, Institut Godinot, 51100 Reims, France
| | - Dimitri Papathanassiou
- Service de Médecine Nucléaire, Institut Godinot, 51100 Reims, France; Laboratoire de Biophysique, UFR de Médecine, Université de Reims Champagne-Ardenne, 51100 Reims, France; CReSTIC UR 3804, Université de Reims Champagne-Ardenne, Reims, France
| | - Pierre Nazeyrollas
- Cardiology Department, University Hospital of Reims, rue du Général-Koenig, 51100 Reims, France; Laboratoire de recherche en Santé Publique, Vieillissement, Qualité de vie et Réadaptation des Sujets Fragiles, EA 3797, Université de Reims Champagne-Ardenne, Reims, France
| | - Damien Metz
- Cardiology Department, University Hospital of Reims, rue du Général-Koenig, 51100 Reims, France
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23
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Stähli BE, Linke A, Westermann D, Van Mieghem NM, Leistner DM, Massberg S, Alber H, Mügge A, Musumeci G, Kesterke R, Schneider S, Kastrati A, Ford I, Ruschitzka F, Kasel MA, Stähli BE, Kasel M, Ruschitzka F, Linke A, Van Mieghem N, Massberg S, Westermann D, Alber H, Mügge A, Leistner DM, Musumeci G, Schneider S, Kastrati A, Ford I, Savonitto S, Witzenbichler B, Swaans M, Swedberg K, Pocock S, Maggioni A. A randomized comparison of the treatment sequence of percutaneous coronary intervention and transcatheter aortic valve implantation: Rationale and design of the TAVI PCI trial. Am Heart J 2024; 277:104-113. [PMID: 39121916 DOI: 10.1016/j.ahj.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND About half of patients with severe aortic stenosis present with concomitant coronary artery disease. The optimal timing of percutaneous coronary intervention (PCI) and transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis and concomitant coronary artery disease remains unknown. STUDY DESIGN The TAVI PCI trial is a prospective, international, multicenter, randomized, 2-arm, open-label study planning to enroll a total of 986 patients. It is designed to investigate whether the strategy "angiography-guided complete revascularization after (within 1-45 days) TAVI" is noninferior to the strategy "angiography-guided complete revascularization before (within 1-45 days) TAVI" using the Edwards SAPIEN 3 or 3 Ultra Transcatheter Heart Valve in patients with severe aortic stenosis and concomitant coronary artery disease. Patients are randomized in a 1:1 ratio to one of the 2 treatment strategies. The primary end point is a composite of all-cause death, nonfatal myocardial infarction, ischemia-driven revascularization, rehospitalization (valve- or procedure-related including heart failure), or life-threatening/disabling or major bleeding at 1 year. CONCLUSIONS The TAVI PCI trial tests the hypothesis that the strategy "PCI after TAVI" is noninferior to the strategy "PCI before TAVI" in patients with severe aortic stenosis and concomitant coronary artery disease.
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Affiliation(s)
- Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum Dresden, University Clinic, Dresden, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Nicolas M Van Mieghem
- Department of Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - David M Leistner
- Department of Cardiology, University Heart Centre Frankfurt, University Hospital Frankfurt; DZHK (German Centre for Cardiovascular Research), Partner Site Rhine-Main, Frankfurt/Main, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU Munich, DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, LMU University Hospital, Munich, Germany
| | - Hannes Alber
- Department of Internal Medicine and Cardiology, Landeskrankenhaus, Klagenfurt, Austria
| | - Andreas Mügge
- Department of Cardiology and Rhythmology, University Hospital St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | | | - Rahel Kesterke
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | | | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Markus A Kasel
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, the Center for Translational and Experimental Cardiology, and the Faculty of Medicine, Zurich, Switzerland
| | - Markus Kasel
- Department of Cardiology, University Heart Center, University Hospital Zurich, the Center for Translational and Experimental Cardiology, and the Faculty of Medicine, Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, the Center for Translational and Experimental Cardiology, and the Faculty of Medicine, Zurich, Switzerland
| | - Axel Linke
- Technische Universität Dresden, Department of Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Dresden, Germany
| | - Nicolas Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU University Hospital, LMU Munich, Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, University of Freiburg Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hannes Alber
- Department of Cardiology, Public Hospital Klagenfurt am Woerthersee, Klagenfurt am Woerthersee, Austria
| | - Andreas Mügge
- University Hospital St Josef-Hospital, Cardiology and Rhythmology, Ruhr University Bochum, Germany
| | - David M Leistner
- Department of Medicine, Cardiology, Goethe University Hospital, and DZHK (German Center for Cardiovascular Research), Partner Site Rhein-Main, Frankfurt, Germany
| | - Giuseppe Musumeci
- Cardiology Department, Azienda Ospedaliera Ordine Mauriziano Umberto I, Turin, Italy
| | | | - Adnan Kastrati
- Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | | | | | - Martin Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Karl Swedberg
- Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aldo Maggioni
- ANMCO Research Center, Heart Care Foundation, Firenze, Italy
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24
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Shekhar S, Isogai T, Agrawal A, Kaw R, Mahalwar G, Krishnaswamy A, Puri R, Reed G, Mentias A, Kapadia S. Outcomes and Predictors of Stroke After Transcatheter Aortic Valve Replacement in the Cerebral Protection Device Era. J Am Heart Assoc 2024; 13:e034298. [PMID: 39101495 DOI: 10.1161/jaha.124.034298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/06/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Studies have shown inconclusive results on the effectiveness of cerebral protection devices (CPDs) with transcatheter aortic valve replacement. We aimed to analyze the national statistics on stroke and other outcomes with CPD use. METHODS AND RESULTS The Nationwide Readmissions Database (2017-2020) was queried to obtain data on patients undergoing transcatheter aortic valve replacement. Outcomes were compared between patients with a CPD and patients without a CPD. Of 271 804 patients undergoing transcatheter aortic valve replacement, CPD was used in 7.3% of patients. In a multivariable logistic regression analysis, CPD use was not associated with lower overall stroke rates (1.6% versus 1.9% without CPD; odds ratio, 0.95 [95% CI, 0.84-1.07]; P=0.364), but it was significantly associated with lower major stroke rates (1.2% versus 1.5% without CPD; odds ratio, 0.85 [95% CI, 0.74-0.98]; P=0.02). Patients with a CPD also had a shorter length of stay, higher routine discharges to home/self-care (74.9% versus 70.6%), and lower mortality rates (0.7% versus 1.3%). The 30-day (9.6% versus 11.7%) and 180-day (24.6% versus 28.2%) readmission rates were significantly lower in the CPD cohort. Among patients who developed stroke, patients with a CPD had more frequent routine discharges. Prior valve surgery was associated with the highest risk of overall and major stroke. CONCLUSIONS CPD use during transcatheter aortic valve replacement was not independently associated with a lower risk of overall stroke but was associated with a lower risk of major stroke in a multivariable model. Data from future randomized trials that may offset any potential confounders in our study are required to help identify patients who would benefit from the use of these devices.
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Affiliation(s)
- Shashank Shekhar
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Roop Kaw
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Gauranga Mahalwar
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Grant Reed
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Amgad Mentias
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
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25
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Abdel-Razek O, El Khoury A, McGrail D, Laham RJ. Successful transcatheter aortic valve replacement in a failing HAART 300 aortic valve annuloplasty ring: A case report. Catheter Cardiovasc Interv 2024. [PMID: 39099535 DOI: 10.1002/ccd.31177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/24/2024] [Accepted: 07/28/2024] [Indexed: 08/06/2024]
Abstract
Transcutaneous aortic valve replacement (TAVR) has evolved from a complex procedure meant only for patients at prohibitive risk for surgery to a commonly performed procedure across a wide variety of clinical scenarios including the treatment of failed aortic valve bioprosthesis. Annuloplasty rings in the aortic position such as HAART 300 (Biostable Science and Engineering) have been introduced in the management of native aortic regurgitation. Percutaneous management of failed bioprosthesis rings in the aortic position has not been widely described. We present a case of a 69-year-old man with recurrent aortic regurgitation successfully treated with TAVR using a SAPIEN 3 valve within a HAART 300 ring.
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Affiliation(s)
- Omar Abdel-Razek
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alessandro El Khoury
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel McGrail
- Department of Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Roger J Laham
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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26
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Fukuhara S, Kim KM, Yang B, Romano M, Ailawadi G, Patel HJ, Deeb GM. Reoperation following transcatheter aortic valve replacement: Insights from 10 years' experience. J Thorac Cardiovasc Surg 2024; 168:488-497.e3. [PMID: 37164056 DOI: 10.1016/j.jtcvs.2023.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Use of transcatheter aortic valve replacement (TAVR) has demonstrated dramatic growth in the past decade. This study aims to investigate implications of post-TAVR reoperation from our 10-year experience. METHODS Between 2011 and 2022, 66 post-TAVR patients underwent a reoperation, consisting of 42 (63.6%) patients with native TAVR and 24 (36.4%) patients with valve-in-valve TAVR (VIV-TAVR) after surgical aortic valve replacement. RESULTS The aggregate proportion of patients belonging to the low-/intermediate-risk group at the time of TAVR exceeded that of the high-/extreme-risk cohort in 2021. The native TAVR group received a larger TAVR valve, whereas more frequent low-risk status at the time of TAVR than the VIV-TAVR group. Concurrent procedures were highly common during reoperation and isolated surgical aortic valve replacement represented only 18.2% of the entire cohort. The native TAVR group demonstrated significantly higher TAVR explant difficulty index score (2.0 vs 1.0 points; P < .001) and operative mortality (14.2% vs 0%; P = .079) compared with the VIV-TAVR group. The 8-year cumulative incidence of reoperation was 1.9% and 14.1% (subdistribution hazard ratio, 8.0; 95% CI, 4.1-15.9; P < .001) in the native and VIV-TAVR group, respectively. Furthermore, cumulative incidence of valve reintervention, combining reoperations and redo TAVRs, was 3.3% and 19.0% (subdistribution hazard ratio, 6.2; 95% CI, 3.6-10.9; P < .001). CONCLUSIONS Low-/intermediate-risk patients are emerging as the predominant group necessitating reoperations. Native TAVR was associated with lower postimplant reintervention rates, albeit with higher reoperative technical difficulty and mortality. Conversely, VIV-TAVR was associated with higher reintervention, but demonstrated lower technical difficulty and mortality for reoperation.
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Affiliation(s)
- Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
| | - Karen M Kim
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Bo Yang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Matthew Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
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27
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Nguyen ET, Green CR, Adams SJ, Bishop H, Gleeton G, Hague CJ, Hanneman K, Harris S, Strzelczyk J, Dennie C. CAR and CSTR Cardiac Computed Tomography (CT) Practice Guidelines: Part 2-Non-Coronary Imaging. Can Assoc Radiol J 2024; 75:502-517. [PMID: 38486374 DOI: 10.1177/08465371241233228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024] Open
Abstract
The cardiac computed tomography (CT) practice guidelines provide an updated review of the technological improvements since the publication of the first Canadian Association of Radiologists (CAR) cardiac CT practice guidelines in 2009. An overview of the current evidence supporting the use of cardiac CT in the most common clinical scenarios, standards of practice to optimize patient preparation and safety as well as image quality are described. Coronary CT angiography (CCTA) is the focus of Part I. In Part II, an overview of cardiac CT for non-coronary indications that include valvular and pericardial imaging, tumour and mass evaluation, pulmonary vein imaging, and imaging of congenital heart disease for diagnosis and treatment monitoring are discussed. The guidelines are intended to be relevant for community hospitals and large academic centres with established cardiac CT imaging programs.
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Affiliation(s)
- Elsie T Nguyen
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | | | - Scott J Adams
- Department of Medical Imaging, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Helen Bishop
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Guylaine Gleeton
- Department of Radiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, QC, Canada
| | - Cameron J Hague
- Department of Diagnostic Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Kate Hanneman
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Scott Harris
- Department of Radiology, Memorial University, St. John's, NL, Canada
| | - Jacek Strzelczyk
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada
| | - Carole Dennie
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON, Canada
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28
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McHugh S, Allaham H, Chahal D, Gupta A. Coronary Artery Revascularization in Patients Undergoing Transcatheter Aortic Valve Replacement. Cardiol Clin 2024; 42:333-338. [PMID: 38910018 DOI: 10.1016/j.ccl.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Patients with concomitant severe aortic stenosis and significant coronary artery disease present a diagnostic and therapeutic challenge in clinical practice. There are no clear-cut guidelines as to the timing of revascularization in these patients who are referred for transcatheter aortic valve replacement (TAVR). This article aims to show that in patients without high-grade proximal coronary artery disease, revascularization after TAVR is safe, feasible, and practical. Additionally, the use of preoperative TAVR computed tomographic angiography might be used in both intermediate and high-risk patients rather than invasive coronary angiography to assess for significant proximal coronary artery disease to help guide the timing of revascularization.
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Affiliation(s)
| | | | - Diljon Chahal
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Anuj Gupta
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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29
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Fallahtafti P, Soleimani H, Ebrahimi P, Ghaseminejad‐Raeini A, Karimi E, Shirinezhad A, Sabri M, Mehrani M, Taheri H, Siegel R, Shah N, Nanna M, Hakim D, Hosseini K. Comparative Analysis of PCI Strategies in Aortic Stenosis Patients Undergoing TAVI: A Systematic Review and Network Meta-Analysis. Clin Cardiol 2024; 47:e24324. [PMID: 39054901 PMCID: PMC11272956 DOI: 10.1002/clc.24324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has been increasingly used in patients with severe aortic stenosis (AS). Since coronary artery disease (CAD) is common among these patients, it is crucial to choose the best method and timing of revascularization. This study aims to compare different timing strategies of percutaneous coronary intervention (PCI) in patients with severe AS undergoing TAVI to clarify whether PCI timing affects the patients' outcomes or not. METHODS A frequentist network meta-analysis was conducted comparing three different revascularization strategies in patients with CAD undergoing TAVI. The 30-day all-cause mortality, in-hospital mortality, all-cause mortality at 1 year, 30-day rates of myocardial infarction (MI), stroke, and major bleeding, and the need for pacemaker implantation at 6 months were analyzed in this study. RESULTS Our meta-analysis revealed that PCI during TAVI had higher 30-day mortality (RR = 2.46, 95% CI = 1.40-4.32) and in-hospital mortality (RR = 1.70, 95% CI = [1.08-2.69]) compared to no PCI. Post-TAVI PCI was associated with higher 1-year mortality compared to other strategies. While no significant differences in major bleeding or stroke were observed, PCI during TAVI versus no PCI (RR = 3.63, 95% CI = 1.27-10.43) showed a higher rate of 30-day MI. CONCLUSION Our findings suggest that among patients with severe AS and CAD undergoing TAVI, PCI concomitantly with TAVI seems to be associated with worse 30-day outcomes compared with no PCI. PCI after TAVI demonstrated an increased risk of 1-year mortality compared to alternative strategies. Choosing a timing strategy should be individualized based on patient characteristics and procedural considerations.
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Affiliation(s)
- Parisa Fallahtafti
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Hamidreza Soleimani
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Pouya Ebrahimi
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | | | - Elaheh Karimi
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
- School of MedicineTehran University of Medical SciencesTehranIran
| | | | - Mahshad Sabri
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Mehdi Mehrani
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Homa Taheri
- Smidt Heart InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Robert Siegel
- Smidt Heart InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Neeraj Shah
- Independence Health estmoreland HospitalGreensburgPennsylvaniaUSA
| | - Michael Nanna
- Section of Cardiovascular MedicineYale University School of MedicineNew HavenCTUSA
| | - Diaa Hakim
- Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
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30
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Khan MS, Baqi A, Tahir A, Ghumman GM, Ullah W, Shah J, Sattar Y, Mir T, Sheikh Z, Salman F, Baghal M, Luthra K, Khatri V, Waqar Z, Khan MWZ, Taleb M, Ali SS. National Estimates for the Percentage of All Readmissions With Demographic Features, Morbidity, Overall and Gender-Specific Mortality of Transcutaneous Versus Open Surgical Tricuspid Valve Replacement/Repair. Cardiol Res 2024; 15:223-232. [PMID: 39205967 PMCID: PMC11349133 DOI: 10.14740/cr1625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/24/2024] [Indexed: 09/04/2024] Open
Abstract
Background The aim of the study was to determine national estimates for the percentage of all readmissions with demographic features, length of stay (LOS), cost analysis, comorbidities, complications, overall and gender-specific mortality and complications of transcutaneous tricuspid valve replacement/repair (TTVR) vs. open surgical tricuspid valve replacement/repair (open TVR). Methods Data were extrapolated from the Nationwide Readmissions Database (NRD) 2015-19. Of the 75,266,750 (unweighted) cases recorded in the 2015 - 2019 dataset, 429 had one or more of the percutaneous approach codes as per the ICD-10 dataset, and 10,077 had one or more of the open approach codes. Results Overall, the number of cases performed each year through open TVR was higher than TTVR, but there was an increased trend towards the TTVR every passing year. TTVR was performed more in females and advanced age groups than open TVR. The LOS and cost were lower in the TTVR group than in open TVR. Patients undergoing TTVR had more underlying comorbidities like congestive heart failure, hypertension, and uncomplicated diabetes mellitus. Overall mortality was 3.49% in TTVR vs. 6.09% in open TVR. The gender-specific analysis demonstrated higher female mortality in the open TVR compared to TTVR (5.45% vs. 3.03%). Male mortality was statistically insignificant between the two groups (6.8% vs. 4.3%, P-value = 0.15). Patients with TTVR had lower rates of complications than open TVR, except for arrhythmias, which were higher in TTVR. Patients undergoing open TVR required more intracardiac support, such as intra-aortic balloon pump (IABP) and Impella, than TTVR. Conclusion TTVR is an emerging alternative to open TVR in patients with tricuspid valve diseases, especially tricuspid regurgitation. Despite having more underlying comorbidities, the TTVR group had lower in-hospital mortality, hospital cost, LOS, and fewer complications than open TVR.
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Affiliation(s)
| | - Abdul Baqi
- Department of Internal Medicine, Mercy Saint Vincent Medical Center, Toledo, OH, USA
| | - Ayesha Tahir
- Department of Internal Medicine, Mercy Saint Vincent Medical Center, Toledo, OH, USA
| | | | - Waqas Ullah
- Department of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Jay Shah
- Department of Cardiology, Mercy Saint Vincent Medical Center, Toledo, OH, USA
| | - Yasar Sattar
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Tanveer Mir
- Department of Cardiology, Detroit Medical Center/Wayne State University, Detroit, MI, USA
| | - Zain Sheikh
- Department of Internal Medicine, Franciscan Health Care, Michigan City, IN, USA
| | - Fnu Salman
- Department of Cardiology, Mercy Saint Vincent Medical Center, Toledo, OH, USA
| | - Moaaz Baghal
- Department of Cardiology, Mercy Saint Vincent Medical Center, Toledo, OH, USA
| | - Kritika Luthra
- Department of Cardiology, Mercy Saint Vincent Medical Center, Toledo, OH, USA
| | - Vinod Khatri
- Department of Pulmonology, Mercy Saint Vincent Medical Center, Toledo, OH, USA
| | - Zainulabedin Waqar
- Department of Internal Medicine, Mercy Saint Vincent Medical Center, Toledo, OH, USA
| | | | - Mohammed Taleb
- Department of Cardiology, Mercy Saint Vincent Medical Center, Toledo, OH, USA
| | - Syed Sohail Ali
- Department of Cardiology, Mercy Saint Vincent Medical Center, Toledo, OH, USA
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Imamura T, Ushijima R, Sobajima M, Fukuda N, Ueno H, Kinugawa K. Prognostic impact of insomnia in patients receiving trans-catheter aortic valve replacement. J Cardiol 2024; 84:113-118. [PMID: 38580176 DOI: 10.1016/j.jjcc.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/27/2024] [Accepted: 03/14/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND The presence of insomnia exhibits a profound association with diverse cardiovascular pathologies. However, its prognostic implications in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis remain ambiguous. METHODS This retrospective study enrolled patients who underwent TAVR for severe aortic stenosis at a prominent academic center from 2015 to 2022. The impact of insomnia, operationally defined as the prescription of soporific agents, on the two-year composite primary outcome comprising all-cause mortality and hospital readmissions was scrutinized. RESULTS A cohort of 345 patients (median age 85 years, 99 males) was encompassed in the analysis. All subjects underwent successful TAVR and subsequent discharge. The presence of insomnia (N = 91) emerged as an independent predictor of the two-year composite endpoint, with an adjusted hazard ratio of 1.66 (95 % confidence interval 1.08-2.57, p = 0.022), significantly delineating the two-year cumulative incidence of the primary endpoint (40 % versus 30 %, p = 0.035). CONCLUSION Approximately one-fourth of TAVR candidates manifested symptoms of insomnia, a condition autonomously correlated with heightened mortality and morbidity following the TAVR procedure. The optimal strategy for addressing insomnia in TAVR candidates constitutes a paramount consideration for future interventions.
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Affiliation(s)
- Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
| | - Ryuichi Ushijima
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Mitsuo Sobajima
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Nobuyuki Fukuda
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Hiroshi Ueno
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
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Li R, Luo Q, Huddleston SJ. African Americans have worse outcomes after transcatheter and surgical aortic valve replacement: A national inpatient sample analysis from 2015 to 2020. J Cardiol 2024; 84:105-112. [PMID: 38373538 DOI: 10.1016/j.jjcc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Racial disparities in transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are controversial among African Americans (AA). This study investigated racial disparities comparing AA and Caucasians undergoing aortic valve replacement. METHODS Patients who underwent SAVR and TAVR for aortic stenosis were identified in National Inpatient Sample from Q4 2015-2020. In-hospital perioperative outcomes, length of stay, days from admission to operation, and total hospital charge, were compared between AA and Caucasians using multivariable analysis, adjusting for sex, age, socioeconomic status, comorbidity, and hospital characteristics. RESULTS In TAVR, 51,394 (84.41 %) were Caucasians and 2433 (4.00 %) were AA. In SAVR, there were 50,080 (78.52 %) Caucasians and 3565 (5.59 %) AA. Compared to Caucasians, AA underwent TAVR had a higher risk of complications such as major adverse cardiovascular events (MACE) [adjusted odds ratio (aOR) = 1.335, p = 0.02)], respiratory complications (aOR = 1.363, p = 0.01), acute kidney injury (AKI) (aOR = 1.468, p < 0.01), pulmonary embolism (aOR = 4.65, p = 0.05), hemorrhage/hematoma (aOR = 1.202, p < 0.01), or superficial wound complication (aOR = 1.414, p = 0.04). AA who underwent SAVR had higher risks of morality (aOR = 1.184, p < 0.05) and surgical complications including MACE (aOR = 1.263, p < 0.01), pericardial complications (aOR = 1.563, p < 0.01), cardiogenic shock (aOR = 1.578, p < 0.01), respiratory complications (aOR = 1.261, p < 0.01), AKI (aOR = 1.642, p < 0.01), venous thromboembolism (aOR = 1.613, p < 0.01), hemorrhage/hematoma (aOR = 1.129, p < 0.01), infection (aOR = 1.234, p < 0.01), superficial wound complications (aOR = 1.756, p < 0.01), vascular complications (aOR = 1.592, p < 0.01), and diaphragmatic paralysis (aOR = 2.181, p = 0.02). In both TAVR and SAVR, AA had longer waiting times from admission to operation (p < 0.01), longer hospital stays (p < 0.01), and higher hospital charges (p < 0.01). CONCLUSION AA were underrepresented, especially in TAVR. AA experienced higher in-hospital mortality post-SAVR, but not after TAVR. Furthermore, AA had more complications for both TAVR and SAVR. These findings underscore the pronounced disparities among AA in aortic valve replacement.
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Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Qianyun Luo
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Stephen J Huddleston
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
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Di Pietro G, Improta R, De Filippo O, Bruno F, Birtolo LI, Tocci M, Fabris T, Saade W, Colantonio R, Celli P, Sardella G, Esposito G, Tarantini G, Mancone M, D'Ascenzo F. Transcatheter Aortic Valve Replacement in Low Surgical Risk Patients: An Updated Metanalysis of Extended Follow-Up Randomized Controlled Trials. Am J Cardiol 2024; 224:56-64. [PMID: 38729335 DOI: 10.1016/j.amjcard.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/03/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
The long-term safety and effectiveness of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR) in low surgical risk has not been evaluated in a pooled analysis. An electronic database search was conducted for randomized controlled trials with a maximal 5 years clinical and echocardiographic follow-up including low surgical risk patients who underwent TAVR or SAVR. We calculated odds ratio (OR) and 95% confidence intervals (CIs) using a random-effects model. Subgroups analysis was performed for permanent pacemaker implantation and paravalvular leaks. Three randomized controlled trials were included with a total of 2,611 low surgical risk patients (Society of Thoracic Surgeons score <4%). Compared with SAVR, the TAVR group had similar rates of all-cause mortality (OR 0.94,95% CI 0.65 to 1.37, p = 0.75) and disabling stroke (OR 0.84, 95% CI 0.52 to 1.36, p = 0.48). No significant differences were registered in the TAVR group in terms of major cardiovascular events (OR 0.96, 95% CI 0.67 to 1.38, p = 0.83), myocardial infarction (OR 0.69, 95% CI 0.34 to 1.40, p = 0.31), valve thrombosis (OR 3.11, 95% CI 0.29 to 33.47, p = 0.35), endocarditis (OR 0.71,95% CI 0.35 to 1.48, p = 0.36), aortic valve reintervention (OR 0.93, 95% CI 0.52 to 1.66, p = 0.80), and rehospitalization (OR 0.80, 95% CI 0.52 to 1.02, p = 0.07) compared with SAVR. However, TAVR patients had a higher risk of paravalvular leaks (OR 8.21, 95% CI 4.18 to 16.14, p <0.00001), but lower rates of new-onset atrial fibrillation (OR 0.27,95% CI 0.17 to 0.30, p <0.0001). The rates of permanent pacemaker implantation were comparable from 1 year up to a maximum of 5 years (OR 1.32, 95% CI 0.88 to 1.97, p = 0.18). Lastly, TAVR had a greater effective orifice area (0.10 cm2/m2, 95% CI 0.05 to 0.15, p = 0.0001), but similar transvalvular mean gradients (0.60, 95% CI 3.94 to 2.73, p = 0.72). In conclusion, TAVR patients had similar long-term outcomes compared with SAVR, except for an elevated risk of paravalvular leaks in the TAVR group and increased rates of atrial fibrillation in the SAVR cohort.
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Affiliation(s)
- Gianluca Di Pietro
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy; Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
| | - Riccardo Improta
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy; Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
| | - Ovidio De Filippo
- Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
| | - Francesco Bruno
- Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Marco Tocci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Tommaso Fabris
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Wael Saade
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Riccardo Colantonio
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Paola Celli
- Department of General and Specialistic Surgery "Paride Stefanini", "Sapienza" University of Rome, Rome, Italy
| | - Gennaro Sardella
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy.
| | - Fabrizio D'Ascenzo
- Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
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Hyung K An J, Faridmoayer E, Haefner L, Salami AC, Sharath SE, Kougias P. Trends and predictors of inflation-adjusted costs in transcatheter and surgical aortic valve replacement in a nationally representative sample. Surgery 2024; 176:289-294. [PMID: 38772777 DOI: 10.1016/j.surg.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/05/2024] [Accepted: 04/13/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Transcatheter aortic valve replacement has become an accepted alternative to surgical aortic valve replacement. We examined the trends and predictors in inflation-adjusted costs of transcatheter aortic valve replacement and surgical aortic valve replacement. METHODS National Inpatient Sample identified patients who underwent aortic valve replacement for severe aortic stenosis by International Classification of Diseases, Ninth and Tenth Revisions, codes. Hospitalization costs were inflation-adjusted using the Federal Reserve's consumer price index to reflect current valuation. Outcomes of interest were unadjusted trend in annual cost for each procedure and predictors of in-patient cost. Generalized linear models with a log link function identified predictors of adjusted costs. Interaction terms determined where cost predictors were different by operation type. RESULTS Between 2011 and 2019, the mean annual inflation-adjusted cost of surgical aortic valve replacement increased from $62,853 to $63,743, in contrast to decreasing cost of transcatheter aortic valve replacement from $64,913 to $56,042 ($1,854 per year; P = .004). Significant independent predictors of patient-level cost included operation type (transcatheter aortic valve replacement associated with $9,625 increase; P < .001), incidence of in-hospital mortality ($28,836 increase; P < .001), elective status ($2,410 decrease; P < .001), Elixhauser Index ($995 increase; P < .001), and postoperative length of stay ($2,014 per day increase; P < .001). Compared to discharges with Medicare, discharges with private insurance and Medicaid paid $736 less (P = .004) and $1,863 less (P = .01), respectively. Increasing hospital volume was a significant predictor of decreasing patient level cost (P < .001). CONCLUSION Annual cost of transcatheter aortic valve replacement has decreased significantly and has been a more cost-effective modality compared to surgical aortic valve replacement since 2017. Predictors of patient-level costs allow for mindful preparation of healthcare systems for aortic valve replacement.
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Affiliation(s)
- Ju Hyung K An
- Department of Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY. https://twitter.com/kja485
| | - Erfan Faridmoayer
- Department of Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY. https://twitter.com/ErfanFarid
| | - Lindsay Haefner
- Department of Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY
| | - Aitua C Salami
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN. https://twitter.com/ACSalami
| | - Sherene E Sharath
- Department of Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY.
| | - Panos Kougias
- Department of Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY. https://twitter.com/KougiasP
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Radico F, Biancari F, D’Ascenzo F, Saia F, Luzi G, Bedogni F, Amat-Santos IJ, De Marzo V, Dimagli A, Mäkikallio T, Stabile E, Blasco-Turrión S, Testa L, Barbanti M, Tamburino C, Porto I, Fabiocchi F, Conrotto F, Pelliccia F, Costa G, Stefanini GG, Macchione A, La Torre M, Bendandi F, Juvonen T, Pasceri V, Wańha W, Benedetto U, Miraldi F, Dobrev D, Zimarino M. Red blood cell transfusion and mortality after transcatheter aortic valve implantation via transapical approach: A propensity-matched comparison from the TRITAVI registry. IJC HEART & VASCULATURE 2024; 53:101460. [PMID: 39070183 PMCID: PMC11278079 DOI: 10.1016/j.ijcha.2024.101460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/07/2024] [Accepted: 06/21/2024] [Indexed: 07/30/2024]
Abstract
Objective Bleeding is frequent during transcatheter aortic valve implantation (TAVI), especially when performed through a transapical approach (TA), and is associated with a worse prognosis. The present study aims to test the implication of red blood cell (RBC) transfusion and the optimal transfusion strategy in this context. Methods Among 11,265 participants in the multicenter TRITAVI (Transfusion Requirements in Transcatheter Aortic Valve Implantation) registry, 548 patients (4.9%) who received TA-TAVI at 19 European centers were included. One-to-one propensity score matching was performed to reduce treatment selection bias and potential confounding among transfused versus non-transfused patients. The primary endpoint of the study was the 30-day occurrence of all-cause mortality. Results 209 patients (38 %) received RBC transfusions. The primary endpoint occurred in 47 (8.6 %) patients. Propensity score matching identified 188 pairs of patients with and without RBC transfusion. In the propensity score-matched analysis, RBC transfusion was associated with increased 30-day mortality (HR 3.35, 95 % CI 1.51 - 7.39; p = 0.002). At multivariable cox regression analysis, RBC transfusion was an independent predictor of 30-day mortality (HR 3.07, 95 % CI 1.01-9.41, p = 0.048), as well as baseline ejection fraction (HR 0.96, 95 % CI 0.92-0.99, p = 0.043), and acute kidney injury (HR 3.95, 95 % CI 1.11-14.05, p = 0.034). Conclusions RBC transfusion is an independent predictor of short-term mortality in patients undergoing TA-TAVI, regardless of major bleeding.Clinical trial registration: https://www.clinicaltrials.gov Unique identifier: NCT03740425.
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Affiliation(s)
- Francesco Radico
- Department of Cardiology, ASL2 Abruzzo and Department of Neuroscience, Imaging and Clinical Sciences, ’G. D’Annunzio’ University of Chieti-Pescara, Italy
| | - Fausto Biancari
- Department of Medicine, South Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Fabrizio D’Ascenzo
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Francesco Saia
- Department of Cardiothoracic Vascular, University Hospital, Bologna, Italy
| | - Giampaolo Luzi
- Cardiovascular Department, Azienda Ospedaliera Regionale “San Carlo”, Potenza, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Ignacio J. Amat-Santos
- CIBERCV, Interventional Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Vincenzo De Marzo
- Department of Cardiology, ASL2 Abruzzo and Department of Neuroscience, Imaging and Clinical Sciences, ’G. D’Annunzio’ University of Chieti-Pescara, Italy
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties University of Genoa Italy
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, the United States of America
| | - Timo Mäkikallio
- Department of Medicine, South Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Eugenio Stabile
- Cardiovascular Department, Azienda Ospedaliera Regionale “San Carlo”, Potenza, Italy
| | - Sara Blasco-Turrión
- CIBERCV, Interventional Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
| | - Italo Porto
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties University of Genoa Italy
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa Italy
| | - Franco Fabiocchi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Galeazzi-Sant’Ambrogio Hospital, I.R.C.C.S. Milan, Italy
| | - Federico Conrotto
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | | | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
| | | | - Andrea Macchione
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa Italy
| | - Michele La Torre
- Department of Cardiothoracic Vascular, University Hospital, Bologna, Italy
| | - Francesco Bendandi
- Department of Cardiothoracic Vascular, University Hospital, Bologna, Italy
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | | | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Umberto Benedetto
- Department of Cardiac Surgery, University “G. d’Annunzio”, Chieti, Italy
| | - Fabio Miraldi
- Department of Cardiovascular Sciences, University Sapienza, Rome, Italy
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
- Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
- Department of Integrative Physiology, Baylor College of Medicine, Houston, TX, the United States of America
| | - Marco Zimarino
- Department of Cardiology, ASL2 Abruzzo and Department of Neuroscience, Imaging and Clinical Sciences, ’G. D’Annunzio’ University of Chieti-Pescara, Italy
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Etiwy M, Flannery LD, Li SX, Morrison FJ, Kim J, Tanguturi VK, Fraccaro C, Coylewright M, Turchin A, Elmariah S, Wasfy JH. Examining lack of referrals to heart valve specialists as mechanisms of potential underutilization of aortic valve replacement. Am Heart J 2024; 274:54-64. [PMID: 38621577 DOI: 10.1016/j.ahj.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/29/2024] [Accepted: 04/11/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Recent studies suggest that aortic valve replacement (AVR) remains underutilized. AIMS Investigate the potential role of non-referral to heart valve specialists (HVS) on AVR utilization. METHODS Patients with severe aortic stenosis (AS) between 2015 and 2018, who met class I indication for intervention, were identified. Baseline data and process-related parameters were collected to analyze referral predictors and evaluate outcomes. RESULTS Among 981 patients meeting criteria AVR, 790 patients (80.5%) were assessed by HVS within six months of index TTE. Factors linked to reduced referral included increasing age (OR: 0.95; 95% CI: 0.94-0.97; P < .001), unmarried status (OR: 0.59; 95% CI: 0.43-0.83; P = .002) and inpatient TTE (OR: 0.27; 95% CI: 0.19-0.38; P < .001). Conversely, higher hematocrit (OR: 1.13; 95% CI: 1.09-1.16; P < .001) and eGFR (OR: 1.01; 95% CI: 1.00-1.02; P = .003), mean aortic valve gradient (OR: 1.03; 95% CI: 1.01-1.04; P < .001) and preserved LVEF (OR: 1.59; 95% CI: 1.02-2.48; P = .04), were associated with increased referral likelihood. Moreover, patients assessed by HVS referral as a time-dependent covariate had a significantly lower two-year mortality risk than those who were not (aHR: 0.30; 95% CI: 0.23-0.39; P < .001). CONCLUSION A substantial proportion of severe AS patients meeting indications for AVR are not evaluated by HVS and experience markedly increased mortality. Further research is warranted to assess the efficacy of care delivery mechanisms, such as e-consults, and telemedicine, to improve access to HVS expertise.
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Affiliation(s)
- Muhammad Etiwy
- Department of Medicine, Division of Hospital Medicine, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH; Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laura D Flannery
- Department of Medicine, Division of Cardiology, OhioHealth Doctors Hospital, Columbus, OH
| | - Shawn X Li
- Department of Medicine, Division of Cardiology, The University of California San Francisco, CA
| | - Fritha J Morrison
- Department of Medicine, Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joonghee Kim
- Department of Medicine, Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Varsha K Tanguturi
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Megan Coylewright
- Erlanger Health System, University of Tennessee-Chattanooga, Chattanooga, TN
| | - Alexander Turchin
- Department of Medicine, Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sammy Elmariah
- Department of Medicine, Division of Cardiology, The University of California San Francisco, CA,.
| | - Jason H Wasfy
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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Han M, Kang J, Kwon S, Jeon J, You SJ, Hwang D, Han JK, Yang HM, Park KW, Kang HJ, Koo BK, Kim HS. The Impact of Transcatheter Aortic Valve Implantation on Health Care Costs and Clinical Outcomes Based on Frailty Risk: A Nationwide Cohort Analysis. Can J Cardiol 2024:S0828-282X(24)00584-1. [PMID: 39095015 DOI: 10.1016/j.cjca.2024.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is preferred for treating severe aortic stenosis in older, frail populations, yet the impact of frailty on economic and clinical outcomes of TAVI is not well studied. METHODS This retrospective cohort study included 2175 TAVI patients from 2015 to 2019, using Korea's National Health Insurance Service database, stratifying patients into low, intermediate, and high-frailty groups, using the Hospital Frailty Risk Score (HFRS). Health care costs, admissions, and total length of hospitalization were analyzed using Wilcoxon-rank test 12 months pre- and post-TAVI. Composite endpoint of death, stroke, and major bleeding, with individual outcomes, were compared using χ2 tests and Kaplan-Meier analysis. RESULTS Mean age was 80.2 years, and 47.3% were male; 747 (34.3%) were low frailty, 1159 (53.3%) were moderate frailty, and 269 (12.4%) were high frailty. After TAVI, medical costs decreased in the intermediate- (pre-TAVI: 2,269,000 KRW [$1668 USD], post-TAVI: 1,607,000 KRW [$1181 USD]; P < 0.001) and high-frailty groups (pre-TAVI: 3,949,000 KRW [$2904 USD], post-TAVI: 2,188,000 KRW [$1609 USD]; P < 0.001). All frailty groups had shorter length of hospital stay post-TAVI (26 to 21 days in the low-frailty, 44 to 31 days in the intermediate-frailty, and 65 to 41 days in the high-frailty group; all P <0.001). The composite outcome was higher in the frailer groups (27.8% in the low-frailty vs 31.5% in the intermediate-frailty vs 37.9% in the high-frailty group; P = 0.008). All groups showed comparable rates of cardiovascular death, stroke, or bleeding. CONCLUSIONS TAVI is clinically viable and cost-saving treatment option for frail patients with severe aortic stenosis.
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Affiliation(s)
- Minju Han
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sol Kwon
- Medtronic Korea, Ltd, Seoul, South Korea
| | | | | | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Kyu Han
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Han-Mo Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jae Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Wu DA, Lang P, Varghese D, Al-Attar N, Shaikhrezai K, Zamvar V, Nair S. Short-term outcomes after surgical aortic valve replacement in elderly patients - results of a comparative cohort study. J Cardiothorac Surg 2024; 19:474. [PMID: 39085905 PMCID: PMC11290239 DOI: 10.1186/s13019-024-02970-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 07/03/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND With the introduction of transcatheter aortic valve implantation, the role of surgical aortic valve replacement (SAVR) in elderly patients has been called into question. We investigated the short-term outcomes of SAVR in the elderly population. METHODS All patients aged ≥ 70 years who underwent isolated SAVR in our centre between 2008 and 2017 were included in the study. Survival at 30 days and 1 year were compared for patients aged 70-79 years (n = 809) versus patients aged ≥ 80 years (n = 322). Factors associated with poorer survival outcomes were identified using multivariable Cox regression analysis. RESULTS Patients aged 70-79 years and patients aged ≥ 80 years had similar survival rates at 30 days (98.1% vs. 98.4%, p = 0.732) and 1 year (96.0% vs. 94.1%, p = 0.162) post-SAVR. This remained true after multivariable adjustment. Risk factors for 30 day all-cause mortality included insulin dependent diabetes (HR 6.17, 95% CI 1.32-28.92, p = 0.021) and increasing cardiopulmonary bypass time (HR 2.72, 95% CI 1.89-3.91, p < 0.0001). Significant risk factors for 1 year all-cause mortality were New York Heart Association (NYHA) class IV (HR 6.25, 95% CI 1.55-25.24, p = 0.010) and longer cardiopulmonary bypass time (HR 1.94, 95% CI 1.40-2.69, p < 0.0001). Similar results were obtained for cardiac-specific mortality. CONCLUSIONS Short-term outcomes of SAVR are excellent in elderly patients and age alone is not a predictor of poorer outcomes. However, the increased risk of mortality in patients with insulin-dependent diabetes and those with severe functional impairment (NYHA class IV) should be carefully considered when selecting patients for SAVR in this elderly population.
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Affiliation(s)
- Diana A Wu
- Golden Jubilee National Hospital, Agamemnon Street, Glasgow, G81 4DY, UK
| | - Peter Lang
- Golden Jubilee National Hospital, Agamemnon Street, Glasgow, G81 4DY, UK.
| | - David Varghese
- Golden Jubilee National Hospital, Agamemnon Street, Glasgow, G81 4DY, UK
| | - Nawwar Al-Attar
- Golden Jubilee National Hospital, Agamemnon Street, Glasgow, G81 4DY, UK
| | - Kasra Shaikhrezai
- Golden Jubilee National Hospital, Agamemnon Street, Glasgow, G81 4DY, UK
| | - Vipin Zamvar
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK
| | - Sukumaran Nair
- Golden Jubilee National Hospital, Agamemnon Street, Glasgow, G81 4DY, UK
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Cammardella AG, Russo M, Di Mauro M, Romagnoni C, Ceresa F, Patanè F, Gelpi G, Pollari F, Barili F, Parolari A, Ranocchi F. SURgical vs. PERcutaneous ACCESS in Transfemoral Transcatheter Aortic Valve Implantation (SU-PER-ACCESS Study). J Clin Med 2024; 13:4471. [PMID: 39124736 PMCID: PMC11313030 DOI: 10.3390/jcm13154471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/15/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Background: The transfemoral (TF) approach is the most common route in TAVI, but it is still associated with a risk of bleeding and vascular complications. The aim of this study was to compare the clinical outcomes between surgical cut-down (SC) and percutaneous (PC) approach. (2) Methods: Between January 2018 and June 2022, 774 patients underwent a transfemoral TAVI procedure. After propensity matching, 323 patients underwent TAVI in each group. (3) Results: In the matched population, 15 patients (4.6%) in the SC group vs. 34 patients in the PC group (11%) experienced minor vascular complications (p = 0.02), while no difference for major vascular complication (1.5% vs. 1.9%) were reported. The rate of minor bleeding events was higher in the percutaneous group (11% vs. 3.1%, p <.001). The SC group experienced a higher rate of non-vascular-related access complications (minor 8% vs. 1.2%; major 2.2% vs. 1.2%; p < 0.001). (4) Conclusions: SC for TF-TAVI did not alter the mortality rate at 30 days and was associated with reduced minor vascular complication and bleeding. PC showed a lower rate of non-vascular-related access complications and a lower length of stay. The specific approach should be tailored to the patient's clinical characteristics.
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Affiliation(s)
| | - Marco Russo
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, 00152 Rome, Italy
| | - Michele Di Mauro
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Claudia Romagnoni
- Department of Cardiothoracic Surgery, IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, 20122 Milano, Italy
| | - Fabrizio Ceresa
- Department of Cardiothoracic Surgery, Azienda Ospedaliera Papardo, 98158 Messina, Italy
| | - Francesco Patanè
- Department of Cardiothoracic Surgery, Azienda Ospedaliera Papardo, 98158 Messina, Italy
| | - Guido Gelpi
- Department of Cardiothoracic Surgery, IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, 20122 Milano, Italy
| | - Francesco Pollari
- Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, 90471 Nuremberg, Germany
| | - Fabio Barili
- Department of Biomedical and Clinical Sciences, Universitá degli Studi di Milano, 20122 Milan, Italy
- University Cardiac Surgery Unit, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20157 Milan, Italy
- Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Alessandro Parolari
- University Unit of Cardiac Surgery, IRCCS Policlinico S. Donato, S. Donato Milanese, 20097 Milan, Italy
- Department of Biomedical Sciences, University of Milano, 20174 Milan, Italy
| | - Federico Ranocchi
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, 00152 Rome, Italy
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Al-Bayati A, Alrifai A, Darmoch F, Alkhaimy H, Fanari Z. Transcatheter aortic valve replacement outcomes in patients with high gradient versus low ejection fraction low gradient severe aortic stenosis: A meta-analysis of randomized controlled trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00606-7. [PMID: 39089911 DOI: 10.1016/j.carrev.2024.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/23/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The outcome of Low Flow-Low Gradient (LF-LG) severe aortic stenosis (AS) patients who underwent Transcatheter Aortic Valve Replacement (TAVR) procedure is not well defined. We conducted a systematic review of the literature to compare the outcomes of TAVR in LF-LG AS patients to the more traditional high gradient (HG) aortic stenosis. METHODS We comprehensively searched for controlled randomized and non-randomized studies from 4 online databases. We are presenting the data using risk ratios (95 % confidence intervals) and measuring heterogeneity using Higgins' I2 index. RESULTS Our analysis included 4380 patients with 3425 HG patients and 955 LF-LG patients from 6 cohort (5 retrospective and 1 prospective) studies. When compared to LFLG; TAVR was associated with significantly lower 30 days mortality in HG patients (5.1 % vs 7.4 %; relative risk [RR]: 0.55; 95 % confidence interval [CI]: 0.35 to 0.86; p < 0.01). Similar findings were also observed in 12-month cardiovascular (CV) mortality (5.5 % vs. 10.4 %; RR: 0.47; 95 % CI: 0.38 to 0.60; p < 0.01 and 12-month all-cause mortality (15.9 % vs 20.9 %; RR: 0.70; 95 % CI: 0.49 to 1.00; p < 0.05). There was no significant difference in myocardial infarction (MI) after TAVR between HG and LF-LG at 30 days (0.16 % vs. 0.95 %; p < 0.09) or 12 months (0.43 % vs. 0.95 %; p = 0.20). Similarly, there was no difference in stroke rates at 30 days (2.9 % vs. 2.86 %) or at 12 months (3.6 % vs. 3.06 %). CONCLUSIONS AND RELEVANCE Patients with LF-LG severe AS who underwent TAVR had worse 1-year all-cause mortality, 30-day all-cause, and 1-year CV mortality when compared to TAVR in HG severe AS. There was no difference in MI or stroke rates. Therefore, with heart team discussion and informed patient decision regarding the risk and benefit, TAVR would still offer better outcomes in LFLG AS compared to conservative medical management.
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Affiliation(s)
| | | | - Fahed Darmoch
- Northside Hospital Cardiovascular Institute, Cumming, GA, USA
| | - Haytham Alkhaimy
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Zaher Fanari
- University of California San Francisco, Fresno, CA, USA.
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Luca T, Cristina G, Giulia C, Claudia F, Marianna A, Mauro M, Giuseppe B, Bruno M, Matteo M, Barbara B, Arnaldo P, Erica F, Antonio S, Mattia S, Francesco DF, Carmine M, Mazzapicchi A, Nedy B, Tullio P, Marco DC, Francesco B. Transcatheter aortic valve replacement with corevalve self-expanding bioprosthesis: Clinical and durability data up to 12 years. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00590-6. [PMID: 39089909 DOI: 10.1016/j.carrev.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/19/2024] [Accepted: 07/17/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND AND AIMS Transcatheter aortic valve replacement (TAVR) determined a paradigm shift in the treatment of patients with severe symptomatic aortic stenosis but data on very long-term durability are lacking. We sought to evaluate the clinical and hemodynamic outcomes of the CoreValve porcine pericardial self-expanding bioprosthesis at 12-year follow-up. METHODS 882 inoperable or high-risk patients were treated with the CoreValve bioprosthesis in 8 Italian high-volume centers between 2007 and 2011. The endpoints were 12-year all-cause and cardiovascular mortality, and Cumulative Incidence Functions (CIFs) for severe Structural Valve Deterioration (SVD), Bioprosthetic Valve Dysfunction (BVD), Bioprosthetic Valve Failure (BVF), and severe Hemodynamic Valve Deterioration (HVD). VARC-3 definitions were applied. RESULTS Baseline characteristics included a mean age of 83 ± 6 years, and NYHA class III or IV in 76.3 % of patients. The actuarial risk of death at 12 years after TAVR was 95.5 % (CI 93.5 %- 97.1 %). The actual risk of cardiovascular death, weighted against the risk of non-cardiac death at 12 years was 23.9 % (21.0 %-26.8 %). The 12-year actual risk of BVD was 7.0 % (5.3 %-8.9 %), of SVD was 3.6 % (2.5 %-5.2 %), of BVF was 3.12 % (2.02 %-4.57 %), and of severe HVD was 1.7 % (0.9 %-2.9 %). Mean transaortic gradient significantly decreased after the procedure (52 ± 15 mmHg vs 9 ± 5 mmHg, p < 0.001), and remained stable up to 12 years (12 ± 4 mmHg, P = 0.08 vs. discharge). CONCLUSIONS The first-generation CoreValve bioprosthesis showed reassuring clinical and hemodynamic performance at 12-year follow-up.
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Affiliation(s)
- Testa Luca
- Cardiology Department, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy.
| | - Giannini Cristina
- Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Costa Giulia
- Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Fiorina Claudia
- Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | - Adamo Marianna
- Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | - Massussi Mauro
- Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | - Bruschi Giuseppe
- De Gasperis" Cardio Center ASST Niguarda Metropolitan Hospital, Milan, Italy
| | - Merlanti Bruno
- De Gasperis" Cardio Center ASST Niguarda Metropolitan Hospital, Milan, Italy
| | - Montorfano Matteo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Bellini Barbara
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Poli Arnaldo
- Interventional Cardiology Unit, ASST Ovest Milanese, Legnano Hospital, Milan, Italy
| | - Ferrara Erica
- Interventional Cardiology Unit, ASST Ovest Milanese, Legnano Hospital, Milan, Italy
| | - Sisinni Antonio
- Cardiology Department, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | - Squillace Mattia
- Cardiology Department, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | | | - Musto Carmine
- Interventional Cardiology Unit, S. Camillo Forlanini Hospital, Rome, Italy
| | | | - Brambilla Nedy
- Cardiology Department, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | | | - De Carlo Marco
- Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Bedogni Francesco
- Cardiology Department, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
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Lee SH, Yoon SJ, Sun BJ, Kim HM, Kim HY, Lee S, Shim CY, Kim EK, Cho DH, Park JB, Seo JS, Son JW, Kim IC, Lee SH, Heo R, Lee HJ, Park JH, Song JM, Lee SC, Kim H, Kang DH, Ha JW, Kim KH. 2023 Korean Society of Echocardiography position paper for diagnosis and management of valvular heart disease, part I: aortic valve disease. J Cardiovasc Imaging 2024; 32:11. [PMID: 39061115 PMCID: PMC11282617 DOI: 10.1186/s44348-024-00019-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/24/2023] [Indexed: 07/28/2024] Open
Abstract
This manuscript represents the official position of the Korean Society of Echocardiography on valvular heart diseases. This position paper focuses on the clinical management of valvular heart diseases with reference to the guidelines recently published by the American College of Cardiology/American Heart Association and the European Society of Cardiology. The committee tried to reflect the recently published results on the topic of valvular heart diseases and Korean data by a systematic literature search based on validity and relevance. In part I of this article, we will review and discuss the current position of aortic valve disease in Korea.
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Affiliation(s)
- Sun Hwa Lee
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Se-Jung Yoon
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Byung Joo Sun
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyue Mee Kim
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hyung Yoon Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Sahmin Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong-Sook Seo
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jung-Woo Son
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - In-Cheol Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Sang-Hyun Lee
- Division of Cardiology, Pusan National Yangsan Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National Yangsan Hospital, Busan, Republic of Korea
| | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
- Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jong-Min Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyungseop Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
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Eng MH, Khalili H, Vavalle J, Al-Azizi KM, Waggoner T, Southard JA, Fang K, Hahn RT, Lee J, Wang DD, Eleid MF, O'Neill WW, Abbas AE. 3-Year Outcomes of Balloon-Expandable Valves: 20-mm vs Larger Valves (≥23 mm). JACC Cardiovasc Interv 2024:S1936-8798(24)00857-4. [PMID: 39177555 DOI: 10.1016/j.jcin.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/09/2024] [Accepted: 06/04/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND A prior Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry-based analysis reported similar 1-year clinical outcomes with small (20-mm) vs large (≥23-mm) balloon-expandable valves (BEV). OBJECTIVES The aim of this study was to describe mid-term 3-year clinical outcomes for small vs large BEV and the relationship between discharge echocardiographic mean gradient (MG) and different definitions of prothesis-patient mismatch (PPM) with clinical outcomes. METHODS Using the TVT Registry with Centers for Medicare and Medicaid Services linkage, a propensity-matched analysis of patients receiving 20- vs ≥23-mm BEVs was performed. Spline curves and Kaplan-Meier plots with adjusted HRs determined the relationship between MG and 3-year mortality. RESULTS In total, 316,091 patients were analyzed; after propensity matching, 8,100 pairs of each group were compared. The 20-mm BEV was associated with higher MGs compared with ≥23-mm BEVs (16.2 ± 7.2 mm Hg vs 11.8 ± 5.7 mm Hg; P < 0.0001). At 3 years, there was no difference in mortality between 20- and ≥23-mm BEVs (31.5% vs 32.5%, respectively; HR: 0.97; 95% CI: 0.90-1.05). Compared with an MG of 10 to 30 mm Hg, an MG <10 mm Hg (HR: 1.25; 95% CI:1.22-1.27) was associated with increased 3-year mortality. Measured severe PPM and predicted no PPM were associated with increased 3-year mortality (33.5% vs 32.9% vs 32.1%; P < 0.0001) and (33.5% vs 31.1% vs 30%; P < 0.0001), respectively. Low MG and severe measured PPM were associated with lower left ventricular ejection fraction (LVEF). CONCLUSIONS Patients with small-prosthesis BEVs (20 mm) had identical 3-year survival as those with larger (≥23-mm) BEV valves. Severe measured PPM and low MG (<10 mm Hg), but not predicted severe PPM, were associated with lower LVEF and increased mortality, suggesting that LVEF is the culprit for worse outcomes.
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Affiliation(s)
- Marvin H Eng
- Banner University Medical Center-Phoenix, Phoenix, Arizona, USA.
| | - Houman Khalili
- Florida Atlantic University, Boca Raton, Florida, USA; Memorial Healthcare System, Hollywood, Florida, USA
| | - John Vavalle
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | | | - Tom Waggoner
- Tucson Medical Center Healthcare, Tucson, Arizona, USA
| | - Jefferey A Southard
- Division of Cardiovascular Medicine, University of California, Davis, Davis, California, USA
| | - Kenith Fang
- Banner University Medical Center-Phoenix, Phoenix, Arizona, USA
| | - Rebecca T Hahn
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - James Lee
- Center for Structural Heart Disease, Henry Ford Hospital, Cardiology Division, Detroit, Michigan, USA
| | - Dee Dee Wang
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William W O'Neill
- Center for Structural Heart Disease, Henry Ford Hospital, Cardiology Division, Detroit, Michigan, USA
| | - Amr E Abbas
- Corewell Health East, William Beaumont University Hospital, Royal Oak, Michigan, USA
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Imamura T, Narang N, Ushijima R, Sobajima M, Fukuda N, Ueno H, Kinugawa K. Impaired Gastrointestinal Motility and Worsening Heart Failure in Patients Receiving Trans-Catheter Aortic Valve Replacement. J Clin Med 2024; 13:4301. [PMID: 39124567 PMCID: PMC11313607 DOI: 10.3390/jcm13154301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 06/18/2024] [Accepted: 07/20/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Impaired gastric motility in the form of constipation may often occur in elderly patients with chronic heart failure. Candidates for trans-catheter aortic replacement (TAVR) are of old age and have multiple comorbidities, probably including constipation. However, the clinical implication of a history of constipation in patients receiving TAVR remains unknown. Methods: Patients who underwent TAVR at our large academic center between 2015 and 2022 were eligible. The prognostic impact of the prescribed laxative type and number, which was assumed as the severity of constipation, on the incidence of death or heart failure readmission two years after index discharge was investigated. Results: A total of 344 patients were included. Median age was 85 years, and 99 patients were men. Patients with any laxatives (N = 166) had higher systolic blood pressure, higher plasma B-type natriuretic peptide levels, and a lower prescription rate of renin-angiotensin system inhibitors at the time of index discharge after TAVR (p < 0.05 for all). The number of laxative types was independently associated with the composite primary outcome with an adjusted hazard ratio of 1.83 (95% confidence interval 1.27-2.63, p = 0.001) with a cutoff of one type of laxative used, which significantly stratified the 2-year cumulative incidence of the primary outcome (18% versus 7%, p = 0.001). Conclusions: The presence of constipation was associated with worse clinical outcomes following TAVR. The prognostic impact of an aggressive intervention for constipation remains a future concern in this cohort.
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Affiliation(s)
- Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Nikhil Narang
- Advocate Christ Medical Center, Oak Lawn, IL 60453, USA
| | - Ryuichi Ushijima
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Mitsuo Sobajima
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Nobuyuki Fukuda
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Hiroshi Ueno
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan
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Spadaccio C, Nenna A, Pisani A, Laskawski G, Nappi F, Moon MR, Biancari F, Jassar AS, Greason KL, Shrestha ML, Bonaros N, Rose D. Sutureless Valves, a "Wireless" Option for Patients With Aortic Valve Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 84:382-407. [PMID: 39019533 DOI: 10.1016/j.jacc.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/21/2024] [Accepted: 05/03/2024] [Indexed: 07/19/2024]
Abstract
Transcatheter technologies triggered the recent revision of the guidelines that progressively widened the indications for the treatment of aortic stenosis. On the surgical realm, a technology avoiding the need for sutures to anchor the prosthesis to the aortic annulus has been developed with the aim to reduce the duration of cardiopulmonary bypass and simplify the process of valve implantation. In addition to a transcatheter aortic valve replacement (TAVR)-like stent that exerts a radial force, these so-called "rapid deployment valves" or "sutureless valves" for aortic valve replacement also have cuffs to improve sealing and reduce the risk of paravalvular leak. Despite promising, the actual advantage of sutureless valves over traditional surgical procedures (surgical aortic valve replacement) or TAVR is still debated. This review summarizes the current comparative evidence reporting outcomes of "sutureless valves" for aortic valve replacement to TAVR and surgical aortic valve replacement in the treatment of aortic valve stenosis.
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Affiliation(s)
- Cristiano Spadaccio
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom; Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Antonio Nenna
- Cardiovascular Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Angelo Pisani
- Cardiac Surgery, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Grzegorz Laskawski
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom
| | - Francesco Nappi
- Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Marc R Moon
- Cardiothoracic Surgery, Baylor College of Medicine/Texas Heart Institute, Houston, Texas, USA
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital/University of Helsinki, Helsinki, Finland
| | - Arminder S Jassar
- Cardiac Surgery, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
| | - Kevin L Greason
- Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Malakh L Shrestha
- Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA; Cardiothoracic Surgery, Hannover Medical School, Hannover, Germany
| | - Nikolaos Bonaros
- Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - David Rose
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom
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46
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Bapat VN, Fukui M, Zaid S, Okada A, Jilaihawi H, Rogers T, Khalique O, Cavalcante JL, Landes U, Sathananthan J, Tarantini G, Tang GHL, Blackman DJ, De Backer O, Mack MJ, Leon MB. A Guide to Transcatheter Aortic Valve Design and Systematic Planning for a Redo-TAV (TAV-in-TAV) Procedure. JACC Cardiovasc Interv 2024; 17:1631-1651. [PMID: 39048251 DOI: 10.1016/j.jcin.2024.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/27/2024] [Accepted: 04/30/2024] [Indexed: 07/27/2024]
Abstract
Transcatheter aortic valve replacement (TAVR) has become more common than surgical aortic valve replacement since 2016, with over 200,000 procedures globally each year. As patients increasingly outlive their TAVR devices, managing these cases is a growing concern. Treatment options include surgical removal of the old TAVR device (transcatheter aortic valve [TAV] explant) or implantation of a new transcatheter aortic valve (redo TAV). Redo TAV is complex because of the unique designs of TAV devices; compatibility issues; and the need for individualized planning based on factors such as implant depth, shape, and coronary artery relationships. This review serves as a comprehensive guide for redo TAV, detailing the design characteristics of TAV devices, device compatibility, standardized terminology, and a structured approach for computed tomography analysis. It aims to facilitate decision making, risk identification, and achieving optimal outcomes in redo TAV procedures.
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Affiliation(s)
- Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
| | - Miho Fukui
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Syed Zaid
- Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas, USA
| | - Atsushi Okada
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Hasan Jilaihawi
- Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, California, USA
| | - Toby Rogers
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Omar Khalique
- Division of Cardiovascular Imaging at St. Francis Hospital, New York, New York, USA
| | - João L Cavalcante
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Uri Landes
- Edith Wolfson Medical Center, Cardiology Department, Tel-Aviv University, Holon, Israel
| | | | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | | | - Ole De Backer
- The Heart Center, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Martin B Leon
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
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Ungar A, Rivasi G, Testa GD, Boureau AS, Mattace-Raso F, Martínez-Sellés M, Bo M, Petrovic M, Werner N, Benetos A. Geriatricians' role in the management of aortic stenosis in frail older patients: a decade later. Eur Geriatr Med 2024:10.1007/s41999-024-01015-9. [PMID: 39037643 DOI: 10.1007/s41999-024-01015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 06/25/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Increasing evidence supports the implementation of geriatric assessment in the workup of older patients with aortic stenosis (AS). In 2012, an online European survey revealed that geriatricians were rarely involved in the assessment of candidates for transcatheter aortic valve implantation (TAVI). After a "call to action" for early involvement of geriatricians in AS evaluation, the survey was repeated in 2022. Our aim was to investigate whether geriatricians' role changed in the last decade. METHODS Online survey conducted between December 16th, 2021, and December 15th, 2022. All members of the European Geriatric Medicine Society were invited to participate. The survey included 26 questions regarding geriatricians' experience with AS and TAVI. RESULTS Among 193 respondents (79.8% geriatricians), 73 (38%) reported to be involved in AS evaluation at least once a week. During 2 years prior to the survey, 43 (22.3%) had referred > 50% of their patients with severe AS for TAVI. Age influenced TAVI referral in a considerable proportion of respondents (36.8%). TAVI candidates were mainly referred to specialised cardiac centres with multidisciplinary teams (91.8%), including (47.2%) or not including (44.6%) a geriatrician. A total of 38.9% of respondents reported to be part of a multidisciplinary heart team. Geriatricians were less frequently involved (37%) than cardiologists (89.6%) and surgeons (53.4%) in pre-procedural TAVI management. Cardiologists were more frequently involved (85.5%) than geriatricians (33.7%) and surgeons (26.9%) in post-procedural management. CONCLUSIONS Geriatricians' involvement in AS management and multidisciplinary heart teams remains scarce. More efforts should be devoted to implement geriatricians' role in AS decision-making.
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Affiliation(s)
- Andrea Ungar
- Geriatrics and Intensive Care Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Giulia Rivasi
- Geriatrics and Intensive Care Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Giuseppe Dario Testa
- Geriatrics and Intensive Care Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Anne Sophie Boureau
- Nantes Université, CHU Nantes, Pole de Gérontologie Clinique, 44000, Nantes, France
| | - Francesco Mattace-Raso
- Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Mario Bo
- Section of Geriatric, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Molinette, Turin, Italy
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Nikos Werner
- Heart Center Trier, Department of Internal Medicine III, Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany
| | - Athanase Benetos
- Geriatric Department and Federation Hospital-University On Cardiovascular Aging (FHU-CARTAGE), University Hospital of Nancy, Université de Lorraine, Vandoeuvre-Lès-Nancy, France
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Bacco LD, D’Alonzo M, Eusanio MD, Rosati F, Solinas M, Baudo M, Folliguet T, Benussi S, Fischlein T, Muneretto C. Sutureless Aortic Valve Replacement vs. Transcatheter Aortic Valve Implantation in Patients with Small Aortic Annulus: Clinical and Hemodynamic Outcomes from a Multi-Institutional Study. Braz J Cardiovasc Surg 2024; 39:e20230155. [PMID: 39038084 PMCID: PMC11259373 DOI: 10.21470/1678-9741-2023-0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/21/2023] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVE This study aimed to compare hemodynamic performances and clinical outcomes of patients with small aortic annulus (SAA) who underwent aortic valve replacement by means of sutureless aortic valve replacement (SUAVR) or transcatheter aortic valve implantation (TAVI). METHODS From 2015 to 2020, 622 consecutive patients with SAA underwent either SUAVR or TAVI. Through a 1:1 propensity score matching analysis, two homogeneous groups of 146 patients were formed. Primary endpoint: all cause-death at 36 months. Secondary endpoints: incidence of moderate to severe patient-prosthesis mismatch (PPM) and incidence of major adverse cardiovascular and cerebrovascular events (MACCEs). RESULTS All-cause death at three years was higher in the TAVI group (SUAVR 12.2% vs. TAVI 21.0%, P=0.058). Perioperatively, comparable hemodynamic performances were recorded in terms of indexed effective orifice area (SUAVR 1.12 ± 0.23 cm2/m2 vs. TAVI 1.17 ± 0.28 cm2/m2, P=0.265), mean transvalvular gradients (SUAVR 12.9 ± 5.3 mmHg vs. TAVI 12.2 ± 6.2 mmHg, P=0.332), and moderate-to-severe PPM (SUAVR 4.1% vs. TAVI 8.9%, P=0.096). TAVI group showed a higher cumulative incidence of MACCEs at 36 months (SUAVR 18.1% vs. TAVI 32.6%, P<0.001). Pacemaker implantation (PMI) and perivalvular leak ≥ 2 were significantly higher in TAVI group and identified as independent predictors of mortality (PMI: hazard ratio [HR] 3.05, 95% confidence interval [CI] 1.34-6.94, P=0.008; PPM: HR 2.72, 95% CI 1.25-5.94, P=0.012). CONCLUSION In patients with SAA, SUAVR and TAVI showed comparable hemodynamic performances. Moreover, all-cause death and incidence of MACCEs at follow-up were significantly higher in TAVI group.
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Affiliation(s)
- Lorenzo Di Bacco
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia,
University of Brescia, Brescia, Italy
| | - Michele D’Alonzo
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia,
University of Brescia, Brescia, Italy
| | - Marco Di Eusanio
- Cardiovascular Surgery Department, Ospedali Riuniti, Ancona, Italy
| | - Fabrizio Rosati
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia,
University of Brescia, Brescia, Italy
| | - Marco Solinas
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital,
Massa, Italy
| | - Massimo Baudo
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia,
University of Brescia, Brescia, Italy
| | - Thierry Folliguet
- Cardiac surgery, Centre Hospitalier Universitaire Mondor,
Créteil, France
| | - Stefano Benussi
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia,
University of Brescia, Brescia, Italy
| | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg, Nuremberg,
Germany
| | - Claudio Muneretto
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia,
University of Brescia, Brescia, Italy
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Bonnet M, Maxo L, Lohse T, Mangin L, Courand PY, Ricard C, Bouali A, Boussel L, Aktaa S, Ali N, Gerelli S, Lantelme P, Harbaoui B. Association Between Aortic Wall Thrombus and Thromboembolic Events After Transfemoral Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2024; 17:1680-1690. [PMID: 39048255 DOI: 10.1016/j.jcin.2024.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/05/2024] [Accepted: 05/21/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Thromboembolic events, particularly strokes, remain a major complication of transcatheter aortic valve replacement (TAVR). Embolic protection devices have failed to show significant clinical benefit in large randomized clinical trials. Aortic wall thrombus (AWT) is often observed on multidetector computed tomography during TAVR work-up, but its prognostic significance is uncertain. OBJECTIVES This study sought to evaluate the association between the presence of AWT and the incidence of thromboembolic outcomes in patients undergoing transfemoral (TF) TAVR for severe aortic stenosis. METHODS This was a prospective cohort study of consecutive patients who underwent TF TAVR for severe aortic stenosis between January 2011 and April 2022. A dedicated scale (range: 0-10) was qualitatively used to assess AWT. The primary outcome was a composite of procedural thromboembolic events defined as ischemic stroke, blue toe syndrome, bowel ischemia, or other solid organ infarction. The secondary endpoints were ischemic strokes and procedural death. RESULTS Of the 641 patients included, severe AWT (score ≥8) was identified in 73 (11.4%). The presence of severe AWT was strongly associated with an increase in the primary outcome (OR: 8.48; 95% CI: 3.36-21.40; P < 0.001). This relationship persisted following multivariable analysis, which adjusted for comorbidities and procedural characteristics. The presence of severe AWT was also found to be associated with an increased incidence of stroke and procedural death (OR: 5.66; 95% CI: 2.00-15.30; P = 0.002 and OR: 4.66; 95% CI: 1.80-11.30; P = 0.002, respectively). CONCLUSIONS The presence of severe AWT on preprocedural multidetector computed tomography is strongly associated with thromboembolic complications including stroke and mortality after TF TAVR.
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Affiliation(s)
- Marc Bonnet
- Cardiology Department, (Institut de Cardiologie) Hospital Croix-Rousse and Hospital Lyon Sud, Hospices Civils de Lyon, Lyon, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France; Cardiology Department, Hospital Annecy-Genevois, Metz-Tessy, France
| | - Ludovic Maxo
- Cardiology Department, (Institut de Cardiologie) Hospital Croix-Rousse and Hospital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Thomas Lohse
- Cardiology Department, (Institut de Cardiologie) Hospital Croix-Rousse and Hospital Lyon Sud, Hospices Civils de Lyon, Lyon, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France
| | - Lionel Mangin
- Cardiology Department, Hospital Annecy-Genevois, Metz-Tessy, France
| | - Pierre-Yves Courand
- Cardiology Department, (Institut de Cardiologie) Hospital Croix-Rousse and Hospital Lyon Sud, Hospices Civils de Lyon, Lyon, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France
| | - Cécile Ricard
- Cardiology Department, Hospital Annecy-Genevois, Metz-Tessy, France
| | - Anissa Bouali
- Cardiology Department, (Institut de Cardiologie) Hospital Croix-Rousse and Hospital Lyon Sud, Hospices Civils de Lyon, Lyon, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France
| | - Loïc Boussel
- University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France; Radiology Department, Hospital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Suleman Aktaa
- Cardiology Department, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, United Kingdom
| | - Noman Ali
- Cardiology Department, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, United Kingdom
| | - Sébastien Gerelli
- Cardiac Surgery Department, Hospital Annecy-Genevois, Metz-Tessy, France
| | - Pierre Lantelme
- Cardiology Department, (Institut de Cardiologie) Hospital Croix-Rousse and Hospital Lyon Sud, Hospices Civils de Lyon, Lyon, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France
| | - Brahim Harbaoui
- Cardiology Department, (Institut de Cardiologie) Hospital Croix-Rousse and Hospital Lyon Sud, Hospices Civils de Lyon, Lyon, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France.
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50
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Hung Y, Lin C, Lin CS, Lee CC, Fang WH, Lee CC, Wang CH, Tsai DJ. Artificial Intelligence-Enabled Electrocardiography Predicts Future Pacemaker Implantation and Adverse Cardiovascular Events. J Med Syst 2024; 48:67. [PMID: 39028354 DOI: 10.1007/s10916-024-02088-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
Medical advances prolonging life have led to more permanent pacemaker implants. When pacemaker implantation (PMI) is commonly caused by sick sinus syndrome or conduction disorders, predicting PMI is challenging, as patients often experience related symptoms. This study was designed to create a deep learning model (DLM) for predicting future PMI from ECG data and assess its ability to predict future cardiovascular events. In this study, a DLM was trained on a dataset of 158,471 ECGs from 42,903 academic medical center patients, with additional validation involving 25,640 medical center patients and 26,538 community hospital patients. Primary analysis focused on predicting PMI within 90 days, while all-cause mortality, cardiovascular disease (CVD) mortality, and the development of various cardiovascular conditions were addressed with secondary analysis. The study's raw ECG DLM achieved area under the curve (AUC) values of 0.870, 0.878, and 0.883 for PMI prediction within 30, 60, and 90 days, respectively, along with sensitivities exceeding 82.0% and specificities over 81.9% in the internal validation. Significant ECG features included the PR interval, corrected QT interval, heart rate, QRS duration, P-wave axis, T-wave axis, and QRS complex axis. The AI-predicted PMI group had higher risks of PMI after 90 days (hazard ratio [HR]: 7.49, 95% CI: 5.40-10.39), all-cause mortality (HR: 1.91, 95% CI: 1.74-2.10), CVD mortality (HR: 3.53, 95% CI: 2.73-4.57), and new-onset adverse cardiovascular events. External validation confirmed the model's accuracy. Through ECG analyses, our AI DLM can alert clinicians and patients to the possibility of future PMI and related mortality and cardiovascular risks, aiding in timely patient intervention.
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Affiliation(s)
- Yuan Hung
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taipei, Taiwan, R.O.C
| | - Chin Lin
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Medical Technology Education Center, School of Medicine, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chin-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taipei, Taiwan, R.O.C
| | - Chiao-Chin Lee
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taipei, Taiwan, R.O.C
| | - Wen-Hui Fang
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chia-Cheng Lee
- Medical Informatics Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chih-Hung Wang
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Dung-Jang Tsai
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C..
- Medical Technology Education Center, School of Medicine, National Defense Medical Center, Taipei, Taiwan, R.O.C..
- Department of Statistics and Information Science, Fu Jen Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist, New Taipei City, 242062, Taiwan, R.O.C..
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