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Chamoun N, Jdaidani J, Iskandarani DZ, Ghalayini S, Zgheib A, Khoury A, Alam S, Rebeiz AG, Ghazzal Z, Sawaya F. Short-Term Clinical Outcomes of Transcatheter Aortic Valve Replacement in a Developing Country. Cureus 2024; 16:e58334. [PMID: 38752027 PMCID: PMC11095913 DOI: 10.7759/cureus.58334] [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] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) is an effective alternative to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis in all surgical risk groups. Reports of clinical outcomes post-TAVR in developing countries are scarce. We aimed to address the clinical outcomes and safety profile of TAVR in a developing country. METHODS We conducted a single-center, retrospective study on patients undergoing TAVR at the American University of Beirut Medical Center (AUBMC) from January 2016 to April 2023. We included a total of 399 patients. Our primary endpoint was to assess the rate of TAVR in-hospital and 30-day mortality, neurologic events, and new permanent pacemaker implantation (PPI) in patients, stratified by the Society of Thoracic Surgeons (STS) risk of mortality score. RESULTS Survival rates were 98.7% (394) at discharge vs. 97.5% (389) at 30 days post-procedure. The technical success rate was 95% (379) at the end of the procedure. Device success and early safety rates were 93.5% (373) and 83% (331), respectively at 30 days post-procedure. The all-cause mortality rate increased from 1.3% (5) at discharge to 2.5% (10) at 30-day intervals. The rate of ischemic stroke was 1.3% (five) at discharge and increased to 2% (eight) at 30 days post-procedure. PPI was needed in 5.8% (23) of patients at discharge with an increase to 7% (28) at one-month interval. Overall, the rates of TAVR outcomes among the three risk groups were comparable including neurologic events, valve-related complications, bleeding problems, vascular and access-related complications, and myocardial infarction. CONCLUSION This study at AUBMC highlights the successful implementation of the TAVR program in a developing country, showcasing its efficacy and safety within 30 days post-operation, despite challenges such as financial constraints and limited access to specialized training. Larger cohorts and longer follow-up periods are needed to accurately represent clinical outcomes in developing countries.
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Affiliation(s)
- Nadia Chamoun
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Jennifer Jdaidani
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | | | - Sarah Ghalayini
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Ali Zgheib
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Alessandro Khoury
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Samir Alam
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Abdallah G Rebeiz
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Ziyad Ghazzal
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Fadi Sawaya
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
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152
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Ahmad S, Yousaf A, Ghumman GM, Dvalishvili M, Ahsan MJ, Dilibe A, Reis HL, Qavi AH, Szerlip M, Goldsweig AM. Outcomes of transcatheter aortic valve replacement in patients with mitral annular calcification and concomitant mitral valve dysfunction: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 61:99-109. [PMID: 37867120 DOI: 10.1016/j.carrev.2023.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/07/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Calcific aortic stenosis is the principal indication for transcatheter aortic valve replacement (TAVR). Comorbid mitral annular calcification (MAC) is often present in patients undergoing TAVR. Limited data exist on the impact of MAC on TAVR outcomes. We conducted a systematic review and meta-analysis to explore the effects of MAC and concomitant mitral valve dysfunction (MVD) on TAVR outcomes. METHODS A comprehensive literature review was conducted using PubMed, Embase, Google Scholar, ClinicalTrials.gov, Scopus, and OVID for studies until March 20, 2023. Using the random-effects Mantel-Haenszel method, we calculated pooled risk ratios (RRs) and their corresponding 95 % confidence intervals (CIs) for all dichotomous variables. RESULTS Six studies comprising 5822 patients (2541 with MAC [severe MAC (>4 mm thickness) 583; non-severe MAC 1958; 400 with MVD; and 1071 without MVD], 3281 without MAC) met inclusion criteria. At 30 days and 1 year, no significant differences were observed between the overall MAC and no MAC groups in terms of mortality, stroke, and permanent pacemaker implantation. However, MAC with MVD was associated with a higher risk of all-cause mortality compared to MAC without MVD at 30 days (RR = 3.43, 95 % CI 2.04-5.76, P < 0.00001) and at 1 year (RR = 2.44, 95 % CI 1.85-3.20, P < 0.00001). Moreover, the risk of cardiovascular mortality was higher in patients with MAC and MVD compared to those with MAC alone (RR = 2.77, 95 % CI 1.89-4.06, P < 0.00001). Additionally, patients with severe MAC had a higher risk of major bleeding at 30 days compared to the non-severe MAC group (RR = 1.33, 95 % CI 1.04-1.69, P = 0.02). CONCLUSION TAVR appears to be safe in patients with non-severe MAC, but severe MAC is associated with a higher risk of major bleeding and concomitant MVD increases the mortality risk in patients undergoing TAVR.
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Affiliation(s)
- Soban Ahmad
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Department of Medicine, East Carolina University, Greenville, NC, USA.
| | - Amman Yousaf
- Department of Medicine, McLaren Flint-Michigan State University, Flint, MI, USA
| | | | | | | | - Arthur Dilibe
- Department of Medicine, East Carolina University, Greenville, NC, USA
| | - Heidi Lynn Reis
- William E Laupus Health Sciences Library, East Carolina University, Greenville, NC, USA
| | - Ahmed Hassaan Qavi
- Division of Cardiovascular Medicine, East Carolina Heart Institute, Greenville, NC, USA
| | - Molly Szerlip
- Department of Cardiology, Baylor Scott and White, The Heart Hospital Plano, Plano, TX, USA
| | - Andrew Michael Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Department of Cardiology, Baystate Medical Center/UMass Chan Medical School, Springfield, MA, USA
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153
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Russo G, Zambrano A, Burzotta F, Pedicino D, Graziani F, Cangemi S, Bianchini F, Bruno P, Locorotondo G, Calabrese M, Aurigemma C, Romagnoli E, Trani C. Temporal trends of frame expansion and paravalvular leak reduction after transcatheter aortic valve replacement with self-expandable prostheses. Minerva Cardiol Angiol 2024; 72:172-181. [PMID: 38088090 DOI: 10.23736/s2724-5683.23.06368-8] [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: 04/11/2024]
Abstract
BACKGROUND Paravalvular leakage (PVL) is a common finding after transcatheter aortic valve replacement (TAVR) and affects late clinical outcome. It is more frequent with self-expandable (SE) transcatheter-heart-valve (THV). Few is known about SE-THV expansion after implantation. The purpose is to assess SE-THV frame expansion and its possible influence on PVL. METHODS We designed a prospective pilot study to assess the time-course of SE-THV frame dimensions and PVL after TAVR. Consecutive patients undergoing TAVR with SE-THV were enrolled. Prosthesis fluoroscopy and echocardiography were prospectively performed immediately after TAVR (T0) and before discharge (T1) to grade PVL. Prosthesis diameters were assessed in 2 fluoroscopic orthogonal views. PVL reduction ≥1+ from T0 to T1 at echocardiography was the primary study endpoint. RESULTS Twenty-five patients were enrolled. Mean interval between T0 and T1 evaluations was 5 days. Grade 1 or 2 was present in 76% of patients at T0 and in 68% at T1 (P=0.034). A total of 7 patients (28%) improved PVL ≥1 grade from T0 to T1. Differences between T0 and T1 fluoroscopic diameters were not statistically significant. When comparing the diameter changes according to PVL evolution, patients with PVL improvement (as compared with those without) had significantly larger minimum diameter increase at both annulus/inflow (P=0.016) and outflow/distal edge (P=0.027). CONCLUSIONS PVL may improve in the early days after SE-THV and those patients with PVL improvement may have THV frame expansion. Further studies are needed to confirm such preliminary observations and to establish the clinical relevance of this phenomenon.
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Affiliation(s)
- Giulio Russo
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Aniello Zambrano
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Francesco Burzotta
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
- Sacred Heart Catholic University, Rome, Italy
| | - Daniela Pedicino
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Francesca Graziani
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Stefano Cangemi
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Francesco Bianchini
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Piergiorgio Bruno
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Gabriella Locorotondo
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Michele Calabrese
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Cristina Aurigemma
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Enrico Romagnoli
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Carlo Trani
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
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154
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Im JE, Jung EY, Lee SS, Min HK. Right anterior mini-thoracotomy aortic valve replacement versus transcatheter aortic valve implantation in octogenarians: a single-center retrospective study. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2024; 41:96-102. [PMID: 38404057 DOI: 10.12701/jyms.2023.01228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/26/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND The aim of this study was to compare the early outcomes of octogenarians undergoing minimally invasive right anterior mini-thoracotomy aortic valve replacement (RAT-AVR) with those undergoing transcatheter aortic valve implantation (TAVI) for aortic valve disease. METHODS In this single-center retrospective study, data were collected from octogenarians before and after RAT-AVR and TAVI between January 2021 and July 2022. Short-term outcomes, including the length of hospital stay, in-hospital mortality, all-cause mortality, and other major postoperative complications, were compared and analyzed. RESULTS There were no significant differences in in-hospital mortality, stroke, acute kidney dysfunction requiring renal replacement therapy, length of intensive care unit stay, or length of hospital stay. However, the TAVI group had a higher incidence of permanent pacemaker insertion (10% vs. 0%, p=0.54) and paravalvular leaks (75% vs. 0%, p<0.001). CONCLUSION In the present study on octogenarians, both TAVI and RAT-AVR showed comparable short-term results. Although both procedures were considered safe and effective in the selected group, RAT-AVR had a lower incidence of complete atrioventricular block and paravalvular regurgitation.
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Affiliation(s)
- Ji Eun Im
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Eun Yeung Jung
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Seok Soo Lee
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Ho-Ki Min
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine, Daegu, Korea
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155
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Rigattieri S, Bernelli C, Tomassini F, Caretta G, Moshiri S, Berni A, Varbella F, Menozzi A. Transcatheter aortic valve intervention in hospitals without cardiac surgery departments: a future scenario? Minerva Cardiol Angiol 2024; 72:204-211. [PMID: 35687317 DOI: 10.23736/s2724-5683.22.06076-8] [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: 02/18/2024]
Abstract
Transcatheter aortic valve intervention (TAVI) was introduced in early 2000 to offer treatment to inoperable patients with severe aortic valve stenosis. In a couple of decades, the procedure resulted effective and safe also in patients with intermediate to low risk for surgery; therefore, due to the progressive ageing of the population, the clinical need for TAVI is continuously increasing and is hardly met by the availability of the procedure, the so-called "TAVI capacity". As a result, many patients encounter difficulties in being referred to TAVI centers or face long waiting list times, thus risking severe adverse events (including death) before the procedure is performed. Although contemporary guidelines and consensus documents recommend that TAVI should only be performed in hospitals with active cardiac surgery departments, starting TAVI programs also in interventional cardiac laboratories without on-site cardiac surgery could represent a way to increase TAVI capacity, thus leading to a greater number of patients being treated in less time. On the other side of the coin, such a strategy may jeopardize patient safety in case of periprocedural complications needing bailout surgery and may lead to a suboptimal multidisciplinary Heart Team evaluation. This review aims to assess and discuss available clinical data and implementation of TAVI programs in hospitals without on-site active cardiac surgery departments considering the growing unmet clinical need and technical advancement of TAVI platforms, yet not overlooking the recommendations of international scientific societies.
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Affiliation(s)
- Stefano Rigattieri
- Interventional Cardiology Unit, Sant'Andrea University Hospital, Rome, Italy -
| | - Chiara Bernelli
- Department of Cardiology, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Francesco Tomassini
- Interventional Cardiology Unit, Ospedale degli Infermi, Rivoli, Turin, Italy
| | - Giorgio Caretta
- Section of Cardiology, Sant'Andrea Hospital, ASL 5, La Spezia, Italy
| | - Shahram Moshiri
- Department of Cardiology, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | - Andrea Berni
- Interventional Cardiology Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Ferdinando Varbella
- Interventional Cardiology Unit, Ospedale degli Infermi, Rivoli, Turin, Italy
| | - Alberto Menozzi
- Section of Cardiology, Sant'Andrea Hospital, ASL 5, La Spezia, Italy
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156
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Asif N, Ayoade P, Razzouk J, Bohen D, Tooker M, Gladstone L, Hoff J, Mohsen A, Arnold S, Rabkin DG. Multilayer Perceptron Neural Network Analysis of Fluoroscopic Working Angle on Transcatheter Aortic Valve Implantation Complications. Cureus 2024; 16:e59144. [PMID: 38803728 PMCID: PMC11129667 DOI: 10.7759/cureus.59144] [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] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND We sought to determine whether there is a relationship between the fluoroscopic working angle used to achieve a co-planar view during the deployment of the prosthesis during transcatheter aortic valve implantation (TAVI) and rates of complications, including paravalvular leaks, complete heart block, annular rupture, stroke, valve embolization, discharge to a skilled nursing facility and death within thirty days. METHODS All patients undergoing TAVI at our institution from 2015 to 2022 were retrospectively analyzed. Images were reviewed to determine the fluoroscopic working angle during deployment, and medical records were used to determine the incidence and type of complication. A multilayer perceptron was employed to evaluate the predictive ability of the fluoroscopic working angle during deployment on complications of one-day and 30-day paravalvular leak, 30-day mortality, the need for a new pacemaker, discharge to a skilled nursing facility, stroke and the requirement for emergency intervention. RESULTS Eight hundred and thirty-four patients were included in the study. Fluoroscopic working angle had excellent predictive value for stroke (area under the receiver operating characteristic curve (AUROC) of 0.812), one-day (AUROC 0.850), and 30-day paravalvular leak (AUROC 0.801). However, feature importance and scaled weighting analysis indicated that only a working angle in the left anterior oblique/cranial quadrant was informative for the development of an outcome of interest specific to a working angle quadrant (30-day paravalvular leak). CONCLUSION Fluoroscopic working angle may be a useful way to further refine well-established risk calculi during TAVI.
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Affiliation(s)
- Nathan Asif
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, USA
| | - Peace Ayoade
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, USA
| | - Jacob Razzouk
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, USA
| | - Daniel Bohen
- Viterbi School of Engineering, University of Southern California, Los Angeles, USA
| | - Megan Tooker
- Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, USA
| | - Lynne Gladstone
- Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, USA
| | - Jason Hoff
- Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, USA
| | - Amr Mohsen
- Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, USA
| | - Steve Arnold
- Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, USA
| | - David G Rabkin
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Loma Linda, USA
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157
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Elbaz-Greener G, Rahamim E, Abu Ghosh Z, Shadafny N, Alcalai R, Korach A, Carasso S, Wijeysundera HC, Igor T, Amir O, Rozen G, Planer D. Sex difference and outcome trends following surgical aortic valve replacement from the National Inpatient Sample (NIS) Database. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:161-168. [PMID: 38332715 DOI: 10.23736/s0021-9509.23.12729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND Based on worldwide registries, approximately 50% of patients who underwent aortic valve replacement (AVR) via surgical aortic valve replacement are females. Although AVR procedures have improved greatly in recent years, differences in outcome including mortality between sexes remain. We aimed to investigate the trends in SAVR outcomes in females versus males. METHODS Using the 2011-2017 National Inpatient Sample (NIS) database, we identified hospitalizations for patients with diagnosis of aortic stenosis during which SAVR was performed. Patients' sociodemographic and clinical characteristics, procedure complications, and mortality were analyzed. Piecewise regression analyses were performed to assess temporal trends in SAVR utilization in females versus males. Multivariable analyses were performed to identify predictors of in-hospital mortality. RESULTS A total of 392,087 hospitalizations for SAVR across the USA were analyzed. Utilization of SAVR in both sex patients decreased significantly during the years 2011-2017. Males compared to females had significantly higher rates of hyperlipidemia, chronic renal disease, peripheral artery disease, coronary artery disease and tended to be smokers. Differences in mortality rates among sexes were observed for SAVR procedures. Women had higher in-hospital mortality with 3.7% compared to men with 2.5% (OR 1.38 [95% CI 1.33-1.43, P<0.001]). In a multivariable regression model analysis adjusted for potential confounders, women had higher mortality risk with odd ratio (OR 1.38 [95% CI 1.33-1.43], P<0.001). Women had significantly higher rates of vascular complications (5.1% compared to men with 4.6%, P=0.002). CONCLUSIONS Utilization of SAVR showed a downward trend during the study period. Higher in-hospital mortality was recorded in females compared to males.
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Affiliation(s)
- Gabby Elbaz-Greener
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel -
| | - Eldad Rahamim
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Zahi Abu Ghosh
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Naseem Shadafny
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronny Alcalai
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amit Korach
- Department of Cardiac Surgery, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shemy Carasso
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
- Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Harindra C Wijeysundera
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Tomas Igor
- Institute for Cardiovascular Disease of Vojvodina, Belgrade, Serbia
| | - Offer Amir
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Guy Rozen
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - David Planer
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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158
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Guerra PG, Simpson CS, Van Spall HGC, Asgar AW, Billia P, Cadrin-Tourigny J, Chakrabarti S, Cheung CC, Dore A, Fordyce CB, Gouda P, Hassan A, Krahn A, Luc JGY, Mak S, McMurtry S, Norris C, Philippon F, Sapp J, Sheldon R, Silversides C, Steinberg C, Wood DA. Canadian Cardiovascular Society 2023 Guidelines on the Fitness to Drive. Can J Cardiol 2024; 40:500-523. [PMID: 37820870 DOI: 10.1016/j.cjca.2023.09.033] [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: 08/30/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
Cardiovascular conditions are among the most frequent causes of impairment to drive, because they might induce unpredictable mental state alterations via diverse mechanisms like myocardial ischemia, cardiac arrhythmias, and vascular dysfunction. Accordingly, health professionals are often asked to assess patients' fitness to drive (FTD). The Canadian Cardiovascular Society previously published FTD guidelines in 2003-2004; herein, we present updated FTD guidelines. Because there are no randomized trials on FTD, observational studies were used to estimate the risk of driving impairment in each situation, and recommendations made on the basis of Canadian Cardiovascular Society Risk of Harm formula. More restrictive recommendations were made for commercial drivers, who spend longer average times behind the wheel, use larger vehicles, and might transport a larger number of passengers. We provide guidance for individuals with: (1) active coronary artery disease; (2) various forms of valvular heart disease; (3) heart failure, heart transplant, and left ventricular assist device situations; (4) arrhythmia syndromes; (5) implantable devices; (6) syncope history; and (7) congenital heart disease. We suggest appropriate waiting times after cardiac interventions or acute illnesses before driving resumption. When short-term driving cessation is recommended, recommendations are on the basis of expert consensus rather than the Risk of Harm formula because risk elevation is expected to be transient. These recommendations, although not a substitute for clinical judgement or governmental regulations, provide specialists, primary care providers, and allied health professionals with a comprehensive list of a wide range of cardiac conditions, with guidance provided on the basis of the level of risk of impairment, along with recommendations about ability to drive and the suggested duration of restrictions.
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Affiliation(s)
- Peter G Guerra
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada.
| | | | - Harriette G C Van Spall
- McMaster University, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada, and Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Anita W Asgar
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | - Phyllis Billia
- University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Julia Cadrin-Tourigny
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | - Santabhanu Chakrabarti
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher C Cheung
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Annie Dore
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | - Christopher B Fordyce
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pishoy Gouda
- University of Alberta, Edmonton, Alberta, Canada
| | - Ansar Hassan
- Mitral Center of Excellence, Maine Medical Center, Portland, Maine, USA
| | - Andrew Krahn
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica G Y Luc
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Susanna Mak
- University of Toronto, Sinai Health, Toronto, Ontario, Canada
| | | | | | - Francois Philippon
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Hôpital Laval, Laval, Québec, Canada
| | - John Sapp
- Dalhousie University, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | | | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Hôpital Laval, Laval, Québec, Canada
| | - David A Wood
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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159
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El Sherbini AH, Servito M, Zidan A, Elsherif S, Ko G, Elgendy IY, Ya'Qoub L. Sex differences in the outcomes after transcatheter aortic valve replacement with newer generation devices: A meta-analysis. Catheter Cardiovasc Interv 2024; 103:808-814. [PMID: 38461377 DOI: 10.1002/ccd.30985] [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: 07/06/2023] [Revised: 01/21/2024] [Accepted: 02/11/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is a reasonable therapeutic approach among patients with symptomatic severe aortic stenosis irrespective of surgical risk. Data regarding sex-specific differences in the outcomes with newer generation valves are limited. METHODS Electronic databases were searched for studies assessing sex differences in the outcomes of patients undergoing TAVR with newer generation valves (SAPIEN 3 or Evolut). Random effects model was constructed for summary estimates. RESULTS Four observational studies with 4522 patients (44.8% women) were included in the meta-analysis. Women were older and had a lower prevalence of coronary artery disease and mean EuroScore. Women had a higher incidence of short-term mortality (up to 30 days) (risk ratio [RR]: 1.60, 95% confidence interval [CI]: 1.14-2.25), but no difference in 1-year mortality (RR: 0.92, 95% CI: 0.72-1.17). There was no significant difference in the incidence of major bleeding (RR: 1.16, 95% CI: 0.86-1.57), permanent pacemaker (PPM) (RR: 0.80, 95% CI: 0.62-1.04), or disabling stroke (RR: 1.16, 95% CI: 0.54-2.45). CONCLUSION In this meta-analysis, we found that women undergoing TAVR with newer-generation devices were older but had a lower prevalence of comorbidities. Women had a higher incidence of short-term mortality but no difference in the 1-year mortality, bleeding, PPM, or stroke compared with men. Future studies are required to confirm these findings.
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Affiliation(s)
- Adham H El Sherbini
- Department of Internal Medicine Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Maria Servito
- Division of Cardiac Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ali Zidan
- Department of Internal Medicine Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Salma Elsherif
- Department of Internal Medicine Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Grace Ko
- Department of Internal Medicine Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Lina Ya'Qoub
- Division of Cardiovascular Medicine, University of California San Francisco, San Francisco, USA
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Parekh J, Sharma V, Robl J, Kshetri R, Osnard M, Vutthikraivit W, Arustamyan M, Deshmukh A, Rossen J, Horwitz PA, Panaich S. Temporary-Permanent Pacemakers in the Management of Conduction Abnormalities in Patients Undergoing Transcatheter Aortic Valve Replacement. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101310. [PMID: 39130177 PMCID: PMC11308022 DOI: 10.1016/j.jscai.2024.101310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 08/13/2024]
Abstract
Background Injury to the cardiac conduction system requiring a permanent pacemaker (PPM) implantation is a known adverse outcome of transcatheter aortic valve replacement (TAVR). Temporary-permanent pacemakers (TPPM) have been used as a bridge to PPM implantation in patients with systemic infection; however, there are only a few reports of its routine use in patients undergoing TAVR. This study aimed to assess the utility of routine use of TPPM in patients undergoing TAVR with a high risk of needing a PPM or those who develop high-grade conduction abnormalities during/after TAVR. Methods Between April 2015 and December 2021, 978 patients underwent TAVR at our institution, of whom 111 patients had TPPM placed before or during/after TAVR during the study period. In total, 89 patients were included in the final analysis. Results The median age was 78 years (IQR, 71-84 years); 52 (58.4%) patients with preexisting native conduction disease were considered high risk for advanced heart block and had TPPM placed before TAVR. In addition, 37 (41.6%) patients had TPPM placed during/after TAVR. Of the 89 patients who received TPPM, 51 (57.3%) were treated with a balloon-expandable valve and 38 (42.7%) with a self-expandable valve. Of the patients who underwent TPPM placement, only 49 (55.1%) required a PPM, and TPPM was removed in 40 (44.9%) patients. TPPM was in place for a median of 6 days (IQR, 2-11 days). Only 1 of the 89 patients (1.1%) who received a TPPM had lead dislodgment. No other complications were noted. Median length of stay was 3 days (IQR, 2-4 days). Conclusions In patients with high-risk baseline conduction abnormalities before TAVR and those who develop new high-grade conduction abnormalities during/after TAVR, TPPM provides a feasible and safe method for pacing that could allow early ambulation, facilitate early discharge, and prevent unnecessary PPM implantations in some patients.
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Affiliation(s)
- Jai Parekh
- Department of Internal Medicine/Cardiovascular Disease, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Vikram Sharma
- Department of Internal Medicine/Cardiovascular Disease, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Jared Robl
- Department of Internal Medicine/Cardiovascular Disease, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Rupesh Kshetri
- Department of Internal Medicine/Cardiovascular Disease, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Michael Osnard
- Department of Internal Medicine/Cardiovascular Disease, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Wasawat Vutthikraivit
- Department of Internal Medicine/Cardiovascular Disease, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Michael Arustamyan
- Department of Internal Medicine/Cardiovascular Disease, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Abhishek Deshmukh
- Department of Internal Medicine/Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - James Rossen
- Department of Internal Medicine/Cardiovascular Disease, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Phillip A. Horwitz
- Department of Internal Medicine/Cardiovascular Disease, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Sidakpal Panaich
- Department of Internal Medicine/Cardiovascular Disease, University of Iowa Hospitals and Clinics, Iowa City, Iowa
- Swedish Heart and Vascular Institute, Seattle, Washington
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161
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Badhwar V, Pereda D, Khaliel FH, Poffo R, Darehzereshki A, Mehaffey JH, Yan TD, Melnitchouk S, Geirsson A, Arghami A, Navia JL, Raikar GV, Weber AC, Ramzy D, Černý Š, Vojáček J, Smith RL, Bonatti J, Thourani VH, Wei LM. Outcomes following initial multicenter experience with robotic aortic valve replacement: Defining a path forward. J Thorac Cardiovasc Surg 2024; 167:1244-1250. [PMID: 38246340 DOI: 10.1016/j.jtcvs.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.
| | - Daniel Pereda
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Feras H Khaliel
- Division of Cardiac Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Robinson Poffo
- Department of Cardiovascular Surgery, Hospital Moriah, Sao Paulo, Brazil
| | - Ali Darehzereshki
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - J Hunter Mehaffey
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Tristan D Yan
- Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Arnar Geirsson
- Division of Cardiac, Thoracic and Vascular Surgery, New York-Presbyterian Columbia University Medical Center, New York, NY
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Jose L Navia
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Florida, Weston, Fla
| | - Goya V Raikar
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Pleasant Prairie, Wis
| | - Alberto C Weber
- Department of Cardiovascular Surgery, Herzzentrum Hislanden, Zurich, Switzerland
| | - Danny Ramzy
- Division of Cardiac Surgery, McGovern Medical School, UTHealth, Houston, Tex
| | - Štěpán Černý
- Department of Cardiac Surgery, University Hospital Motol, Prague, Czech Republic
| | - Jan Vojáček
- Department of Cardiac Surgery, University Hospital, Hradec Kralove, Czech Republic
| | - Robert L Smith
- Division of Cardiac Surgery, Baylor Scott & White Health, Plano, Tex
| | - Johannes Bonatti
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Vinod H Thourani
- Department of Cardiothoracic Surgery, Piedmont Healthcare, Atlanta, Ga
| | - Lawrence M Wei
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
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162
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Tanner R, Giacoppo D, Saber H, Barton D, Sugrue D, Roy A, Blake G, Spence MS, Margey R, Casserly IP. Trends in transcatheter aortic valve implantation practice and clinical outcomes at an Irish tertiary referral centre. Open Heart 2024; 11:e002610. [PMID: 38538065 PMCID: PMC10982748 DOI: 10.1136/openhrt-2024-002610] [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: 01/13/2024] [Accepted: 02/16/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE A paucity of data exists on how transcatheter aortic valve implantation (TAVI) practice has evolved in Ireland. This study sought to analyse temporal trends in patient demographics, procedural characteristics, and clinical outcomes at an Irish tertiary referral centre. METHODS The prospective Mater TAVI database was divided into time tertiles based on when TAVI was performed: Group A, November 2008-April 2013; Group B, April 2013-September 2017; and Group C, September 2017-February 2022. Patient and procedural characteristics and clinical outcomes were compared across groups. RESULTS A total of 1063 (Group A, 59; Group B, 268; and Group C:, 736) patients were treated with TAVI during the study period (mean age 81.1±7.4, mean Society of Thoracic Surgeons score 5.9±5.1).Conscious sedation (Group A, 0%; Group B, 59.9%; and Group C, 90.2%, p<0.001) and femoral artery access (Group A, 76.3%; Group B, 90.7%; and Group C, 96.6%, p<0.001) were used more frequently over time. The median length of hospital stay reduced from 9 days (IQR 7, 18) in Group A to 2 days (IQR 2, 3) in Group C. In-hospital death was numerically higher in Group A compared with Group C (6.8% vs 1.9%, p=0.078). At 1-year follow-up, the rate of death and/or stroke was similar in Group A and Group C (20.3% vs 12.0%, adjusted HR 1.49, 95% CI (0.59 to 3.74)). CONCLUSION There was exponential growth in TAVI procedural volume during the study period. A minimalist approach to TAVI emerged, and this was associated with significantly shorter procedure duration and hospital stay. Clinical outcomes at 1-year follow-up did not change significantly over time.
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Affiliation(s)
- Richard Tanner
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Daniele Giacoppo
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Hassan Saber
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - David Barton
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Declan Sugrue
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Andrew Roy
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Gavin Blake
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Mark S Spence
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Ronan Margey
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Ivan P Casserly
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
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163
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Eerdekens R, Kats S, Grutters JP, Green M, Shore J, Candolfi P, Oortwijn W, Harst PVD, Tonino P. Cost-utility analysis of TAVI compared with surgery in patients with severe aortic stenosis at low risk of surgical mortality in the Netherlands. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:24. [PMID: 38528520 DOI: 10.1186/s12962-024-00531-6] [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: 10/26/2023] [Accepted: 03/19/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND There is growing evidence to support the benefits of transcatheter aortic valve implantation (TAVI) over surgical aortic valve replacement (SAVR) in patients with symptomatic severe aortic stenosis (sSAS) who are at high- or intermediate-risk of surgical mortality. The PARTNER 3 trial showed clinical benefits with SAPIEN 3 TAVI compared with SAVR in patients at low risk of surgical mortality. Whether TAVI is also cost-effective compared with SAVR for low-risk patients in the Dutch healthcare system remains uncertain. This article presents an analysis using PARTNER 3 outcomes and costs data from the Netherlands to inform a cost-utility model and examine cost implications of TAVI over SAVR in a Dutch low-risk population. METHODS A two-stage cost-utility analysis was performed using a published and validated health economic model based on adverse events with both TAVI and SAVR interventions from a published randomized low risk trial dataset, and a Markov model that captured lifetime healthcare costs and patient outcomes post-intervention. The model was adapted using Netherlands-specific cost data to assess the cost-effectiveness of TAVI and SAVR. Uncertainty was addressed using deterministic and probabilistic sensitivity analyses. RESULTS TAVI generated 0.89 additional quality-adjusted life years (QALYs) at a €4742 increase in costs per patient compared with SAVR over a lifetime time horizon, representing an incremental cost-effectiveness ratio (ICER) of €5346 per QALY gained. Sensitivity analyses confirm robust results, with TAVI remaining cost-effective across several sensitivity analyses. CONCLUSIONS Based on the model results, compared with SAVR, TAVI with SAPIEN 3 appears cost-effective for the treatment of Dutch patients with sSAS who are at low risk of surgical mortality. Qualitative data suggest broader societal benefits are likely and these findings could be used to optimize appropriate intervention selection for this patient population.
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Affiliation(s)
- Rob Eerdekens
- Heart Center, Catharina Hospital, Eindhoven, The Netherlands
| | - Suzanne Kats
- Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Michelle Green
- York Health Economics Consortium, University of York, Heslington, York, UK
| | - Judith Shore
- York Health Economics Consortium, University of York, Heslington, York, UK
| | | | - Wija Oortwijn
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Pim Tonino
- Heart Center, Catharina Hospital, Eindhoven, The Netherlands
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164
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Sugiyama Y, Moriyama N, Miyashita H, Yokoyama H, Ochiai T, Shishido K, Jalanko M, Yamanaka F, Vähäsilta T, Laine M, Saito S. Long-Term Assessment of Survival After Transcatheter Aortic Valve Implantation - Insights From the International Transcatheter Aortic Valve Implantation Registry. Circ J 2024; 88:462-471. [PMID: 38030300 DOI: 10.1253/circj.cj-23-0593] [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: 12/01/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis (AS), but despite estimates of life expectancy after TAVI being essential in heart team discussion, these data are scarce. Therefore, the current study sought to assess long-term survival and its trends in relation to chronological age, surgical risk, and treatment period. METHODS AND RESULTS We included 2,414 consecutive patients who underwent TAVI for severe symptomatic AS between 2008 and 2021 at 2 international centers. For the analysis, long-term survival was evaluated according to age, surgical risk, and treatment period categorized into 3 groups, respectively. The longest follow-up was 13.5 years. Overall survival was 67.6% at 5 years and 26.9% at 10 years. Younger patients, lower surgical risk, and later treatment period showed better survival (log-rank P<0.001, respectively). In the multivariate analysis, age <75years, lower surgical risk, and later time period were significantly associated with better survival. The incidence of paravalvular leakage ≥moderate, red blood cell transfusion, and acute kidney injury were independently associated with increasing risk of 5-year death. CONCLUSIONS In a real-world registry, survival was substantial following TAVI, especially in younger and lower surgical-risk patients, with improving outcomes over time. This should be considered in heart team discussions of life-long management for AS patients after TAVI.
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Affiliation(s)
- Yoichi Sugiyama
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital
- Heart and Lung Center, Helsinki University and Helsinki University Central Hospital
| | - Noriaki Moriyama
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital
| | - Hirokazu Miyashita
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital
| | - Hiroaki Yokoyama
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital
| | - Tomoki Ochiai
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital
| | - Koki Shishido
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital
| | - Mikko Jalanko
- Heart and Lung Center, Helsinki University and Helsinki University Central Hospital
| | - Futoshi Yamanaka
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital
| | - Tommi Vähäsilta
- Heart and Lung Center, Helsinki University and Helsinki University Central Hospital
| | - Mika Laine
- Heart and Lung Center, Helsinki University and Helsinki University Central Hospital
| | - Shigeru Saito
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital
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165
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Gallitto E, Faggioli G, Saia F, Palmerini T, Pini R, Bruno AG, Feroldi FM, Alaidroos M, Ghetti G, Taglieri N, Caputo S, Donati F, Marrozzini C, Gargiulo M. The role of the vascular surgeon in transcatheter aortic valve implantation. Vascular 2024:17085381241237844. [PMID: 38504140 DOI: 10.1177/17085381241237844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has become the standard treatment for severe aortic valve stenosis in patients at increased surgical risk. Percutaneous transfemoral (TF) is the access of choice due to its reduced invasiveness and perioperative morbidity/mortality compared with the trans-axillary, aortic, and apical routes. On the other hand, vascular access complications (VACs) of the TF access are associated with prolonged hospitalization, 30-day, and 1-year mortality. In addition, the concomitance of peripheral arterial disease may require associated endovascular management. A multidisciplinary team with Interventional Cardiologists and Vascular Surgeons may minimize the rate of VACs in patients with challenging femoral-iliac access or concomitant disease of other vascular districts, thus optimizing the outcome of TF-TAVI. The aim of this study was to evaluate the role of Vascular Surgeons in TF TAVI procedures. METHODS We conducted a retrospective single-center review of all TF-TAVI procedures assisted by Vascular Surgeons between January 2016 and December 2020 in a high-volume tertiary hospital. Pre, intra, and postoperative data were analyzed by a dedicated group of Interventional Cardiologists and Vascular Surgeons. VACs were defined according with the Valve Academic Research Consortium (VARC) three guidelines. The outcomes of TF-TAVI procedures with Vascular Surgeons involvement were assessed as study's endpoints. RESULTS Overall, 937 TAVI procedures were performed with a TF approach ranging between 78% (2016) and 98% (2020). Vascular Surgeons were involved in 67 (7%) procedures with the following indications: concomitant abdominal aortic aneurysm (EVAR + TAVI) - 3 (4%), carotid stenosis (TAVI + CAS) - 2 (3%), hostile femoral/iliac access, or VACs - 62 (93%). Balloon angioplasty of iliac artery pre-TAVI implantation was performed in 51 cases (conventional PTA: 38/51%-75%; conventional PTA + intravascular lithotripsy: 13/51%-25%; stenting: 5/51%-10%). TAVI procedure was successfully completed by percutaneous TF approach in all 62 cases with challenging femoral/iliac access. VACs necessitating interventions were 18/937 (2%) cases, localized to the common femoral or common/external iliac artery in 15/18 (83%) and 3/18 (17%) cases, respectively. They were managed by surgical or endovascular maneuvers in 3/18 (17%) and 15/18 (83%) cases, respectively. Fifteen/18 (83%) VACs were treated during the index procedure. There was no procedure-related mortality or 30-day readmission. CONCLUSION In our experience, Vascular Surgeon assistance in TAVI procedures was not infrequent and allowed safe and effective device introduction through challenging TF access. Similarly, the concomitant significant disease of other vascular districts could be safely addressed, potentially reducing postoperative related mortality and morbidity. The implementation of multidisciplinary team with interventional cardiologists and vascular surgeons should be encouraged whenever possible.
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Affiliation(s)
- Enrico Gallitto
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Gianluca Faggioli
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesco Saia
- Division of Interventional Cardiology, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Tullio Palmerini
- Division of Interventional Cardiology, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Rodolfo Pini
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonio Giulio Bruno
- Division of Interventional Cardiology, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesca Maria Feroldi
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Moad Alaidroos
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Gabriele Ghetti
- Division of Interventional Cardiology, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Nevio Taglieri
- Division of Interventional Cardiology, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Stefania Caputo
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesco Donati
- Division of Interventional Cardiology, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Cinzia Marrozzini
- Division of Interventional Cardiology, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Mauro Gargiulo
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Rosseel L, Montarello NJ, Nuyens P, Tirado-Conte G, Quagliana A, Cornelis K, Floré V, Rosseel M, Bieliauskas G, Sondergaard L, De Backer O. A systematic algorithm for large-bore arterial access closure after TAVI: the TAVI-MultiCLOSE study. EUROINTERVENTION 2024; 20:e354-e362. [PMID: 37982158 PMCID: PMC10949328 DOI: 10.4244/eij-d-23-00725] [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: 08/27/2023] [Accepted: 11/01/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Despite transcatheter aortic valve implantation (TAVI) having become a routine procedure, access site bleeding and vascular complications are still a concern which contribute to procedure-related morbidity and mortality. AIMS The TAVI-MultiCLOSE study aimed to assess the safety and efficacy of a new vascular closure algorithm for percutaneous large-bore arterial access closure following transfemoral (TF)-TAVI. METHODS All consecutive TF-TAVI cases in which the MultiCLOSE vascular closure algorithm was used were prospectively included in a multicentre, observational study. This stepwise algorithm entails the reinsertion of a 6-8 Fr sheath (primary access) following the initial preclosure with one or two suture-based vascular closure devices (VCDs). This provides the operator with the opportunity to perform a quick and easy angiographic control and tailor the final vascular closure with either an additional suture- or plug-based VCD, or neither of these. RESULTS Among 630 patients who underwent TF-TAVI utilising the MultiCLOSE algorithm, complete arterial haemostasis was achieved in 616 patients (98%). VCD failure occurred in 14 patients (2%), treated with either balloon inflation (N=1), covered stent (N=12) or surgical repair (N=1). Overall, this vascular closure approach resulted in a minor and major vascular complication rate of 2.2% and 0.6%, respectively. At 30 days, only one new minor vascular complication (0.2%) was noted. In-hospital and 30-day all-cause mortality rates were 0.2% and 1.0%, respectively. CONCLUSIONS Use of the MultiCLOSE vascular closure algorithm was demonstrated to contribute to an easy, safe, efficacious and durable vascular closure after TF-TAVI, resulting in a major vascular complication rate of less than 1%.
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Affiliation(s)
- Liesbeth Rosseel
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Cardiology Department, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium
| | - Nicholas J Montarello
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Philippe Nuyens
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Angelo Quagliana
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kristoff Cornelis
- Cardiology Department, Algemeen Ziekenhuis Maria Middelares, Ghent, Belgium
| | - Vincent Floré
- Cardiology Department, Algemeen Ziekenhuis Maria Middelares, Ghent, Belgium
| | - Michael Rosseel
- Cardiology Department, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium
| | - Gintautas Bieliauskas
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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167
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Holierook M, Henstra MJ, Dolman DJ, Chekanova EV, Veenis L, Beijk MAM, de Winter RJ, Baan J, Vis MM, Lemkes JS, Snaterse M, Henriques JPS, Delewi R. Higher Edmonton Frail Scale prior to transcatheter Aortic Valve Implantation is related to longer hospital stay and mortality. Int J Cardiol 2024; 399:131637. [PMID: 38065322 DOI: 10.1016/j.ijcard.2023.131637] [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: 02/02/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 12/31/2023]
Abstract
BACKGROUND International guidelines for the management of valvular heart disease recommend frailty assessment prior to Transcatheter Aortic Valve Implantation (TAVI), however there is no consensus how to assess frailty. We investigated whether frailty status assessed with the Edmonton Frail Scale (EFS, range 0-17 points) relates to length of stay (LOS), short- and long-term mortality and adverse outcomes after TAVI. METHODS In this study we included 357 patients between April 2016 till December 2018. EFS was assessed at baseline. Patients were classified into low (0-3), intermediate (4-7) or high frailty status (8-17). LOS was defined as the number of days between admission and discharge. Mortality data were obtained up to four years after TAVI. Adverse events were defined by Valve Academic Research Consortium (VARC)-2 criteria and collected <30 days after TAVI. RESULTS Patients with higher frailty status had longer median LOS (days (IQR): low 5 (3), intermediate 6 (4) and high 7 (5), p < 0.001) and higher mortality: low vs intermediate vs high at 30 days 0.5%, 2.2%, 7.0% (p = 0.050), 1 year 3.7%, 10.0%, 15.2% (p = 0.052), 2 years 9.2%, 17.8%, 31.7% (p = 0.003), 3 years 17.2%, 24.0, 47.0% (p = 0.001) and 4 years 19.6%, 30.8%, 55.6% (p < 0.001). Frail patients received more often a pacemaker (2.6%, 6.6%, 13.5%, p = 0.048). CONCLUSION In clinical practice, the EFS is a useful tool to screen for frailty in TAVI patients. This tool may possibly be expanded to determine benefit versus harm-risk in these patients and whether specific pre-procedurally interventions are needed in order to reduce mortality.
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Affiliation(s)
- Marja Holierook
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Marieke J Henstra
- Amsterdam UMC location University of Amsterdam, Internal Medicine Geriatrics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Doortje J Dolman
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Elena V Chekanova
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Linda Veenis
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Marcel A M Beijk
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Robbert J de Winter
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jan Baan
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Marije M Vis
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jorrit S Lemkes
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Marjolein Snaterse
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - José P S Henriques
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Ronak Delewi
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands
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168
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McGrath D, Lee H, Sun C, Kawabori M, Zhan Y. Right transaxillary transcatheter aortic valve replacement is comparable to left despite challenges. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02015-z. [PMID: 38460099 DOI: 10.1007/s11748-024-02015-z] [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: 10/20/2023] [Accepted: 02/03/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES Transaxillary access is the most popular alternative to transfemoral transcatheter aortic valve replacement. Although left transaxillary access is generally preferred, right transaxillary transcatheter aortic valve replacement could be challenging because of the opposing axillary artery and aortic curvatures, which may warrant procedural modifications to improve alignment. Our aim is to compare our single center's outcomes for left and right transaxillary access groups and to evaluate procedural modifications for facilitating right transaxillary transcatheter aortic valve replacement. METHODS Patient characteristics and outcomes were compared for consecutive left or right axillary TAVRs performed from 6/2016 to 6/2022 with SAPIEN 3. The effects of our previously reported "flip-n-flex" technique on procedural efficiency and new conduction disturbances were subanalyzed in the right axillary group. RESULTS Right and left transaxillary transcatheter aortic valve replacement were performed in 25 (18 with the "flip-n-flex" technique) and 26 patients, respectively. There were no significant differences between patient characteristics or outcomes. Right axillary subanalysis showed the "flip-n-flex" technique group had significantly shorter fluoroscopy times (21.2 ± 6.2 vs 29.6 ± 12.4 min, p = 0.03) and a trend towards less permanent pacemaker implantation (6.3% vs. 42.9%, p = 0.07) compared to the group without "flip-n-flex". CONCLUSIONS In our study, despite anatomical challenges, right transaxillary transcatheter aortic valve replacement is comparable to left access. The "flip-n-flex" technique advances right transaxillary as an appealing access for patients with few options.
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Affiliation(s)
| | - Hansuh Lee
- Tufts University School of Medicine, Boston, MA, USA
| | - Charley Sun
- Tufts University School of Medicine, Boston, MA, USA
| | - Masashi Kawabori
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA
| | - Yong Zhan
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA.
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169
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Kapadia SR, Krishnaswamy A, Whisenant B, Potluri S, Iyer V, Aragon J, Gideon P, Strote J, Leonardi R, Agarwal H, Larrain G, Sanchez C, Panaich SS, Harvey J, Vahl T, Menon V, Wolski K, Wang Q, Leon MB. Concomitant Left Atrial Appendage Occlusion and Transcatheter Aortic Valve Replacement Among Patients With Atrial Fibrillation. Circulation 2024; 149:734-743. [PMID: 37874908 DOI: 10.1161/circulationaha.123.067312] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is common in patients undergoing transcatheter aortic valve replacement (TAVR) and is associated with increased risk of bleeding and stroke. While left atrial appendage occlusion (LAAO) is approved as an alternative to anticoagulants for stroke prevention in patients with AF, placement of these devices in patients with severe aortic stenosis, or when performed at the same time as TAVR, has not been extensively studied. METHODS WATCH-TAVR (WATCHMAN for Patients with AF Undergoing TAVR) was a multicenter, randomized trial evaluating the safety and effectiveness of concomitant TAVR and LAAO with WATCHMAN in AF patients. Patients were randomized 1:1 to TAVR + LAAO or TAVR + medical therapy. WATCHMAN patients received anticoagulation for 45 days followed by dual antiplatelet therapy until 6 months. Anticoagulation was per treating physician preference for patients randomized to TAVR + medical therapy. The primary noninferiority end point was all-cause mortality, stroke, and major bleeding at 2 years between the 2 strategies. RESULTS The study enrolled 349 patients (177 TAVR + LAAO and 172 TAVR + medical therapy) between December 2017 and November 2020 at 34 US centers. The mean age of patients was 81 years, and the mean scores for CHA2DS2-VASc and HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/alcohol concomitantly) were 4.9 and 3.0, respectively. At baseline, 85.4% of patients were taking anticoagulants and 71.3% patients were on antiplatelet therapy. The cohorts were well-balanced for baseline characteristics. The incremental LAAO procedure time was 38 minutes, and the median contrast volume used for combined procedures was 119 mL versus 70 mL with TAVR alone. At the 24-month follow-up, 82.5% compared with 50.8% of patients were on any antiplatelet therapy, and 13.9% compared with 66.7% of patients were on any anticoagulation therapy in TAVR + LAAO compared with TAVR + medical therapy group, respectively. For the composite primary end point, TAVR + LAAO was noninferior to TAVR + medical therapy (22.7 versus 27.3 events per 100 patient-years for TAVR + LAAO and TAVR + medical therapy, respectively; hazard ratio, 0.86 [95% CI, 0.60-1.22]; Pnoninferiority<0.001). CONCLUSIONS Concomitant WATCHMAN LAAO and TAVR is noninferior to TAVR with medical therapy in severe aortic stenosis patients with AF. The increased complexity and risks of the combined procedure should be considered when concomitant LAAO is viewed as an alternative to medical therapy for patients with AF undergoing TAVR. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03173534.
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Affiliation(s)
- Samir R Kapadia
- Cleveland Clinic, Cleveland, OH (S.R.K., A.K., V.M., K.W., Q.W.)
| | | | | | | | | | | | - Philip Gideon
- Banner University Medical Center, Phoenix, AZ (P.G.)
| | | | - Robert Leonardi
- Lexington Medical Heart and Vascular Center, West Columbia, SC (R.L.)
| | | | | | | | | | | | - Torsten Vahl
- Columbia University Medical Center, New York, NY (T.V., M.B.L.)
| | - Venu Menon
- Cleveland Clinic, Cleveland, OH (S.R.K., A.K., V.M., K.W., Q.W.)
| | - Kathy Wolski
- Cleveland Clinic, Cleveland, OH (S.R.K., A.K., V.M., K.W., Q.W.)
| | - Qiuqing Wang
- Cleveland Clinic, Cleveland, OH (S.R.K., A.K., V.M., K.W., Q.W.)
| | - Martin B Leon
- Columbia University Medical Center, New York, NY (T.V., M.B.L.)
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170
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Linder M, Grundmann D, Kellner C, Demal T, Waldschmidt L, Bhadra O, Ludwig S, Voigtländer L, von der Heide I, Nebel N, Hannen L, Schirmer J, Reichenspurner H, Blankenberg S, Conradi L, Schofer N, Schäfer A, Seiffert M. Intravascular Lithotripsy-Assisted Transfemoral Transcatheter Aortic Valve Implantation in Patients with Severe Iliofemoral Calcifications: Expanding Transfemoral Indications. J Clin Med 2024; 13:1480. [PMID: 38592323 PMCID: PMC10932192 DOI: 10.3390/jcm13051480] [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: 02/05/2024] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Transfemoral transcatheter aortic valve implantation (TAVI) has become the standard treatment for most patients with severe symptomatic aortic stenosis. Intravascular lithotripsy may facilitate transfemoral TAVI (IVL-TAVI) even in patients with severely calcified iliofemoral disease. We assessed technical aspects and clinical outcomes of this novel approach compared to alternative transaxillary access (TAX-TAVI). (2) Methods: IVL-TAVI was performed for severe iliofemoral calcifications precluding standard transfemoral access in 30 patients from 2019 to 2022 at a single academic heart center. IVL was performed as part of the TAVI procedure in all cases. Results were compared to a control group of 44 TAX-TAVI procedures performed for the same indication from 2016 to 2021. The safety outcome was a composite of all-cause death, stroke, access-related bleeding ≥ type 2 within 24 h and major vascular access site complications at 30 days. The efficacy outcome was defined as a technical success according to VARC-3. (3) Results: Median age was 78.2 [74.3, 82.6] years, 45.9% were female and mean STS-PROM was 3.6% [2.3, 6.0]. Iliofemoral calcifications were more severe in the IVL-TAVI vs. TAX-TAVI groups (lesion length: 63.0 mm [48.6, 80.3] vs. 48.5 mm [33.1, 68.8]; p = 0.043, severe calcification at target lesion: 90.0% vs. 68.2%; p = 0.047, and median arc calcification 360.0° [297.5, 360.0] vs. 360.0° [180.0, 360.0]; p = 0.033). Technical success was achieved in 93.3% vs. 81.8% (p = 0.187) in IVL- and TAX-TAVI and the safety outcome occurred in 10.0% vs. 31.8% in IVL- and TAX-TAVI (p = 0.047), respectively. (4) Conclusions: IVL-assisted transfemoral TAVI was feasible and safe with favorable outcomes compared to TAX-TAVI. IVL may further expand the number of patients eligible for transfemoral TAVI and may help overcome limitations of an alternative access.
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Affiliation(s)
- Matthias Linder
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
- Department of Cardiology, Regio Kliniken Pinneberg GmbH, Fahltskamp 74, 25421 Pinneberg, Germany
| | - David Grundmann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
| | - Caroline Kellner
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
- Centre for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Till Demal
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, 24105 Kiel, Germany
| | - Lara Waldschmidt
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
| | - Oliver Bhadra
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
| | - Lisa Voigtländer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, 24105 Kiel, Germany
| | - Ina von der Heide
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
| | - Nicole Nebel
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
| | - Laura Hannen
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
- Centre for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, 24105 Kiel, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
| | - Niklas Schofer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
| | - Andreas Schäfer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
| | - Moritz Seiffert
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
- Centre for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, 24105 Kiel, Germany
- Department of Cardiology and Angiology, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany
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171
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Menhour S, Abellan Van Kan G, Toulza O, Lhermusier T, Nourhashemi F, Rolland Y. [Percutaneous aortic valve replacement: outcome of patients evaluated by EMG at Toulouse University Hospital preprocedure]. SOINS. GERONTOLOGIE 2024; 29:36-41. [PMID: 38418070 DOI: 10.1016/j.sger.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Transcatheter Aortic Valve Implantation has become the preferred method of aortic valve replacement in the elderly. Preoperative standardized geriatric assessment (SGA) helps guide the decision to proceed, taking into account geriatric parameters not targeted by surgical risk scores. This is a descriptive, retrospective study of patients who underwent EGS at the Toulouse University Hospital, analyzing their length of stay and postoperative care pathway.
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Affiliation(s)
- Soumiya Menhour
- Centre hospitalier intercommunal de Castres-Mazamet,6 avenue de la Montagne-Noire, 81108 Castres, France.
| | | | - Olivier Toulza
- CHU de Toulouse, 2 rue Charles-Viguerie, 31300 Toulouse, France
| | | | | | - Yves Rolland
- CHU de Toulouse, 2 rue Charles-Viguerie, 31300 Toulouse, France
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172
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Bate AP, Franke KB, Jones DR, Chokka RG, Gibb C, Lau JK, Montarello J, Psaltis PJ, Roberts-Thomson RL. Psoas Muscle Area as a Predictor of Transcatheter Aortic Valve Implantation Outcomes. Heart Lung Circ 2024; 33:310-315. [PMID: 38320880 DOI: 10.1016/j.hlc.2023.10.016] [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: 09/20/2022] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Frailty is a well-recognised predictor of outcomes after transcatheter aortic valve implantation (TAVI). Psoas muscle area (PMA) is a surrogate marker for sarcopaenia and is a validated assessment tool for frailty. The objective of this study was to examine frailty as a predictor of outcomes in TAVI patients and assess the prognostic usefulness of adding PMA to established frailty assessments. METHODS Frailty assessments were performed on 220 consecutive patients undergoing TAVI. These assessments used four markers (serum albumin, handgrip strength, gait speed, and a cognitive assessment), which were combined to form a composite frailty score. Preprocedural computed tomography scans were used to calculate cross-sectional PMA for each patient. The primary outcomes were all-cause mortality at 1-year and post-procedure length of hospital stay. RESULTS Frailty status, as defined by the composite frailty score, was independently predictive of length of hospital stay (p=0.001), but not predictive of 1-year mortality (p=0.161). Albumin (p=0.036) and 5-metre walk test (p=0.003) were independently predictive of 1-year mortality. The PMA, when adjusted for gender, and normalised according to body surface area, was not predictive of 1-year mortality. Normalised PMA was associated with increased post-procedure length of stay within the female population (p=0.031). CONCLUSIONS A low PMA is associated with increased length of hospital stay in female TAVI patients but does not provide additional predictive value over traditional frailty scores. The PMA was not shown to correlate with TAVI-related complications or 1-year mortality.
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Affiliation(s)
- Alexander P Bate
- Department of Medicine, The University of Adelaide, Adelaide, SA, Australia; Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia.
| | - Kyle B Franke
- Department of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Dylan R Jones
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Ramesh G Chokka
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Catherine Gibb
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Jerrett K Lau
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Joseph Montarello
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Peter J Psaltis
- Department of Medicine, The University of Adelaide, Adelaide, SA, Australia; Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Ross L Roberts-Thomson
- Department of Medicine, The University of Adelaide, Adelaide, SA, Australia; Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
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173
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Fialka NM, EL-Andari R, Wang S, Dokollari A, Kent WDT, Fatehi Hassanabad A. The Perceval Sutureless Bioprosthetic Aortic Valve: Evolution of Surgical Valve Technology. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:125-135. [PMID: 38465600 PMCID: PMC11055413 DOI: 10.1177/15569845241231989] [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: 03/12/2024]
Abstract
OBJECTIVE The surgical treatment of aortic stenosis continues to evolve, and sutureless aortic valve replacement (SUAVR) is an emerging technology. With the Perceval S (Corcym, London, UK) as the only true sutureless valve on the market, the objective of this review is to analyze the current literature on Perceval S. Focusing on valve design and deployment as well as applications of the technology for challenging pathology, clinical outcomes are assessed, including a comparison with transcatheter AVR (TAVR). METHODS PubMed and MEDLINE were searched by 3 authors for studies analyzing SUAVR from inception to May 19, 2023. RESULTS SUAVR facilitates minimally invasive surgery and offers an alternative strategy for patients with small aortic annuli. It also has a time-saving advantage for patients who require complex operations. SUAVR results in excellent long-term morbidity, mortality, durability, and hemodynamic function. In comparison with conventional surgical AVR (SAVR), SUAVR does have a greater risk of postoperative pacemaker implantation; however, increasing user experience and refinements in implantation technique have contributed to reductions in this outcome. SUAVR results in morbidity and mortality that is similar to rapid-deployment AVR. Midterm outcomes are superior to TAVR; however, further robust investigation into all of these comparisons is ultimately necessary. CONCLUSIONS SUAVR bridges the gap in technology between SAVR and TAVR. The application of this exciting technology will undoubtedly grow in the coming years, during which additional investigation is paramount to optimize preoperative planning, valve deployment, and reintervention strategies.
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Affiliation(s)
- Nicholas M. Fialka
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Ryaan EL-Andari
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Shaohua Wang
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Aleksander Dokollari
- Section of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - William D. T. Kent
- Section of Cardiac Surgery, Division of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AB, Canada
| | - Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Division of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AB, Canada
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174
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Ullah W, Sana MK, Mukhtar M, Syed SH, Zahid S, Alkhouli M, Vishnevsky A. Transcatheter Aortic Valve Replacement Across Hemodynamic Subtypes of Severe Aortic Valve Stenosis: A Network Meta-analysis. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101255. [PMID: 39131772 PMCID: PMC11307878 DOI: 10.1016/j.jscai.2023.101255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 08/13/2024]
Abstract
Background Studies assessing outcomes of transcatheter aortic valve replacement (TAVR) in patients with severe aortic valve stenosis (AS) with hemodynamic subtypes have demonstrated mixed results with respect to outcomes and periprocedural complications. This study aimed to assess the outcomes of TAVR in patients across various hemodynamic subtypes of severe AS. Methods PubMed, Embase, and Cochrane databases were searched through September 2023 to identify all observational studies comparing outcomes of TAVR in patients with paradoxical low flow low gradient (pLFLG), classic LFLG, and high gradient AS (HGAS). The primary outcome was major adverse cardiovascular events (MACE). The secondary outcomes were components of MACE (mortality, myocardial infarction [MI], stroke). A bivariate, influential, and frequentist network meta-analysis model was used to obtain the net odds ratio (OR) with a 95% CI. Results A total of 21 studies comprising 17,298 (8742 experimental and 8556 HGAS) patients were included in the quantitative analysis. TAVR was associated with a significant reduction in the mean aortic gradient, and an increase in the mean aortic valve area irrespective of the AS type. Compared with HGAS, TAVR in classic LFLG had a significantly higher (OR, 1.68; 95% CI, 1.04-2.72), while pLFLG (OR, 0.98; 95% CI, 0.72-1.35) had a statistically similar incidence of MACE at a median follow-up of 1-year. TAVR in LFLG also had a significantly higher need for surgery (OR, 3.57; 95% CI, 1.24-10.32), and a greater risk of periprocedural (OR, 2.00; 95% CI, 1.17-3.41), 1-month (OR, 1.69; 95% CI, 1.08-2.64), and 12-month (OR, 1.41; 95% CI, 1.05-1.88) mortality compared with HGAS. The incidence of MI, major bleeding, vascular complications, paravalvular leak, pacemaker implantation, and rehospitalizations was not significantly different between all other types of AS (HGAS vs LFLG, pLFLG). Conclusions TAVR is an effective strategy in severe AS irrespective of the hemodynamic subtypes. Relatively, pLFLG did not have significantly different risk of periprocedural complications compared with HGAS, while classical LFLG AS had higher risk of MACE, primarily driven by the greater mortality risk.
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Affiliation(s)
- Waqas Ullah
- Department of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Muhammad Khawar Sana
- Department of Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
| | - Maryam Mukhtar
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Sohaib Hasan Syed
- Department of Cardiology, Saint Mary Mercy Hospital, Livonia, Michigan
| | - Salman Zahid
- Department of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | | | - Alec Vishnevsky
- Department of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
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175
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Awad AK, Ahmed A, Mathew DM, Varghese KS, Mathew SM, Khaja S, Newell PC, Okoh AK, Hirji S. Minimally invasive, surgical, and transcatheter aortic valve replacement: A network meta-analysis. J Cardiol 2024; 83:177-183. [PMID: 37611742 DOI: 10.1016/j.jjcc.2023.08.010] [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: 03/13/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has evolved as an alternative to surgical aortic valve replacement (SAVR). In addition to full-sternotomy (FS), recent reports have shown successful minimally-invasive SAVR approaches, including mini-sternotomy (MS) and mini-thoracotomy (MT). This network-meta-analysis (NMA) seeks to provide an outcomes comparison based on these different modalities (MS, MT, TAVR) compared with FS as a reference arm for the management of aortic valve disease. METHODS A comprehensive literature search was performed to identify studies that compared minimally-invasive SAVR (MS/MT) to conventional FS-SAVR, and/or TAVR. Bayesian NMA was performed using the random effects model. Outcomes were pooled as risk ratios (RR) with their 95 % confidence intervals (CIs). Our primary outcomes included 30-day mortality, stroke, acute kidney injury (AKI), major bleeding, new permanent pacemaker (PPM), and paravalvular leak (PVL). We also assessed long-term mortality at the latest follow-up. RESULTS A total of 27,117 patients (56 studies) were included; 10,397 patients had FS SAVR, 9523 had MS, 5487 had MT, and 1710 had TAVR. Compared to FS, MS was associated with statistically-significantly lower rates of 30-day mortality (RR, 0.76, 95%CI 0.59-0.98), stroke (RR, 0.84, 95%CI 0.72-0.97), AKI (RR, 0.76, 95%CI 0.61-0.94), and long-term mortality (RR 0.84, 95%CI 0.72-0.97) at a weighted mean follow-up duration of 10.4 years, while MT showed statistically-significantly higher rates of 30-day PVL (RR, 3.76, 95%CI 1.31-10.85) and major bleeding (RR 1.45; 95%CI 1.08-1.94). TAVR had statistically significant lower rates of 30-day AKI (RR 0.49, 95%CI 0.31-0.77), but showed statistically-significantly higher PPM (RR 2.50; 95%CI 1.60-3.91) and 30-day PVL (RR 12.85, 95%CI 5.05-32.68) compared to FS. CONCLUSIONS MS was protective against 30-day mortality, stroke, AKI, and long-term mortality compared to FS; TAVR showed higher rates of 30-day PVL and PPM but was protective against AKI. Conversely, MT showed higher rates of 30-day PVL and major bleeding. With the emergence of TAVR, the appropriate benchmarks for SAVR comparison in future trials should be the minimally-invasive SAVR approaches to provide clinical equipoise.
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Affiliation(s)
- Ahmed K Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Adham Ahmed
- City University of New York School of Medicine, New York, NY, USA
| | - Dave M Mathew
- City University of New York School of Medicine, New York, NY, USA
| | | | - Serena M Mathew
- City University of New York School of Medicine, New York, NY, USA
| | - Sofia Khaja
- City University of New York School of Medicine, New York, NY, USA
| | - Paige C Newell
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Sameer Hirji
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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176
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Yunoki J, Morita S, Hayashi N, Jinnouchi K, Morokuma H, Itoh M, Kamohara K. The comparison of the clinical outcomes and costs between surgical aortic valve replacement and transcatheter aortic valve implantation based on the Japanese Diagnosis Procedure Combination database. Surg Today 2024; 54:240-246. [PMID: 37395799 DOI: 10.1007/s00595-023-02722-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE We evaluated the clinical outcomes and costs of surgical aortic valve replacement (SAVR) and transfemoral transcatheter aortic valve implantation (TAVI) for aortic stenosis using the Japanese Diagnosis Procedure Combination (DPC) database. METHODS Using our extraction protocol, we retrospectively analyzed summary tables in the DPC database from 2016 to 2019, which were provided by the Ministry of Health, Labor and Welfare. A total of 27,278 patients were available (SAVR, n = 12,534; TAVI, n = 14,744). RESULTS The TAVI group was older than the SAVR group (SAVR vs. TAVI: 74.6 vs. 84.5 years; P < 0.01), with a lower in-hospital mortality (1.0 vs. 0.6%; P < 0.01) and a shorter hospital stay (26.9 vs. 20.3 days; P < 0.01). TAVI conferred more total medical service reimbursement points than SAVR (493,944 vs. 605,241 points; P < 0.01), especially materials points (147,830 vs. 434,609 points; P < 0.01). Total insurance claims for TAVI were approximately 1 million yen higher than those for SAVR. Regarding the details of costs, only the operation cost was higher, while other costs were lower with TAVI than with SAVR. CONCLUSION Our analysis revealed that both SAVR and TAVI showed acceptable clinical outcomes. TAVI was associated with higher total insurance claims than SAVR. If the material cost of TAVI operations can be reduced, greater cost-effectiveness can be expected.
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Affiliation(s)
- Junji Yunoki
- Department of Thoracic & Cardiovascular Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | | | - Nagi Hayashi
- Department of Thoracic & Cardiovascular Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Kouki Jinnouchi
- Department of Thoracic & Cardiovascular Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Hiroyuki Morokuma
- Department of Thoracic & Cardiovascular Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Manabu Itoh
- Department of Thoracic & Cardiovascular Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Keiji Kamohara
- Department of Thoracic & Cardiovascular Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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177
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Malhotra G, Cole CMW, Cox SV, Ross JDW, Dooris M, Moore PT, Chong AA, Dahiya A, Korver K, Hayman SM, Camuglia AC. Third-Generation Transcatheter Aortic Heart Valve with Reverse Parachute Sealing Cuff in Patients with Aortic Valve Disease. Heart Lung Circ 2024; 33:324-331. [PMID: 38184427 DOI: 10.1016/j.hlc.2023.11.019] [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: 06/08/2023] [Revised: 09/18/2023] [Accepted: 11/08/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND The Navitor (Abbott Inc, IL, USA) transcatheter heart valve is a novel third-generation self-expanding bioprosthesis with specific features to mitigate paravalvular regurgitation (PVR). Owing to its novelty, there is a paucity of data on its application in clinical practice. METHODS Consecutive cohort analysis of the use of the Navitor system in an as-treated clinical setting at a quaternary heart hospital. RESULTS Sixty consecutive non-clinical trial patients treated with Navitor were identified. All patients underwent a successful procedure. The mean age was 79.3 years (±SD 7.82), 56.67% (n=34) were female, and the mean STS score was 4.87 (±SD 5.70). At 30 days post-procedure, all patients were alive with no readmissions for heart failure. One patient had a major vascular complication (1.7%). Four patients (7.14% of patients without a pre-existing pacemaker) received a new permanent pacemaker. Two patients (3.4%) had a non-disabling stroke. PVR at 30 days was trivial or none in 75% of patients, and no patient had worse than mild PVR. CONCLUSIONS The Navitor system in this as-treated cohort was associated with favourable clinical, haemodynamic, and safety outcomes.
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Affiliation(s)
- Ganeev Malhotra
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Chris M W Cole
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Stephen V Cox
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Jordan D W Ross
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Mark Dooris
- University of Queensland, Brisbane, QLD, Australia; Mater Hospital and Health Service, Brisbane, QLD, Australia
| | - Peter T Moore
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Adrian A Chong
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia; Mater Hospital and Health Service, Brisbane, QLD, Australia
| | - Arun Dahiya
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Kellee Korver
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Sam M Hayman
- University of Queensland, Brisbane, QLD, Australia; Mater Hospital and Health Service, Brisbane, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Anthony C Camuglia
- Division of Heart Lung and Critical Care, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia; Mater Hospital and Health Service, Brisbane, QLD, Australia.
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178
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Kobari Y, Hayashida K. What is the current optimal antithrombotic therapy after transcatheter aortic valve implantation? Current evidence from Japan and the world. J Cardiol 2024; 83:141-148. [PMID: 37524301 DOI: 10.1016/j.jjcc.2023.07.012] [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: 06/07/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023]
Abstract
Aortic stenosis (AS) is a major valvular disease that can have a negative impact on patients' prognosis, and its prevalence is increasing due to an aging population worldwide. Transcatheter aortic valve implantation (TAVI) is a well-established therapy for symptomatic severe AS utilized across the entire surgical risk spectrum. Based on the recently published evidence of large, randomized controlled trials (RCTs), the number of patients undergoing TAVI is increasing worldwide. Ischemic and bleeding events are common after TAVI and can have serious consequences both immediately after the procedure and in the long-term. Antiplatelet therapy has been traditionally recommended to prevent thromboembolic events after TAVI. The situation regarding the optimal antithrombotic regimen following TAVI is rapidly changing because many game-changing RCTs have been published. This report provides an overview of the current status and remaining issues in the field of optimal antithrombotic therapy following TAVI, including its possible effect on leaflet thrombosis.
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179
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Oks D, Reza S, Vázquez M, Houzeaux G, Kovarovic B, Samaniego C, Bluestein D. Effect of Sinotubular Junction Size on TAVR Leaflet Thrombosis: A Fluid-Structure Interaction Analysis. Ann Biomed Eng 2024; 52:719-733. [PMID: 38097896 DOI: 10.1007/s10439-023-03419-3] [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: 08/23/2023] [Accepted: 12/03/2023] [Indexed: 12/26/2023]
Abstract
TAVR has emerged as a standard approach for treating severe aortic stenosis patients. However, it is associated with several clinical complications, including subclinical leaflet thrombosis characterized by Hypoattenuated Leaflet Thickening (HALT). A rigorous analysis of TAVR device thrombogenicity considering anatomical variations is essential for estimating this risk. Clinicians use the Sinotubular Junction (STJ) diameter for TAVR sizing, but there is a paucity of research on its influence on TAVR devices thrombogenicity. A Medtronic Evolut® TAVR device was deployed in three patient models with varying STJ diameters (26, 30, and 34 mm) to evaluate its impact on post-deployment hemodynamics and thrombogenicity, employing a novel computational framework combining prosthesis deployment and fluid-structure interaction analysis. The 30 mm STJ patient case exhibited the best hemodynamic performance: 5.94 mmHg mean transvalvular pressure gradient (TPG), 2.64 cm2 mean geometric orifice area (GOA), and the lowest mean residence time (TR)-indicating a reduced thrombogenic risk; 26 mm STJ exhibited a 10 % reduction in GOA and a 35% increase in mean TPG compared to the 30 mm STJ; 34 mm STJ depicted hemodynamics comparable to the 30 mm STJ, but with a 6% increase in TR and elevated platelet stress accumulation. A smaller STJ size impairs adequate expansion of the TAVR stent, which may lead to suboptimal hemodynamic performance. Conversely, a larger STJ size marginally enhances the hemodynamic performance but increases the risk of TAVR leaflet thrombosis. Such analysis can aid pre-procedural planning and minimize the risk of TAVR leaflet thrombosis.
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Affiliation(s)
- David Oks
- Barcelona Supercomputing Center, Computer Applications in Science and Engineering, Barcelona, Spain
| | - Symon Reza
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8084, USA
| | - Mariano Vázquez
- Barcelona Supercomputing Center, Computer Applications in Science and Engineering, Barcelona, Spain
- ELEM Biotech SL, Barcelona, Spain
| | - Guillaume Houzeaux
- Barcelona Supercomputing Center, Computer Applications in Science and Engineering, Barcelona, Spain
| | - Brandon Kovarovic
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8084, USA
| | - Cristóbal Samaniego
- Barcelona Supercomputing Center, Computer Applications in Science and Engineering, Barcelona, Spain
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8084, USA.
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180
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Rheude T, Pellegrini C, Xhepa E, Joner M. [Update on the treatment of aortic valve stenosis in symptomatic and asymptomatic patients]. Herz 2024; 49:156-164. [PMID: 38240775 DOI: 10.1007/s00059-023-05229-8] [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] [Accepted: 11/22/2023] [Indexed: 03/07/2024]
Abstract
Aortic valve stenosis is one of the most frequent valvular heart diseases requiring treatment in industrialized countries. The symptom onset is associated with a significantly increased mortality, so that there is a clear indication for treatment in patients with severe, symptomatic aortic valve stenosis; however, data on the optimal treatment of patients with asymptomatic aortic valve stenosis are scarce. Smaller studies in the field of cardiac surgery suggest that early surgical valve replacement is superior to a conservative approach. For this reason, the results of additional adequately powered randomized trials are awaited with great interest. In this year numerous long-term results from randomized comparisons of the two available treatment options (surgical versus transcatheter aortic valve replacement) were published, which will further guide the heart team to find the best treatment approach for each individual.
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Affiliation(s)
- Tobias Rheude
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636, München, Deutschland
| | - Costanza Pellegrini
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636, München, Deutschland
| | - Erion Xhepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636, München, Deutschland
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636, München, Deutschland.
- DZHK (Deutsches Zentrum für Herzkreislaufforschung), partner site Munich Heart Alliance, München, Deutschland.
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181
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Nakashima M, Jilaihawi H, He Y, Williams D, Pushkar I, Williams M, Hisamoto K. Membranous Septum Length Predicts New Conduction Abnormalities in Surgical Aortic Valve Replacement: A Novel Predictor for Permanent Pacemaker Implantation After Surgical Aortic Valve Replacement. J Surg Res 2024; 295:385-392. [PMID: 38070251 DOI: 10.1016/j.jss.2023.11.043] [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: 04/13/2023] [Revised: 11/02/2023] [Accepted: 11/12/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION The membranous septum (MS) length measured by cardiac computed tomography (CT) is useful for the prediction of permanent pacemaker implantation (PPMI) and new left bundle branch block (LBBB) after transcatheter aortic valve replacement. However, its predictive value for patients undergoing surgical aortic valve replacement (SAVR) is unknown. METHODS A total of 2531 consecutive patients were registered in the institutional Society of Thoracic Surgeons database between July 2017 and June 2020. Patients who underwent non-SAVR procedures, had prior pacemaker/implantable cardioverter defibrillator, prior SAVR, no preprocedural CT assessment, or suboptimal CT imaging were excluded. RESULTS A total of 126 SAVR with preprocedural CT assessment were analyzed. Bicuspid aortic valve morphology was confirmed on CT in 59.5% of patients. There were three new PPMIs and five new LBBBs observed after SAVR at the time of discharge. In-hospital mortality was 0.8%. Low left ventricular (LV) ejection fraction (<50%), LV mass index >120 g/m2, large right coronary artery height, and MS length <1.5 mm predicted new PPMI/LBBB. Multivariate analysis showed LV mass index >120 g/m2 (odds ratio: 9.165; 95% confidence interval: 1.644-51.080; P = 0.011) and MS length <1.5 mm (odds ratio: 14.449; 95% confidence interval: 1.632-127.954; P = 0.016) were independent predictors for new PPMI/LBBB. CONCLUSIONS Short MS length on preoperative cardiac CT is a powerful and novel predictor for the risk of new PPMI/LBBB after SAVR. Special care should be taken in patients with short MS length to avoid suture-mediated trauma.
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Affiliation(s)
| | | | - Yuxin He
- Heart Valve Center, NYU Langone Health, New York, New York
| | - David Williams
- Heart Valve Center, NYU Langone Health, New York, New York
| | - Illya Pushkar
- Heart Valve Center, NYU Langone Health, New York, New York
| | | | - Kazuhiro Hisamoto
- Heart Valve Center, NYU Langone Health, New York, New York; Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York.
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182
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Sanoussi A, Aminian A, Abi-Khalil J. One-stop transcatheter aortic valve replacement and fenestrated endovascular aortic aneurysm repair: A case report. Radiol Case Rep 2024; 19:1162-1165. [PMID: 38259706 PMCID: PMC10801146 DOI: 10.1016/j.radcr.2023.12.041] [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: 11/20/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
The management of patients with severe aortic valve stenosis and an abdominal aortic aneurysm is a real therapeutic challenge. Minimally invasive treatment is more beneficial than open surgery for treating both aortic valve stenosis and abdominal aortic aneurysm. We present a case of a 77-year-old male initially treated with a 26 mm Sapien 3 transcatheter aortic valve replacement. Subsequently, using the same femoral access points, a custom fenestrated endoprosthesis and stents in digestive trunks and renal arteries were implanted. Follow-up imaging revealed no dysfunction of the valve, endoprosthesis, or stents. This is the first reported successful concomitant management of significant aortic valve stenosis and infrarenal abdominal aortic aneurysm through transcatheter aortic valve replacement and fenestrated endovascular aortic aneurysm repair.
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Affiliation(s)
- Abderrahim Sanoussi
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Charleroi, 140, Chaussée de Bruxelles, 6042 Charleroi, Belgique
| | - Adel Aminian
- Departement of Interventional Cardiology, Centre Hospitalier Universitaire de Charleroi, 140, Chaussée de Bruxelles, 6042 Charleroi, Belgique
| | - Jâd Abi-Khalil
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Charleroi, 140, Chaussée de Bruxelles, 6042 Charleroi, Belgique
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183
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Carter-Storch R, Hahn RT, Abbas AE, Daubert MA, Douglas PS, Elmariah S, Zhao Y, Mack MJ, Leon MB, Pibarot P, Clavel MA. Effect of Sex and Flow Status on Outcomes After Surgical or Transcatheter Aortic Valve Replacement. JACC. ADVANCES 2024; 3:100853. [PMID: 38938841 PMCID: PMC11198680 DOI: 10.1016/j.jacadv.2024.100853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/13/2023] [Accepted: 11/29/2023] [Indexed: 06/29/2024]
Abstract
Background Low stroke volume index <35 ml/m2 despite preserved ejection fraction (paradoxical low flow [PLF]) is associated with adverse outcomes in patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). However, whether the risk associated with PLF is similar in both sexes is unknown. Objectives The purpose of this study was to analyze the risk associated with PLF in severe aortic stenosis for men and women randomized to TAVR or SAVR. Methods Patients with ejection fraction ≥50% from the PARTNER (Placement of Aortic Transcatheter Valves) 2 and 3 trials were stratified by sex and treatment arm. The impact of PLF on the 2-year occurrence of the composite of death or heart failure hospitalization (primary endpoint) and of all-cause mortality alone (secondary endpoint) was analyzed. Analysis of variance was used to assess baseline differences between groups. Multivariate Cox regression analysis was used to identify predictors of the endpoint. Results Out of 2,242 patients, PLF was present in 390 men and 239 women (30% vs 26%, P = 0.06). PLF was associated with a higher rate of NYHA functional class III to IV dyspnea (60% vs 54%, P < 0.001) and a higher prevalence of atrial fibrillation (39% vs 24%, P < 0.001). PLF was a significant predictor of the primary endpoint among women undergoing SAVR in multivariate analysis (adjusted HR: 2.25 [95% CI: 1.14-4.43], P = 0.02) but was not associated with a worse outcome in any of the other groups (all P > 0.05). Conclusions In women with PLF, TAVR may improve outcomes compared to SAVR. PLF appears to have less impact on outcomes in men.
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Affiliation(s)
- Rasmus Carter-Storch
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Rebecca T. Hahn
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Amr E. Abbas
- Corewell Health, William Beaumont University Hospital, Royal Oak, Michigan, USA
| | | | | | - Sammy Elmariah
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yanglu Zhao
- Edwards Lifesciences, Irvine, California, USA
| | | | | | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
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184
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Onoda H, Imamura T, Ueno H, Oshima A, Ueno Y, Ushijima R, Sobajima M, Kinugawa K. Prognostic impact of elevated erythropoietin levels in patients with severe aortic stenosis receiving trans-catheter aortic valve implantation. J Cardiol 2024; 83:149-154. [PMID: 37479082 DOI: 10.1016/j.jjcc.2023.07.004] [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: 04/06/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Elevated endogenous erythropoietin (EPO) levels are associated with worse clinical outcomes in patients with heart failure (HF). The clinical implication of endogenous EPO levels in patients undergoing trans-catheter aortic valve implantation (TAVI) beyond other conventional risk factors remains unknown. METHODS Consecutive patients with EPO measurements who underwent TAVI for the treatment of their severe aortic stenosis at our institute between May 2015 and December 2020 were included. The association between the endogenous EPO levels and the primary outcome consisting of all-cause mortality and HF hospitalization was evaluated. RESULTS A total of 263 patients (85.1 ± 5.1 years old, 74 men) were included and tertiled according to the baseline EPO levels. The high EPO group had more advanced anemia, renal impairment, and hypoalbuminemia than the other two tertiled groups (p < 0.05 for both). Patients with high EPO had a significantly higher cumulative incidence of the primary outcomes compared to the other two groups (p = 0.002) with an adjusted hazard ratio of 6.0 (95 % confidence interval 1.9-18.1) in its logarithmic value (p < 0.001). CONCLUSIONS Elevated baseline EPO levels were independently associated with mortality and morbidity following TAVI. The clinical implication of aggressive intervention on the elevated EPO levels in this cohort remains the next concern.
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Affiliation(s)
- Hiroshi Onoda
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
| | - Hiroshi Ueno
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Akira Oshima
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Yohei Ueno
- 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
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
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185
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See C, Wang Y, Yang Y, Tirziu D, Papoutsidakis N, Francese DP, Kaple RK, Cleman M, Lansky AJ, Forrest JK. Impact of sex on Transcatheter aortic valve replacement outcomes: Results of a single-center study. Int J Cardiol 2024; 398:131643. [PMID: 38065329 DOI: 10.1016/j.ijcard.2023.131643] [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: 08/04/2023] [Revised: 11/13/2023] [Accepted: 12/03/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Early studies on transcatheter aortic valve replacement (TAVR) outcomes showed that female sex was associated with better survival. With increased use of new-generation valves, the impact of sex on contemporary TAVR outcomes is less well known. METHODS Retrospective analysis using institutional National Cardiovascular Data Registry STS/ACC TVT data was performed on all patients undergoing TAVR at Yale New Haven Hospital from July 2012 to August 2019. New-generation valves were Evolut PRO, Evolut R, and SAPIEN 3. Old-generation valves were CoreValve, SAPIEN, and SAPIEN XT. Log-rank test and Kaplan-Meier curves were used to compare sex differences in survival up to 1 year after TAVR. Cox modeling was used to adjust for baseline and procedural characteristic differences. RESULTS 927 consecutive patients (41.4% women) underwent TAVR. Women were older (82.8 vs 80.6 years old; p < 0.001) with higher STS mortality scores compared with men (7.6% vs 6.4%; p < 0.001) despite lower prevalence of cardiovascular comorbidities including coronary artery disease, peripheral artery disease, and smoking. Most cases used transfemoral access (90.5%) and new-generation devices (72.3%). Women received smaller valves compared with men (20-26 mm: 78.0% vs 32.9%; 29-34 mm: 22.1% vs 67.1%; overall p < 0.0001). There were no statistically significant differences between sexes in both unadjusted and adjusted 1-year mortality. CONCLUSION Our data show no significant difference in 1-year survival between sexes using primarily new generation valves. Further studies should reassess the impact of sex on TAVR outcomes and whether newer technologies like new valve design and sizes, and CT imaging may have eliminated sex-based disparities.
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Affiliation(s)
- Claudia See
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States of America.
| | - Yanting Wang
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States of America; Hackensack Meridian Health Jersey Shore University Medical Center, Neptune City, NJ, United States of America
| | - Yiping Yang
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Daniela Tirziu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Nikolaos Papoutsidakis
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Dominic P Francese
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Ryan K Kaple
- Structural and Congenital Heart Center, Hackensack University Medical Center, Hackensack, NJ, United States of America
| | - Michael Cleman
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Alexandra J Lansky
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - John K Forrest
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States of America
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186
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Noguchi M, Tabata M, Ito J, Kato N, Obunai K, Watanabe H, Yashima F, Watanabe Y, Naganuma T, Yamawaki M, Yamanaka F, Shirai S, Ueno H, Tada N, Yamamoto M, Hayashida K. Midterm outcomes of transcatheter aortic valve replacement in patients with active cancer. Open Heart 2024; 11:e002573. [PMID: 38417913 PMCID: PMC10900309 DOI: 10.1136/openhrt-2023-002573] [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: 11/28/2023] [Accepted: 02/15/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES The clinical outcomes of transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis (AS) and concomitant active cancer remain insufficiently explored. This study aimed to assess the midterm outcomes of TAVR in patients diagnosed with AS and active cancer. METHODS Data from the OCEAN-TAVI, a prospective Japanese registry of TAVR procedures, was analysed to compare prognoses and clinical outcomes in patients with and without active cancer at the time of TAVR. RESULTS Of the 2336 patients who underwent TAVR from October 2013 to July 2017, 89 patients (3.8%) had active cancer, whereas 2247 did not. Among patients with active cancer, 49 had limited-stage cancer (stage 1 or 2). The prevalent cancers identified before TAVR were colon (21%), prostate (18%), lung (15%), liver (11%) and breast (9%). Although the periprocedural complications and 30-day mortality rates were comparable between the groups, the 3-year survival rate after TAVR was notably lower in patients with active cancer (64.7%) than in those without active cancer (74.7%; p=0.016). Nevertheless, the 3-year survival rate of patients with limited-stage cancer (stage 1 or 2) did not significantly differ from those without cancer (70.6% vs 74.7%, p=0.50). CONCLUSIONS The patients with active cancer exhibited significantly reduced midterm survival rates. However, no distinct disparity existed in those with limited-stage cancer (stage 1 or 2). Although TAVR is a viable treatment in patients with AS with active cancer, the type and stage of cancer and prognosis should be carefully weighed in the decision-making process.
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Affiliation(s)
- Masahiko Noguchi
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Joji Ito
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Nahoko Kato
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Kotaro Obunai
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Hiroyuki Watanabe
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroshi Ueno
- Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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187
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Wang X, Wu Y, Li M, Wen J, Liu L, Huang W, He Q, Liao Y, Cong L. Effective health management strategies for patients undergoing valve replacement: a bibliometric analysis of the current research status and future directions. Front Cardiovasc Med 2024; 11:1352437. [PMID: 38476380 PMCID: PMC10929617 DOI: 10.3389/fcvm.2024.1352437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Background Valvular heart disease is a major health concern worldwide. The effective management of patients undergoing valve replacement determines their prognosis. Bibliometric analysis of studies on managing patients with artificial heart valves has not been previously performed. Methods This study analyzed 2,771 publications related to patient management after valve replacement published in the Web of Science Core Collection database between January 1, 2013, and December 31, 2022. Bibliometric analysis was performed using CiteSpace and VOSviewer considering countries, institutions, authors, journals, references, and keywords. Results The countries with the most significant contributions in this field were the United States of America (USA), Germany, and Italy. Leon MB from Columbia University, USA was the most influential author. Transcatheter aortic valve replacement was a current research hotspot, while anticoagulation management was a key area of interest. Combining anticoagulation therapy with internet-linked tools and portable health devices may offer new research avenues. Frailty assessment and intervention were potential future research areas. Conclusions This bibliometric analysis provides clinicians and researchers with useful insights for developing novel ideas and directions to manage the health of patients undergoing valve replacement.
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Affiliation(s)
- Xiaohui Wang
- School of Medicine, Hunan Normal University, Changsha, Hunan, China
| | - Ying Wu
- School of Medicine, Hunan Normal University, Changsha, Hunan, China
| | - Ming Li
- Trauma Center, Zhu Zhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, Hunan, China
| | - Jing Wen
- Nursing Department, Hunan Cancer Hospital, Changsha, Hunan, China
| | - Lijuan Liu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Wenzhuo Huang
- School of Medicine, Hunan Normal University, Changsha, Hunan, China
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qianqian He
- School of Medicine, Hunan Normal University, Changsha, Hunan, China
| | | | - Li Cong
- School of Medicine, Hunan Normal University, Changsha, Hunan, China
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188
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Demirel C, Rothenbühler CF, Huber M, Schweizer M, Todorski I, Gloor DA, Windecker S, Lanz J, Stortecky S, Pilgrim T, Erdoes G. Total Muscle Area and Visceral Adipose Tissue Measurements for Frailty Assessment in TAVR Patients. J Clin Med 2024; 13:1322. [PMID: 38592183 PMCID: PMC10932166 DOI: 10.3390/jcm13051322] [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: 01/14/2024] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is a treatment option for severe aortic valve stenosis. Pre-TAVR assessments, extending beyond anatomy, include evaluating frailty. Potential frailty parameters in pre-TAVR computed tomography (CT) scans are not fully explored but could contribute to a comprehensive frailty assessment. The primary objective was to investigate the impact of total muscle area (TMA) and visceral adipose tissue (VAT) as frailty parameters on 5-year all-cause mortality in patients undergoing TAVR. Methods: Between 01/2017 and 12/2018, consecutive TAVR patients undergoing CT scans enabling TMA and VAT measurements were included. Results: A total of 500 patients qualified for combined TMA and VAT analysis. Age was not associated with a higher risk of 5-year mortality (HR 1.02, 95% CI: 0.998-1.049; p = 0.069). Body surface area normalized TMA (nTMA) was significantly associated with 5-year, all-cause mortality (HR 0.927, 95% CI: 0.927-0.997; p = 0.033), while VAT had no effect (HR 1.002, 95% CI: 0.99-1.015; p = 0.7). The effect of nTMA on 5-year, all-cause mortality was gender dependent: the protective effect of higher nTMA was found in male patients (pinteraction: sex × nTMA = 0.007). Conclusions: Normalized total muscle area derived from a routine CT scan before transcatheter aortic valve replacement complements frailty assessment in patients undergoing TAVR.
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Affiliation(s)
- Caglayan Demirel
- Department of Cardiology, Inselspital, University of Bern, 3012 Bern, Switzerland
| | | | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Inselspital, University of Bern, 3012 Bern, Switzerland
| | - Michelle Schweizer
- Department of Radiology, Inselspital, University of Bern, 3012 Bern, Switzerland
| | - Inga Todorski
- Department of Radiology, Inselspital, University of Bern, 3012 Bern, Switzerland
| | | | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, 3012 Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, University of Bern, 3012 Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, University of Bern, 3012 Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, 3012 Bern, Switzerland
| | - Gabor Erdoes
- Department of Anaesthesiology and Pain Medicine, Inselspital, University of Bern, 3012 Bern, Switzerland
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189
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Groginski T, Mansour A, Kamal D, Saad M. Transcatheter Aortic Valve Replacement for Failed Surgical or Transcatheter Bioprosthetic Valves: A Comprehensive Review. J Clin Med 2024; 13:1297. [PMID: 38592142 PMCID: PMC10932095 DOI: 10.3390/jcm13051297] [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: 01/03/2024] [Revised: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has proven to be a safe, effective, and less invasive approach to aortic valve replacement in patients with aortic stenosis. In patients who underwent prior aortic valve replacement, transcatheter and surgical bioprosthetic valve dysfunction may occur as a result of structural deterioration or nonstructural causes such as prosthesis-patient mismatch (PPM) and paravalvular regurgitation. Valve-in-Valve (ViV) TAVR is a procedure that is being increasingly utilized for the replacement of failed transcatheter or surgical bioprosthetic aortic valves. Data regarding long-term outcomes are limited due to the recency of the procedure's approval, but available data regarding the short- and long-term outcomes of ViV TAVR are promising. Studies have shown a reduction in perioperative and 30-day mortality with ViV TAVR procedures compared to redo surgical repair of failed bioprosthetic aortic valves, but 1-year and 5-year mortality rates are more controversial and lack sufficient data. Despite the reduction in 30-day mortality, PPM and rates of coronary obstruction are higher in ViV TAVR as compared to both redo surgical valve repair and native TAVR procedures. New transcatheter heart valve designs and new procedural techniques have been developed to reduce the risk of PPM and coronary obstruction. Newer generation valves, new procedural techniques, and increased operator experience with ViV TAVR may improve patient outcomes; however, further studies are needed to better understand the safety, efficacy, and durability of ViV TAVR.
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Affiliation(s)
- Taylor Groginski
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA;
| | - Amr Mansour
- Department of Cardiology, Ain Shams University, Cairo 11566, Egypt; (A.M.); (D.K.)
| | - Diaa Kamal
- Department of Cardiology, Ain Shams University, Cairo 11566, Egypt; (A.M.); (D.K.)
| | - Marwan Saad
- Department of Medicine, Division of Cardiology, The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA
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190
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Abbasciano RG, Magouliotis DE, Koulouroudias M, Spiliopoulos K, Xanthopoulos A, Kourliouros A, Casula R, Athanasiou T, Viviano A. Valve Type and Operative Risks in Surgical Explantation of Transcatheter Aortic Valves: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1262. [PMID: 38592075 PMCID: PMC10932147 DOI: 10.3390/jcm13051262] [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: 01/28/2024] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 04/10/2024] Open
Abstract
Indication to perform surgical explantation of TAVR is becoming increasingly more frequent, due to the higher number of transcatheter procedures performed in patients with longer life expectancy. We proposed to perform a systematic review and meta-analysis with metaregression to identify potential factors that can determine an increase in the high mortality and morbidity that characterize these surgical procedures. MEDLINE and Embase were searched for relevant studies. Twelve studies were eligible according to our inclusion criteria. TAVR explantation was confirmed as a procedure with high 30-day mortality (0.17; 95% CI, 0.14-0.21) and morbidity (stroke incidence 5%; 95% CI, 0.04-0.07; kidney injury incidence 16%; 95% CI, 0.11-0.24). The type of transcatheter valve implanted during the index procedure did not influence the outcomes after surgical explantation. The role of these high-risk operations is growing, and it will likely expand in the coming years. Specific tools for risk stratification are required.
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Affiliation(s)
- Riccardo G. Abbasciano
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (R.G.A.); (R.C.)
- Department of Surgery & Cancer, Imperial College, London SW7 2BX, UK;
| | - Dimitrios E. Magouliotis
- Unit of Quality Improvement, Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41 110 Larissa, Greece;
| | - Marinos Koulouroudias
- Department of Cardiac Surgery, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
| | - Kyriakos Spiliopoulos
- Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41 110 Larissa, Greece;
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, 413 34 Larissa, Greece;
| | - Antonios Kourliouros
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Roberto Casula
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (R.G.A.); (R.C.)
| | - Thanos Athanasiou
- Department of Surgery & Cancer, Imperial College, London SW7 2BX, UK;
| | - Alessandro Viviano
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (R.G.A.); (R.C.)
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191
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Will M, Schwarz K, Weiss T, Leibundgut G, Schmidt E, Vock P, Mousavi R, Borovac JA, Kwok CS, Hoppe UC, Mascherbauer J, Lamm G. The impact of concomitant chronic total occlusion on clinical outcomes in patients undergoing transcatheter aortic valve replacement: a large single-center analysis. Front Cardiovasc Med 2024; 11:1338253. [PMID: 38464840 PMCID: PMC10921092 DOI: 10.3389/fcvm.2024.1338253] [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: 11/14/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024] Open
Abstract
Background Coronary artery disease (CAD) is a common finding in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). However, the impact on prognosis of chronic total occlusions (CTOs), a drastic expression of CAD, remains unclear. Methods and results We retrospectively reviewed 1,487 consecutive TAVR cases performed at a single tertiary care medical center. Pre-TAVR angiograms were analyzed for the presence of a CTO. At the time of TAVR, 11.2% (n = 167) patients had a CTO. There was no significant association between the presence of a CTO and in-hospital or 30-day mortality. There was also no difference in long-term survival. LV ejection fraction and mean aortic gradients were lower in the CTO group. Conclusions Our analysis suggests that concomitant CTO lesions in patients undergoing TAVR differ in their risk profile and clinical findings to patients without CTO. CTO lesion per se were not associated with increased mortality, nevertheless CTOs which supply non-viable myocardium in TAVR population were associated with increased risk of death. Additional research is needed to evaluate the prognostic significance of CTO lesions in TAVR patients.
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Affiliation(s)
- Maximilian Will
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Division of Internal Medicine 3, University Hospital St. Pölten, St. Pölten, Austria
- Karl Landsteiner Institute for Cardiometabolics, Karl Landsteiner Society, St Poelten, Austria
| | - Konstantin Schwarz
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Division of Internal Medicine 3, University Hospital St. Pölten, St. Pölten, Austria
| | - Thomas Weiss
- Karl Landsteiner Institute for Cardiometabolics, Karl Landsteiner Society, St Poelten, Austria
- Medical School, Sigmund-Freud University, Vienna, Austria
| | - Gregor Leibundgut
- Klinik für Kardiologie, Universitätsspital Basel, Basel, Switzerland
| | - Elisabeth Schmidt
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Division of Internal Medicine 3, University Hospital St. Pölten, St. Pölten, Austria
| | - Paul Vock
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Division of Internal Medicine 3, University Hospital St. Pölten, St. Pölten, Austria
| | - Roya Mousavi
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Division of Internal Medicine 3, University Hospital St. Pölten, St. Pölten, Austria
| | - Josip A Borovac
- Cardiovascular Diseases Department, University Hospital of Split, Split, Croatia
| | - Chun Shing Kwok
- Department of Post-Qualifying Healthcare Practice, School of Nursing and Midwifery, Birmingham City University, Birmingham, United Kingdom
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Uta C Hoppe
- University Department of Internal Medicine II, Cardiology and Internal Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Julia Mascherbauer
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Division of Internal Medicine 3, University Hospital St. Pölten, St. Pölten, Austria
| | - Gudrun Lamm
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Division of Internal Medicine 3, University Hospital St. Pölten, St. Pölten, Austria
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192
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Oikonomou G, Apostolos A, Drakopoulou M, Simopoulou C, Karmpalioti M, Toskas P, Stathogiannis K, Xanthopoulou M, Ktenopoulos N, Latsios G, Synetos A, Tsioufis C, Toutouzas K. Long-Term Outcomes of Aortic Stenosis Patients with Different Flow/Gradient Patterns Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2024; 13:1200. [PMID: 38592019 PMCID: PMC10932005 DOI: 10.3390/jcm13051200] [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: 01/29/2024] [Revised: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Few data exist on the comparative long-term outcomes of severe aortic stenosis (AS) patients with different flow-gradient patterns undergoing transcatheter aortic valve implantation (TAVI). This study sought to evaluate the impact of the pre-TAVI flow-gradient pattern on long-term clinical outcomes after TAVI and assess changes in the left ventricular ejection fraction (LVEF) of different subtypes of AS patients following TAVI. Methods: Consecutive patients with severe AS undergoing TAVI in our institution were screened and prospectively enrolled. Patients were divided into four subgroups according to pre-TAVI flow/gradient pattern: (i) low flow-low gradient (LF-LG): stroke volume indexed (SVi) ≤ 35 mL/m2 and mean gradient (MG) < 40 mmHg); (ii) normal flow-low gradient (NF-LG): SVi > 35 mL/m2 and MG < 40 mmHg; (iii) low flow-high gradient (LF-HG): Svi 35 mL/m2 and MG ≥ 40 mmHg and (iv) normal flow-high gradient (NF-HG): SVi > 35 mL/m2 and MG ≥ 40 mmHg. Transthoracic echocardiography was repeated at 1-year follow-up. Clinical follow-up was obtained at 12 months, and yearly thereafter until 5-year follow-up was complete for all patients. Results: A total of 272 patients with complete echocardiographic and clinical follow-up were included in our analysis. Their mean age was 80 ± 7 years and the majority of patients (N = 138, 50.8%) were women. 62 patients (22.8% of the study population) were distributed in the LF-LG group, 98 patients (36%) were LF-HG patients, 95 patients (34.9%) were NF-HG, and 17 patients (6.3%) were NF-LG. There was a greater prevalence of comorbidities among LF-LG AS patients. One-year all-cause mortality differed significantly between the four subgroups of AS patients (log-rank p: 0.022) and was more prevalent among LF-LG patients (25.8%) compared to LF-HG (11.3%), NF-HG (6.3%) and NF-LG patients (18.8%). At 5-year follow-up, global mortality remained persistently higher among LF-LG patients (64.5%) compared to LF-HG (47.9%), NF-HG (42.9%), and NF-LG patients (58.8%) (log-rank p: 0.029). At multivariable Cox hazard regression analysis, baseline SVi (HR: 0.951, 95% C.I.; 0.918-0.984), the presence of at least moderate tricuspid regurgitation at baseline (HR: 3.091, 95% C.I: 1.645-5.809) and at least moderate paravalvular leak (PVL) post-TAVI (HR: 1.456, 95% C.I.: 1.106-1.792) were significant independent predictors of late global mortality. LF-LG patients and LF-HG patients exhibited a significant increase in LVEF at 1-year follow-up. A lower LVEF (p < 0.001) and a lower Svi (p < 0.001) at baseline were associated with LVEF improvement at 1-year. Conclusions: Patients with LF-LG AS have acceptable 1-year outcomes with significant improvement in LVEF at 1-year follow-up, but exhibit exceedingly high 5-year mortality following TAVI. The presence of low transvalvular flow and at least moderate tricuspid regurgitation at baseline and significant paravalvular leak post-TAVI were associated with poorer long-term outcomes in the entire cohort of AS patients. The presence of a low LVEF or a low SVi predicts LVEF improvement at 1-year.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” General Hospital of Athens, 11527 Athens, Greece; (G.O.); (A.A.); (M.D.); (C.S.); (M.K.); (P.T.); (K.S.); (M.X.); (N.K.); (G.L.); (A.S.); (C.T.)
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193
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 124] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Lo Russo GV, Alarouri HS, Al‐Abcha A, Vogl B, Mahayni A, Sularz A, Hatoum H, Collins J, Crestanello JA, Alkhouli M. Association of Bovine Arch Anatomy With Incident Stroke After Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2024; 13:e032963. [PMID: 38348804 PMCID: PMC11010090 DOI: 10.1161/jaha.123.032963] [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: 11/15/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Acute ischemic stroke complicates 2% to 3% of transcatheter aortic valve replacements (TAVRs). This study aimed to identify the aortic anatomic correlates in patients after TAVR stroke. METHODS AND RESULTS This is a single-center, retrospective study of patients who underwent TAVR at the Mayo Clinic between 2012 and 2022. The aortic arch morphology was determined via a manual review of the pre-TAVR computed tomography images. An "a priori" approach was used to select the covariates for the following: (1) the logistic regression model assessing the association between a bovine arch and periprocedural stroke (defined as stroke within 7 days after TAVR); and (2) the Cox proportional hazards regression model assessing the association between a bovine arch and long-term stroke after TAVR. A total of 2775 patients were included (59.6% men; 97.8% White race; mean±SD age, 79.3±8.4 years), of whom 495 (17.8%) had a bovine arch morphology. Fifty-seven patients (1.7%) experienced a periprocedural stroke. The incidence of acute stroke was significantly higher among patients with a bovine arch compared with those with a nonbovine arch (3.6% versus 1.7%; P=0.01). After adjustment, a bovine arch was independently associated with increased periprocedural strokes (adjusted odds ratio, 2.16 [95% CI, 1.22-3.83]). At a median follow-up of 2.7 years, the overall incidence of post-TAVR stroke was 6.0% and was significantly higher in patients with a bovine arch even after adjusting for potential confounders (10.5% versus 5.0%; adjusted hazard ratio, 2.11 [95% CI, 1.51-2.93]; P<0.001). CONCLUSIONS A bovine arch anatomy is associated with a significantly higher risk of periprocedural and long-term stroke after TAVR.
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Affiliation(s)
| | | | | | - Brennan Vogl
- Department of Biomedical EngineeringMichigan Technological UniversityHoughtonMI
| | | | - Agata Sularz
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
| | - Hoda Hatoum
- Department of Biomedical EngineeringMichigan Technological UniversityHoughtonMI
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Gao X, Jiang X, Wu Z, Chen N, Gong M, Zhao X, Liu Y, Guo R. Effect of Neutrophil-to-Lymphocyte Ratio on Post-TAVR Mortality and Periprocedural Pulmonary Hypertension. J Interv Cardiol 2024; 2024:4512655. [PMID: 38415185 PMCID: PMC10898951 DOI: 10.1155/2024/4512655] [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: 10/16/2023] [Revised: 01/27/2024] [Accepted: 02/06/2024] [Indexed: 02/29/2024] Open
Abstract
Aims To evaluate the impact of neutrophil-to-lymphocyte ratio (NLR) on periprocedural pulmonary hypertension (PH) and 3-month all-cause mortality in patients with aortic stenosis (AS) who underwent transcatheter aortic valve replacement (TAVR) and to develop a nomogram for predicting the mortality for these patients. Methods and Results 124 patients undergoing TAVR were categorized into three groups according to systolic pulmonary artery pressure (sPAP): Group I (no PH, n = 61) consisted of patients with no pre- and post-TAVR PH; Group II (improved PH, n = 35) consisted of patients with post-TAVR systolic pulmonary artery pressure (sPAP) decreased by more than 10 mmHg compared to pre-TAVR levels; and Group III (persistent PH, n = 28) consisted of patients with post-TAVR sPAP no decrease or less than 10 mmHg, or new-onset PH after the TAVR procedure. The risk of all-cause mortality within 3 months tended to be higher in Group II (11.4%) and Group III (14.3%) compared to Group I (3.3%) (P=0.057). The multinomial logistic regression analysis demonstrated a positive correlation between NLR and both improved PH (OR: 1.182, 95% CI: 1.036-1.350, P=0.013) and persistent PH (OR: 1.181, 95% CI: 1.032-1.352, P=0.016). Kaplan-Meier analysis revealed a significant association between higher NLR and increased 3-month all-cause mortality (16.1% vs. 3.1% in lower NLR group, P=0.021). The multivariable Cox regression analysis confirmed that NLR was an independent predictor for all-cause mortality within 3 months, even after adjusting for clinical confounders. A nomogram incorporating five factors (BNP, heart rate, serum total bilirubin, NLR, and comorbidity with coronary heart disease) was developed. ROC analysis was performed to discriminate the ability of the nomogram, and the AUC was 0.926 (95% CI: 0.850-1.000, P < 0.001). Conclusions Patients with higher baseline NLR were found to be at an increased risk of periprocedural PH and all-cause mortality within 3 months after TAVR.
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Affiliation(s)
- Xin Gao
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaoxiao Jiang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zonglei Wu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Na Chen
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Minghui Gong
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xu Zhao
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yan Liu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ran Guo
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Kikuchi S, Minamimoto Y, Matsushita K, Cho T, Terasaka K, Hanajima Y, Nakahashi H, Gohbara M, Kimura Y, Yasuda S, Okada K, Matsuzawa Y, Iwahashi N, Kosuge M, Ebina T, Morel O, Ohlmann P, Uchida K, Hibi K. Ratio of left ventricular outflow tract area to aortic annulus area and complete atrioventricular block after transcatheter aortic valve replacement for aortic stenosis. Int J Cardiol 2024; 397:131608. [PMID: 38030042 DOI: 10.1016/j.ijcard.2023.131608] [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: 09/10/2023] [Revised: 10/29/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Mechanical compression of cardiac conduction system by transcatheter heart valves leads to complete atrioventricular block (CAVB) after transcatheter aortic valve replacement (TAVR). Bulging of ventricular septum in the left ventricular outflow tract (LVOT) may be associated with greater compression of conduction system, leading to irreversible CAVB. OBJECTIVE This study aimed to investigate the association of ventricular septal bulging with TAVR-related CAVB and permanent pacemaker implantation (PPI). METHODS Among 294 consecutive patients with severe aortic stenosis who underwent TAVR between July 2017 and February 2023, 271 were included in the analysis. As a quantitative evaluation of bulging of the ventricular septum, the ratio of LVOT area to aortic annulus area (L/A ratio) was measured at the systolic phase of computed tomography images. RESULTS TAVR-related CAVB occurred in 64 patients (23.6%). Twenty-eight patients (10.3%) required PPI. The optimal thresholds of L/A ratio for predicting TAVR-related CAVB and PPI were 1.0181 and 0.985, respectively. Patients with less than the cut-off values had higher rate of TAVR-related CAVB and PPI than those above (28.3% vs 13.1%, p = 0.0063; 14.7% vs 4.4%, p = 0.0077, respectively). A multivariate analysis showed that L/A ratio < 1.0181 was an independent predictor of TAVR-related CAVB (odds ratio [OR] 2.65, p = 0.011), in addition to prior right bundle branch block (OR 3.76, p = 0.0005), use of a self-expanding valve (OR 1.99, p = 0.030), and short membranous septum length (OR 0.96, p = 0.037). Only L/A ratio < 0.985 was independently associated with PPI (OR 3.70, p = 0.011). CONCLUSION Low L/A ratio is a predictor of TAVR-related CAVB and PPI.
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Affiliation(s)
- Shinnosuke Kikuchi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yugo Minamimoto
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kensuke Matsushita
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Tomoki Cho
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kengo Terasaka
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yohei Hanajima
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hidefumi Nakahashi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Masaomi Gohbara
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuichiro Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shota Yasuda
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kozo Okada
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasushi Matsuzawa
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Noriaki Iwahashi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Toshiaki Ebina
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Olivier Morel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 1 Place de L'Hôpital, 67091 Strasbourg, France
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 1 Place de L'Hôpital, 67091 Strasbourg, France
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan; Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
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Sa YK, Choi IJ, Chang K, Hwang BH, Chung WB, Lee KY, Choo EH, Kim CJ, Park MW, Choi YS, Park CS, Yoo KD, Jeon DS, Oak MH, Lee J, Kang D. Balloon-Expandable Versus Self-Expandable Valve in Transcatheter Aortic Valve Replacement: A Nation-Wide Study. Am J Cardiol 2024; 213:119-125. [PMID: 38110017 DOI: 10.1016/j.amjcard.2023.12.007] [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: 08/30/2023] [Revised: 11/27/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023]
Abstract
A few studies have reported comparative analysis of clinical outcomes between balloon-expandable valve (BEV) and self-expandable valve (SEV) after transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis using newer-generation devices. However, those reports were mostly limited to short-term outcomes and Western populations. In the present study, data of patients with severe aortic stenosis who underwent TAVR between March 2016 and December 2018 were obtained from the National Health Insurance Service in Korea. The primary end point, defined as all-cause mortality, was compared in BEV (SAPIEN 3, Edwards Lifesciences, Irvine, California) and SEV (Evolut R, Medtronic, Minneapolis, MN) groups using a propensity-score matching analysis. Cumulative event rates of ischemic stroke, repeat procedures, and permanent pacemaker insertion (PPI) were evaluated as secondary outcomes. All events were followed up to a maximum of 3 years. A total of 1,172 patients underwent transfemoral TAVR, of whom 707 (60.3%) were treated with BEV and 452 (38.6%) with SEV. After 1:1 propensity-score matching, the BEV group showed lower all-cause mortality after a median follow-up of 12.0 months (mean: 13.1 ± 9.3 months) based on Cox proportional hazard model analysis (hazard ratio [HR] 0.67, 95% confidence interval [CI] 0.45 to 0.99, p = 0.04). Cumulative incidence of ischemic stroke was not statistically different between the 2 groups (HR 0.68, 95% CI 0.29 to 1.59, p = 0.37). PPI occurred less frequently in the BEV group (HR 0.4, 95% CI 0.25 to 0.64, p < 0.01). Repeat procedures were rare (1 patient in BEV and 2 patients in SEV group). In conclusion, Korean nation-wide data analysis showed that BEV was associated with less all-cause death and incidence of PPI after TAVR than was SEV using a newer-generation device.
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Affiliation(s)
- Young Kyoung Sa
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ik Jun Choi
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Byung-Hee Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Woo-Baek Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kwan Yong Lee
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Eun-Ho Choo
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Chan Joon Kim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Mahn Won Park
- Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yoon Seok Choi
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Chul Soo Park
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ki Dong Yoo
- Division of Cardiology, Department of Internal Medicine, St. Vincent Hospital, The Catholic University of Korea, Seoul, Korea
| | - Doo Soo Jeon
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Min-Ho Oak
- College of Pharmacy, Mokpo National University, Muan, Jeonnam, Korea
| | - Jungkuk Lee
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, Korea
| | - Dongwoo Kang
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, Korea
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Magyari B, Kittka B, Goják I, Schönfeld K, Szapáry LB, Simon M, Kiss R, Bertalan A, Várady E, Gyimesi A, Szokodi I, Horváth IG. Learning Curve for Starting a Successful Single-Centre TAVR Programme with Multiple Devices: Early and Mid-Term Follow-Up. J Clin Med 2024; 13:1088. [PMID: 38398401 PMCID: PMC10889517 DOI: 10.3390/jcm13041088] [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: 01/19/2024] [Revised: 02/02/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Aims: We report 30-day, 1-year, and 3-year outcomes for a new TAVR programme that used five different transcatheter heart valve (THV) systems. Methods: From 2014 to 2020, 122 consecutive patients with severe aortic stenosis (AS) received TAVR based on the Heart Team decision. Outcomes were analysed for the whole study population and in addition the first 63 patients (Cohort A, 2014 to 2019) were compared to the last 59 patients (Cohort B, 2019 to 2020). Outcomes included VARC-2 definitions and device performance assessed via transthoracic echocardiography by independent high-volume investigators. Results: The mean patient age was 77.9 ± 6.1 years old, and 48 (39.3%) were male. The mean logistic Euroscore II was 4.2 ± 4.5, and the mean STS score was 6.9 ± 4.68. The systems used were as follows: Medtronic Corevalve Evolute R/PRO (82 patients-67.2%); Abbott Portico (13-10.6%); Boston Scientific Lotus (10-8.2%); Meril Myval (11-9%); and Boston Scientific Neo Accurate (6-5%). Access was transfemoral (95.9% of patients); surgical cut down (18% vs. percutaneous 77.8%); subclavian (n = 2); trans-axillary (n = 2); and direct aorta (n = 1). VARC-2 outcomes were as follows: device success rate 97.5%; stroke rate 1.6%; major vascular complication 3.3%; permanent pacemaker implantation 12.4%. At discharge, the incidences of grade I and II aortic regurgitation were 39.95 and 55.5%, respectively. At one year, all-cause mortality was 7.4% without admissions for valve-related dysfunction. The 3-year all-cause mortality and all-stroke rates were 22.9% and 4.1%, respectively. Between the 1-year and 3-year follow-ups, valve-related dysfunction was detected in three patients; one had THV system endocarditis that led to death. There was a remarkable but statistically non-significant decrease in mortality from Cohort A to Cohort B [four (6.3%) vs. one patient (1.7%), p = 0.195] and major vascular complications occurred at a significantly higher rate in the Cohort B [zero (0%) vs. four (6.8% patient, p = 0.036)]. Overall, we found that using multiple devices was safe and allowed for a learning team to achieve a high device success rate from the beginning (97.5%). Conclusions: TAVR with different THV systems showed acceptable early and mid-term outcomes for survival, technical success, and valve-related adverse events in high-risk patients with significant AS, even in the learning curve phase.
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Affiliation(s)
- Balázs Magyari
- Heart Institute, Medical School, University of Pécs, 7624 Pécs, Hungary; (B.K.); (I.G.); (K.S.); (L.B.S.); (M.S.); (R.K.); (A.B.); (I.S.); (I.G.H.)
- Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary
| | - Bálint Kittka
- Heart Institute, Medical School, University of Pécs, 7624 Pécs, Hungary; (B.K.); (I.G.); (K.S.); (L.B.S.); (M.S.); (R.K.); (A.B.); (I.S.); (I.G.H.)
- Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary
| | - Ilona Goják
- Heart Institute, Medical School, University of Pécs, 7624 Pécs, Hungary; (B.K.); (I.G.); (K.S.); (L.B.S.); (M.S.); (R.K.); (A.B.); (I.S.); (I.G.H.)
| | - Kristóf Schönfeld
- Heart Institute, Medical School, University of Pécs, 7624 Pécs, Hungary; (B.K.); (I.G.); (K.S.); (L.B.S.); (M.S.); (R.K.); (A.B.); (I.S.); (I.G.H.)
- Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary
| | - László Botond Szapáry
- Heart Institute, Medical School, University of Pécs, 7624 Pécs, Hungary; (B.K.); (I.G.); (K.S.); (L.B.S.); (M.S.); (R.K.); (A.B.); (I.S.); (I.G.H.)
- Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary
| | - Mihály Simon
- Heart Institute, Medical School, University of Pécs, 7624 Pécs, Hungary; (B.K.); (I.G.); (K.S.); (L.B.S.); (M.S.); (R.K.); (A.B.); (I.S.); (I.G.H.)
- Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary
| | - Rudolf Kiss
- Heart Institute, Medical School, University of Pécs, 7624 Pécs, Hungary; (B.K.); (I.G.); (K.S.); (L.B.S.); (M.S.); (R.K.); (A.B.); (I.S.); (I.G.H.)
| | - Andrea Bertalan
- Heart Institute, Medical School, University of Pécs, 7624 Pécs, Hungary; (B.K.); (I.G.); (K.S.); (L.B.S.); (M.S.); (R.K.); (A.B.); (I.S.); (I.G.H.)
| | - Edit Várady
- Department of Medical Imaging, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - András Gyimesi
- EconNet Research Group, Faculty of Business and Economics, University of Pécs, 7624 Pécs, Hungary;
| | - István Szokodi
- Heart Institute, Medical School, University of Pécs, 7624 Pécs, Hungary; (B.K.); (I.G.); (K.S.); (L.B.S.); (M.S.); (R.K.); (A.B.); (I.S.); (I.G.H.)
- Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary
| | - Iván Gábor Horváth
- Heart Institute, Medical School, University of Pécs, 7624 Pécs, Hungary; (B.K.); (I.G.); (K.S.); (L.B.S.); (M.S.); (R.K.); (A.B.); (I.S.); (I.G.H.)
- Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary
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199
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Beyls C, Yakoub-Agha M, Hermida A, Martin N, Crombet M, Hanquiez T, Fournier A, Jarry G, Malaquin D, Michaud A, Abou-Arab O, Leborgne L, Mahjoub Y. Prognostic Value of a New Right Ventricular-to-Pulmonary Artery Coupling Parameter Using Right Ventricular Longitudinal Shortening Fraction in Patients Undergoing Transcatheter Aortic Valve Replacement: A Prospective Echocardiography Study. J Clin Med 2024; 13:1006. [PMID: 38398319 PMCID: PMC10889072 DOI: 10.3390/jcm13041006] [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: 12/19/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
Introduction: Right-ventricular-to-pulmonary artery (RV-PA) coupling, measured as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP), has emerged as a predictor factor in patients undergoing transcatheter aortic valvular replacement (TAVR). Right ventricular longitudinal shortening fraction (RV-LSF) outperformed TAPSE as a prognostic parameter in several diseases. We aimed to compare the prognostic ability of two RV-PA coupling parameters (TAPSE/PASP and the RV-LSF/PASP ratio) in identifying MACE occurrences. Method: A prospective and single-center study involving 197 patients who underwent TAVR was conducted. MACE (heart failure, myocardial infarction, stroke, and death within six months) constituted the primary outcome. ROC curve analysis determined cutoff values for RV-PA ratios. Multivariable Cox regression analysis explored the association between RV-PA ratios and MACE. Results: Forty-six patients (23%) experienced the primary outcome. No significant difference in ROC curve analysis was found (RV-LSF/PASP with AUC = 0.67, 95%CI = [0.58-0.77] vs. TAPSE/PASP with AUC = 0.62, 95%CI = [0.49-0.69]; p = 0.16). RV-LSF/PASP < 0.30%.mmHg-1 was independently associated with the primary outcome. The 6-month cumulative risk of MACE was 59% (95%CI = [38-74]) for patients with RV-LSF/PASP < 0.30%.mmHg-1 and 17% (95%CI = [12-23]) for those with RV-LSF/PASP ≥ 0.30%.mmHg-1; (p < 0.0001). Conclusions: In a contemporary cohort of patients undergoing TAVR, RV-PA uncoupling defined by an RV-LSF/PASP < 0.30%.mmHg-1 was associated with MACE at 6 months.
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Affiliation(s)
- Christophe Beyls
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (M.Y.-A.); (M.C.); (O.A.-A.); (Y.M.)
- UR UPJV 758 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, University of Picardie Jules Verne, F-80054 Amiens, France
| | - Mathilde Yakoub-Agha
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (M.Y.-A.); (M.C.); (O.A.-A.); (Y.M.)
| | - Alexis Hermida
- Rythmology Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France;
| | - Nicolas Martin
- Cardiac Intensive Care Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (N.M.); (T.H.); jarry.geneviè (D.M.); (L.L.)
| | - Maxime Crombet
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (M.Y.-A.); (M.C.); (O.A.-A.); (Y.M.)
| | - Thomas Hanquiez
- Cardiac Intensive Care Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (N.M.); (T.H.); jarry.geneviè (D.M.); (L.L.)
| | - Alexandre Fournier
- Cardiac Intensive Care Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (N.M.); (T.H.); jarry.geneviè (D.M.); (L.L.)
| | - Geneviève Jarry
- Cardiac Intensive Care Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (N.M.); (T.H.); jarry.geneviè (D.M.); (L.L.)
| | - Dorothée Malaquin
- Cardiac Intensive Care Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (N.M.); (T.H.); jarry.geneviè (D.M.); (L.L.)
| | - Audrey Michaud
- Biostatistics Unit, Clinical Research and Innovation Directorate, Amiens-Picardie University Hospital Centre, F-80054 Amiens, France
| | - Osama Abou-Arab
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (M.Y.-A.); (M.C.); (O.A.-A.); (Y.M.)
| | - Laurent Leborgne
- Cardiac Intensive Care Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (N.M.); (T.H.); jarry.geneviè (D.M.); (L.L.)
| | - Yazine Mahjoub
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (M.Y.-A.); (M.C.); (O.A.-A.); (Y.M.)
- UR UPJV 758 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, University of Picardie Jules Verne, F-80054 Amiens, France
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Taghizadeh-Waghefi A, Arzt S, Wenzel L, Petrov A, Wilbring M, Matschke K, Kappert U, Alexiou K. Right Anterior versus Right Transaxillary Access for Minimally Invasive Aortic Valve Replacement: A Propensity Matched Competitive Analysis. J Clin Med 2024; 13:985. [PMID: 38398297 PMCID: PMC10889463 DOI: 10.3390/jcm13040985] [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: 01/19/2024] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Right anterior thoracotomy (RAT-AVR) has been the sole established sternum-sparing technique for minimally invasive aortic valve replacement (MICS-AVR) thus far. Nevertheless, transaxillary access, known as Minimally Invasive Cardiac LATeral Surgery (MICLATS-AVR), represents the latest and innovative advancement in sternum-sparing MICS-AVR access routes. In this study, procedural and clinical outcomes of a substantial transaxillary MICS-AVR cohort are compared to those of a RAT-AVR control group; (2) Patients and Methods: This retrospective study included 918 consecutive patients who underwent MICS-AVR at our facility between 2014 and 2022. This cohort was divided into two surgical access-related groups: RAT-AVR (n = 492) and MICLATS-AVR (n = 426). Procedural data, operative morbidity, and mortality were compared between groups. Further analysis was performed using propensity score matching; (3) Results: After matching, 359 pairs of patients were included and analyzed. There were no notable differences observed between the two groups regarding major adverse cardio-cerebral events. Despite longer cardiopulmonary bypass time in the MICLATS-AVR group (63.1 ± 20.4 min vs. 66.4 ± 18.2 min; p ≤ 0.001) the skin-to-skin time (129.4 ± 35.9 min. vs. 126.5 ± 29.8 min.; p = 0.790) and the aortic cross-clamp time was comparable between both groups (41.9 ± 13.3 min. vs. 43.5 ± 14.4 min.; p = 0.182). The overall hospital stay was significantly shorter in the MICLATS-AVR cohort (9.7 ± 5.2 days vs. 9.2 ± 4.5 days; p = 0.01). Both groups were comparable in terms of postoperative morbidities. However, significantly lower rates of postoperative impaired wound healing were noted in the MICLATS-AVR group (11.7% vs. 3.9%, p < 0.001); (4) Conclusions: In comparing MICLATS-AVR and RAT-AVR, our study found MICLATS-AVR to be at least as safe and time-efficient as RAT-AVR, with no significant differences in MACCE. MICLATS-AVR showed a shorter hospital stay and lower postoperative wound issues, indicating its feasibility and safety as an alternative. Notably, MICLATS-AVR is sternum- and bone-sparing, preserving the right mammary artery, and facilitates combined procedures like multiple valve surgeries.
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Affiliation(s)
- Ali Taghizadeh-Waghefi
- Medical Faculty “Carl Gustav Carus”, TU Dresden, 01307 Dresden, Germany; (S.A.); (A.P.); (M.W.); (K.M.); (U.K.); (K.A.)
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Sebastian Arzt
- Medical Faculty “Carl Gustav Carus”, TU Dresden, 01307 Dresden, Germany; (S.A.); (A.P.); (M.W.); (K.M.); (U.K.); (K.A.)
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Lisa Wenzel
- Medical Faculty “Carl Gustav Carus”, TU Dresden, 01307 Dresden, Germany; (S.A.); (A.P.); (M.W.); (K.M.); (U.K.); (K.A.)
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Asen Petrov
- Medical Faculty “Carl Gustav Carus”, TU Dresden, 01307 Dresden, Germany; (S.A.); (A.P.); (M.W.); (K.M.); (U.K.); (K.A.)
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Manuel Wilbring
- Medical Faculty “Carl Gustav Carus”, TU Dresden, 01307 Dresden, Germany; (S.A.); (A.P.); (M.W.); (K.M.); (U.K.); (K.A.)
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Klaus Matschke
- Medical Faculty “Carl Gustav Carus”, TU Dresden, 01307 Dresden, Germany; (S.A.); (A.P.); (M.W.); (K.M.); (U.K.); (K.A.)
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Utz Kappert
- Medical Faculty “Carl Gustav Carus”, TU Dresden, 01307 Dresden, Germany; (S.A.); (A.P.); (M.W.); (K.M.); (U.K.); (K.A.)
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
| | - Konstantin Alexiou
- Medical Faculty “Carl Gustav Carus”, TU Dresden, 01307 Dresden, Germany; (S.A.); (A.P.); (M.W.); (K.M.); (U.K.); (K.A.)
- Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany
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