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Transcatheter aortic valve implantation at a high-volume center: the Bad Rothenfelde experience. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 14:215-224. [PMID: 29354172 PMCID: PMC5767770 DOI: 10.5114/kitp.2017.72224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 11/23/2017] [Indexed: 11/20/2022]
Abstract
Introduction The “transfemoral (TF) first” approach to access route selection in transcatheter aortic valve implantation (TAVI) is popular; however, the risk of major vascular complications is substantial. The “best for TF” approach identifies only the patients with ideal anatomy for TF-TAVI, potentially minimizing complications. Aim To characterize the outcomes of patients undergoing TAVI at a large-volume site that employs this approach. Material and methods Patients who underwent TAVI at the Bad Rothenfelde Heart Centre between 2008 and 2016 were consecutively enrolled. Findings were compared to those from large, multicenter registries. Results Of the 1,644 patients enrolled, 1,140 underwent TA- and 504 TF-TAVI. Comorbidities were more frequent in TA patients, who also had higher risk scores (EuroSCORE: 25.5% vs. 21.2%; STS score: 11.0% vs. 7.5%; p < 0.001 for both). Rates of conversion to open surgery, major vascular complications and intra-procedural mortality did not differ between groups. At 30 days, mortality rates were higher in the TA group (3.9% vs. 1.9%, p = 0.036). Stroke/transient ischemic attack and permanent pacemaker implantation rates did not differ significantly between groups (2.0% and 9.1% overall, respectively). Compared to multicenter registries, trends in mortality and complication rates were similar, though magnitudes were lower in the present study. In contrast with the present study, major vascular complication rates in multicenter registries are significantly higher for TF compared to TA patients. Conclusions At this high-volume center, the use of a “best for TF” approach to TAVI resulted in low mortality and complication rates.
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Kolkailah AA, Hirji SA, Ejiofor JI, Ramirez Del Val F, Lee J, Norman AV, McGurk S, Mahmood S, Shook D, Vlassakov K, Nyman CB, Shah P, Pelletier MP, Kaneko T. Novel fast-track recovery protocol for alternative access transcatheter aortic valve replacement: application to non-femoral approaches. Interact Cardiovasc Thorac Surg 2018; 26:938-943. [DOI: 10.1093/icvts/ivx409] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/26/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ahmed A Kolkailah
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Sameer A Hirji
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Julius I Ejiofor
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Fernando Ramirez Del Val
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jiyae Lee
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Anthony V Norman
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Siobhan McGurk
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Sadiqa Mahmood
- Department of Quality, Safety and Value, Partners Healthcare, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Douglas Shook
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Kamen Vlassakov
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Charles B Nyman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Pinak Shah
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Marc P Pelletier
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Van Hemelrijck M, Taramasso M, De Carlo C, Kuwata S, Regar E, Nietlispach F, Ferrero A, Weber A, Maisano F. Recent advances in understanding and managing aortic stenosis. F1000Res 2018; 7:58. [PMID: 29375823 PMCID: PMC5770996 DOI: 10.12688/f1000research.11906.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2018] [Indexed: 11/20/2022] Open
Abstract
Over the last few years, treatment of severe symptomatic aortic stenosis in high-risk patients has drastically changed to adopt a less-invasive approach. Transcatheter aortic valve implantation (TAVI) has been developed as a very reproducible and safe procedure, as shown in many trials. When compared to surgery, TAVI has produced superior, or at least comparable, results, and thus a trend to broaden treatment indications to lower-risk patients has erupted as a natural consequence, even though there is a lack of long-term evidence. In this review, we summarize and underline aspects that still remain unanswered that are compulsory if we want to enhance our understanding of this disease.
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Affiliation(s)
- Mathias Van Hemelrijck
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Carlotta De Carlo
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Shingo Kuwata
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Evelyn Regar
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Adolfo Ferrero
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Alberto Weber
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
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Abstract
Transcatheter aortic valve implantation (TAVI) is currently performed through an alternative access in 15% of patients. The transapical access is progressively being abandoned as a result of its invasiveness and poor outcomes. Existing data does not allow TAVI operators to favour one access over another - between transcarotid, trans-subclavian and transaortic - because all have specific strengths and weaknesses. The percutaneous trans-subclavian access might become the main surgery-free alternative access, although further research is needed regarding its safety. Moreover, the difficult learning curve might compromise its adoption. The transcaval access is at an experimental stage and requires the development of dedicated cavo-aortic crossing techniques and closure devices.
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Affiliation(s)
- Pavel Overtchouk
- Centre Hospitalier Regional et Universitaire de Lille Lille, France
| | - Thomas Modine
- Centre Hospitalier Regional et Universitaire de Lille Lille, France
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155
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Asthana N, Mantha A, Yang EH, Suh W, Aksoy O, Shemin RJ, Vorobiof G, Benharash P. Myocardial functional changes in transfemoral versus transapical aortic valve replacement. J Surg Res 2018; 221:304-310. [DOI: 10.1016/j.jss.2017.08.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 07/19/2017] [Accepted: 08/16/2017] [Indexed: 10/18/2022]
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156
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Doshi R, Shlofmitz E, Meraj P. Comparison of Outcomes and Complications of Transcatheter Aortic Valve Implantation in Women Versus Men (from the National Inpatient Sample). Am J Cardiol 2018; 121:73-77. [PMID: 29103601 DOI: 10.1016/j.amjcard.2017.09.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/11/2017] [Accepted: 09/14/2017] [Indexed: 01/09/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is a rapidly emerging procedure for the treatment of intermediate and high-surgical-risk patients with severe aortic stenosis. The impact of gender on in-hospital outcomes has not been studied on a large scale. The aim of this study was to examine gender differences in in-hospital outcomes after TAVI. The National Inpatient Sample (2012 to 2014) using the International Classification of Diseases, 9th Revision, Clinical Modification procedure codes for TAVI (35.05 and 35.06) were used to form this database. Propensity score matching (1:1) was performed and in-hospital outcomes were compared. The primary outcome was in-hospital mortality. Statistical analysis was performed using SAS 9.4 (SAS Institute Inc., Cary, North Carolina). A total of 41,050 (weighted) patients were included in our study. Women accounted for 47.7% (n = 19,570) in our study and presented with older age (81.7 years vs 80.5 years, p ≤ 0.0001). The population was predominantly white (87.4%). After performing propensity score-matched analysis (1:1), no difference in the primary outcome was noted between men and women. The secondary outcomes including stroke, hemorrhage requiring transfusion, and pericardial complications were higher in women. The composite end point of death and stroke occurred more frequently in women than in men. Acute renal failure was higher in men. The post-TAVI length of stay was higher in women (8.3 days vs 7.7 days, p = 0.0007). In conclusion, this large, retrospective registry analysis of patients with severe aortic stenosis who underwent TAVI suggests women may experience higher rates of in-hospital morbidity compared with men.
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Affiliation(s)
- Rajkumar Doshi
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Evan Shlofmitz
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Perwaiz Meraj
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York.
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157
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Toppen W, Suh W, Aksoy O, Benharash P, Bowles C, Shemin RJ, Kwon M. Vascular Complications in the Sapien 3 Era: Continued Role of Transapical Approach to Transcatheter Aortic Valve Replacement. Semin Thorac Cardiovasc Surg 2018. [DOI: 10.1053/j.semtcvs.2018.02.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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158
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Mahtta D, Elgendy IY, Bavry AA. From CoreValve to Evolut PRO: Reviewing the Journey of Self-Expanding Transcatheter Aortic Valves. Cardiol Ther 2017; 6:183-192. [PMID: 29080095 PMCID: PMC5688966 DOI: 10.1007/s40119-017-0100-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Indexed: 12/31/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has become standard therapy for patients with severe aortic stenosis who are deemed at least intermediate risk for surgical valve replacement. Over the past decade, several technological advances have taken place to improve the quality and safety of these devices. The current commercially available valves are broadly grouped into balloon expandable and self-expandable valves. The latest iteration of the self-expandable valve is Medtronic's repositionable valve known as the Evolut PRO system. In this review, we highlight the evidence behind the use of TAVR, improvement in devices over previous generations, clinical evidence behind the CoreValve Evolut PRO system, and the future of TAVR.
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Affiliation(s)
- Dhruv Mahtta
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Islam Y Elgendy
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Anthony A Bavry
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA.
- North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.
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159
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Elmariah S, Fearon WF, Inglessis I, Vlahakes GJ, Lindman BR, Alu MC, Crowley A, Kodali S, Leon MB, Svensson L, Pibarot P, Hahn RT, Thourani VH, Palacios IF, Miller DC, Douglas PS, Passeri JJ. Transapical Transcatheter Aortic Valve Replacement Is Associated With Increased Cardiac Mortality in Patients With Left Ventricular Dysfunction. JACC Cardiovasc Interv 2017; 10:2414-2422. [DOI: 10.1016/j.jcin.2017.09.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/24/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
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160
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O'Hair DP, Bajwa TK, Popma JJ, Watson DR, Yakubov SJ, Adams DH, Sharma S, Robinson N, Petrossian G, Caskey M, Byrne T, Kleiman NS, Zhang A, Reardon MJ. Direct Aortic Access for Transcatheter Aortic Valve Replacement Using a Self-Expanding Device. Ann Thorac Surg 2017; 105:484-490. [PMID: 29174390 DOI: 10.1016/j.athoracsur.2017.07.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 05/19/2017] [Accepted: 07/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) using a self-expanding valve has been shown to be superior to an open operation in high-risk patients. Extensive iliofemoral peripheral vascular disease can prohibit femoral access. In these cases, direct aortic (DA) implantation may be a suitable option. METHODS The current analysis compared outcomes in patients undergoing TAVR with the self-expanding CoreValve prosthesis (Medtronic, Minneapolis, MN) by direct aortic (DA) access vs iliofemoral (IF) access. Patients treated in the CoreValve US High Risk and Extreme Risk Pivotal Trials and Continued Access Study were included. Propensity score matching was used to account for differences in baseline characteristics between groups. Clinical outcomes were compared at 30 days and 1 year. RESULTS We identified 394 matched pairs of IF and DA patients. The all-cause mortality rate was significantly higher in the DA group than in the IF group at 30 days (10.9% vs 4.1%, p < 0.001), but this difference was reduced at 1 year (28.1% vs 23.2%, p = 0.063). All-cause mortality or major stroke was significantly higher for DA vs IF access at 30 days (13.5% vs 5.3%, p < 0.001) and at 1 year (30.4% vs 24.2%, p = 0.025). Major/life-threatening bleeding and acute kidney injury were significantly greater in the DA group at 30 days (66.7% vs 35.4% and 19.7% vs 10.0%, respectively, both p < 0.001). CONCLUSIONS When femoral access is not feasible, DA access allows effective delivery of the valve but incurs an increased risk of death and adverse events, potentially the result of procedural differences.
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Affiliation(s)
- Daniel P O'Hair
- Department of Cardiothoracic Surgery, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin.
| | - Tanvir K Bajwa
- Department of Cardiology, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Jeffrey J Popma
- Department of Internal Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Daniel R Watson
- Department of Cardiothoracic Surgery, OhioHealth, Riverside Methodist Hospital, Columbus, Ohio
| | - Steven J Yakubov
- Department of Cardiology, OhioHealth, Riverside Methodist Hospital, Columbus, Ohio
| | - David H Adams
- Department of Cardiothoracic Surgery, Mount Sinai Health System, New York, New York
| | - Samin Sharma
- Department of Cardiology, Mount Sinai Health System, New York, New York
| | - Newell Robinson
- Department of Cardiothoracic Surgery, St. Francis Hospital, Roslyn, New York
| | | | - Michael Caskey
- Department of Cardiothoracic Surgery, Banner Good Samaritan Regional Medical Center, Phoenix, Arizona
| | - Timothy Byrne
- Department of Cardiology, Banner Good Samaritan Regional Medical Center, Phoenix, Arizona
| | - Neal S Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Angie Zhang
- Coronary and Structural Heart, Medtronic, Mounds View, Minnesota
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
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161
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Arnett DM, Lee JC, Harms MA, Kearney KE, Ramos M, Smith BM, Anderson EC, Tayal R, McCabe JM. Caliber and fitness of the axillary artery as a conduit for large-bore cardiovascular procedures. Catheter Cardiovasc Interv 2017; 91:150-156. [DOI: 10.1002/ccd.27416] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/17/2017] [Accepted: 10/23/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Daniel M. Arnett
- Department of Medicine; University of Washington; Seattle Washington
| | - James C. Lee
- Department of Medicine, Division of Cardiology; Henry Ford Hospital; Detroit Michigan
| | - Michael A. Harms
- Department of Medicine; University of Washington; Seattle Washington
| | - Kathleen E. Kearney
- Department of Medicine, Division of Cardiology; University of Washington; Seattle Washington
| | - Mario Ramos
- Department of Radiology; University of Washington; Seattle Washington
| | - Bryn M. Smith
- School of Medicine; University of Washington; Seattle Washington
| | - Emily C. Anderson
- Department of Medicine, Division of Cardiology; University of Washington; Seattle Washington
| | - Rajiv Tayal
- Department of Medicine, Division of Cardiology; Newark Beth Israel Medical Center; Newark New Jersey
| | - James M. McCabe
- Department of Medicine, Division of Cardiology; University of Washington; Seattle Washington
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162
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Doshi SN, George S, Kwok CS, Mechery A, Mamas M, Ludman PF, Townend JN, Bhabra M. A feasibility study of transaxillary TAVI with the lotus valve. Catheter Cardiovasc Interv 2017; 92:542-549. [DOI: 10.1002/ccd.27409] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 10/03/2017] [Accepted: 10/14/2017] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Chun Shing Kwok
- Royal Stoke University Hospital; Stoke Staffordshire United Kingdom
| | | | - Mamas Mamas
- Royal Stoke University Hospital; Stoke Staffordshire United Kingdom
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163
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Kolte D, Khera S, Sardar MR, Gheewala N, Gupta T, Chatterjee S, Goldsweig A, Aronow WS, Fonarow GC, Bhatt DL, Greenbaum AB, Gordon PC, Sharaf B, Abbott JD. Thirty-Day Readmissions After Transcatheter Aortic Valve Replacement in the United States: Insights From the Nationwide Readmissions Database. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004472. [PMID: 28034845 DOI: 10.1161/circinterventions.116.004472] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/14/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Readmissions after cardiac procedures are common and contribute to increased healthcare utilization and costs. Data on 30-day readmissions after transcatheter aortic valve replacement (TAVR) are limited. METHODS AND RESULTS Patients undergoing TAVR (International Classification of Diseases-Ninth Revision-CM codes 35.05 and 35.06) between January and November 2013 who survived the index hospitalization were identified in the Nationwide Readmissions Database. Incidence, predictors, causes, and costs of 30-day readmissions were analyzed. Of 12 221 TAVR patients, 2188 (17.9%) were readmitted within 30 days. Length of stay >5 days during index hospitalization (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.24-1.73), acute kidney injury (HR, 1.23; 95% CI, 1.05-1.44), >4 Elixhauser comorbidities (HR, 1.22; 95% CI, 1.03-1.46), transapical TAVR (HR, 1.21; 95% CI, 1.05-1.39), chronic kidney disease (HR, 1.20; 95% CI, 1.04-1.39), chronic lung disease (HR, 1.16; 95% CI, 1.01-1.34), and discharge to skilled nursing facility (HR, 1.16; 95% CI, 1.01-1.34) were independent predictors of 30-day readmission. Readmissions were because of noncardiac causes in 61.8% of cases and because of cardiac causes in 38.2% of cases. Respiratory (14.7%), infections (12.8%), bleeding (7.6%), and peripheral vascular disease (4.3%) were the most common noncardiac causes, whereas heart failure (22.5%) and arrhythmias (6.6%) were the most common cardiac causes of readmission. Median length of stay and cost of readmissions were 4 days (interquartile range, 2-7 days) and $8302 (interquartile range, $5229-16 021), respectively. CONCLUSIONS Thirty-day readmissions after TAVR are frequent and are related to baseline comorbidities, TAVR access site, and post-procedure complications. Awareness of these predictors can help identify and target high-risk patients for interventions to reduce readmissions and costs.
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Affiliation(s)
- Dhaval Kolte
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Sahil Khera
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - M Rizwan Sardar
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Neil Gheewala
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Tanush Gupta
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Saurav Chatterjee
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Andrew Goldsweig
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Wilbert S Aronow
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Gregg C Fonarow
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Deepak L Bhatt
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Adam B Greenbaum
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Paul C Gordon
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Barry Sharaf
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - J Dawn Abbott
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.).
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Lareyre F, Raffort J, Dommerc C, Habib Y, Bourlon F, Mialhe C. A 7-Year Single-Center Experience of Transfemoral TAVI: Evolution of Surgical Activity and Impact on Vascular Outcome. Angiology 2017; 69:532-539. [DOI: 10.1177/0003319717737665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) has become a well-established alternative to open surgery to treat aortic stenosis. We describe our 7-year TAVI experience using transfemoral access and identity changes in surgical activity and evaluate its impact on postoperative vascular outcomes. Consecutive patients (N = 340) who underwent TAVI with percutaneous transfemoral access were retrospectively included and divided into 4 quartiles according to the date of intervention. Vascular outcomes were classified according to the Valve Academic Research Consortium 2 classification. The number of patients who underwent transfemoral TAVI increased over time and their clinical characteristics evolved, with a lower Society of Thoracic Surgeons score and less comorbidities. The material used evolved and TAVI could be performed despite higher iliac calcification and tortuosity scores. With experience, the procedural time, the postoperative length of stay at hospital, and the 30-day postoperative mortality significantly decreased. No significant change was observed for vascular outcome, except for minor hematoma. We witnessed an increase in transfemoral TAVI procedure, with changes in clinical and procedural characteristics associated with an improvement in postoperative outcomes.
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Affiliation(s)
- Fabien Lareyre
- Cardiovascular Surgery Unit, Cardiothoracic Centre of Monaco, Monaco
- University of Côte d’Azur, INSERM, CNRS, IRCAN, Nice, France
| | | | - Carine Dommerc
- Cardiovascular Surgery Unit, Cardiothoracic Centre of Monaco, Monaco
| | - Yacoub Habib
- Cardiovascular Surgery Unit, Cardiothoracic Centre of Monaco, Monaco
| | - François Bourlon
- Cardiovascular Surgery Unit, Cardiothoracic Centre of Monaco, Monaco
| | - Claude Mialhe
- Cardiovascular Surgery Unit, Cardiothoracic Centre of Monaco, Monaco
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165
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Arora S, Vaidya SR, Strassle PD, Misenheimer JA, Rhodes JA, Ramm CJ, Wheeler EN, Caranasos TG, Cavender MA, Vavalle JP. Meta-analysis of transfemoral TAVR versus surgical aortic valve replacement. Catheter Cardiovasc Interv 2017; 91:806-812. [DOI: 10.1002/ccd.27357] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/31/2017] [Accepted: 09/09/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Sameer Arora
- Division of Cardiology; University of North Carolina; Chapel Hill North Carolina 27599-7075
| | - Satyanarayana R. Vaidya
- Division of Internal Medicine; Cape Fear Valley Medical Center; Fayetteville North Carolina 28304
| | - Paula D. Strassle
- Department of Epidemiology, Gillings School of Global Public Health; University of North Carolina; Chapel Hill North Carolina 27599-7400
- Department of Surgery; UNC School of Medicine; Chapel Hill North Carolina 27599-7050
| | - Jacob A. Misenheimer
- Division of Cardiology; University of North Carolina; Chapel Hill North Carolina 27599-7075
- Division of Cardiology; The Medical College of Georgia at Augusta University; Augusta Georgia 30912
| | - Jeremy A. Rhodes
- Campbell University School of Osteopathic Medicine; Lillington North Carolina 27546
| | - Cassandra J. Ramm
- Division of Cardiology; University of North Carolina; Chapel Hill North Carolina 27599-7075
| | - Evan N. Wheeler
- Campbell University School of Osteopathic Medicine; Lillington North Carolina 27546
| | - Thomas G. Caranasos
- Department of Surgery; UNC School of Medicine; Chapel Hill North Carolina 27599-7050
| | - Matthew A. Cavender
- Division of Cardiology; University of North Carolina; Chapel Hill North Carolina 27599-7075
| | - John P. Vavalle
- Division of Cardiology; University of North Carolina; Chapel Hill North Carolina 27599-7075
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166
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Arai T, Romano M, Lefèvre T, Hovasse T, Farge A, Le Houerou D, Hayashida K, Watanabe Y, Garot P, Benamer H, Unterseeh T, Bouvier E, Morice MC, Chevalier B. Direct Comparison of Feasibility and Safety of Transfemoral Versus Transaortic Versus Transapical Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2017; 9:2320-2325. [PMID: 27884356 DOI: 10.1016/j.jcin.2016.08.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to compare outcomes among transfemoral (TF), transaortic (TAo), and transapical (TA) transcatheter aortic valve replacement (TAVR). BACKGROUND Very few studies have investigated the differences among TF, TAo, and TA TAVR in terms of safety and feasibility. METHODS Between January 2011 and December 2014, 467 consecutive cases of TF TAVR, 289 cases of TAo TAVR, and 42 cases of TA TAVR were analyzed. Baseline characteristics, procedural characteristics, and outcomes were compared between TF and TAo and between TAo and TA approaches. RESULTS Balloon-expandable prostheses were used in 320 cases of TF TAVR (69%), 209 cases of TAo TAVR (72%), and all cases of TA TAVR. The remaining cases were performed using self-expandable prostheses. Patient age and Society of Thoracic Surgeons score were similar (83.8 years vs. 83.7 years vs. 81.3 years and 6.2% vs. 5.8% vs. 7.1%) among all groups. Although nonsignificant, a trend toward lower 30-day mortality (5% vs. 9%; p = 0.057) was observed with TF TAVR compared with TAo TAVR. Kaplan-Meier analysis revealed a trend toward a higher 1-year survival rate (log-rank p = 0.067) with TF TAVR compared with TAo TAVR. There was no significant difference in 30-day mortality between TAo and TA TAVR (9% vs. 14%; p = 0.283). Kaplan-Meier analysis revealed a trend toward a higher 1-year survival rate (log-rank p = 0.154) with TAo TAVR compared with TA TAVR. CONCLUSIONS Although the 30-day mortality and 1-year survival rates were similar between TF and TAo TAVR patients, a trend in favor of the TF approach was observed. In addition, the TAo approach can be considered as an alternative to the TA approach when the TF approach seems unsuitable.
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Affiliation(s)
- Takahide Arai
- Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Mauro Romano
- Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Thierry Lefèvre
- Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France.
| | - Thomas Hovasse
- Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Arnaud Farge
- Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Daniel Le Houerou
- Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Kentaro Hayashida
- Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France; Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Philippe Garot
- Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Hakim Benamer
- Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Thierry Unterseeh
- Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Erik Bouvier
- Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Marie-Claude Morice
- Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Bernard Chevalier
- Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
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Bittar E, Castilho V. The cost of transcatheter aortic valve implantation according to different access routes. Rev Esc Enferm USP 2017; 51:e03246. [DOI: 10.1590/s1980-220x2016050503246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/10/2017] [Indexed: 11/21/2022] Open
Abstract
Abstract OBJECTIVE Identifying the average direct cost of TAVI (Transcatheter Aortic Valve Implantation) for the different access routes. METHOD This is a research with a quantitative, exploratory and descriptive approach carried out in a government teaching hospital in the state of São Paulo. RESULTS The average direct cost of TAVI procedures by the access routes resulted in R$82,826.38 (transfemoral route), R$79,440.91 (transaortic route) and R$78,173.41 (transapical route). The transcatheter valve cost represented a percentage variation between 78.47% and 83.14% of the total cost of the procedure. The Kruskal-Wallis test was used and presented a statistically significant difference between the three access routes: p=0.008. The Bonferroni test showed a difference in the association between transfemoral and transapical routes, while no statistically significant difference was observed in association with the transaortic route. CONCLUSION The results are important for formulating adequate funding policies for the hospital network and understanding the costs according to the route facilitates rationalizing resources in order for them to be guaranteed for patients who present surgical contraindication to the valve implant.
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168
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Transseptal Transcatheter Mitral Valve Replacement Using Balloon-Expandable Transcatheter Heart Valves. JACC Cardiovasc Interv 2017; 10:1905-1919. [DOI: 10.1016/j.jcin.2017.06.069] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/31/2017] [Accepted: 06/29/2017] [Indexed: 11/18/2022]
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169
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Ott I, Shivaraju A, Schäffer N, Frangieh A, Michel J, Husser O, Hengstenberg C, Mayr P, Colleran R, Pellegrini C, Cassese S, Fusaro M, Schunkert H, Kastrati A, Kasel A. Parallel suture technique with ProGlide: a novel method for management of vascular access during transcatheter aortic valve implantation (TAVI). EUROINTERVENTION 2017; 13:928-934. [DOI: 10.4244/eij-d-16-01036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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170
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Forcillo J, Thourani VH. Transapical and transaortic transcatheter aortic valve replacement: Still part of the game and at what cost? J Thorac Cardiovasc Surg 2017; 154:1233-1234. [DOI: 10.1016/j.jtcvs.2017.05.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 11/29/2022]
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171
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Higuchi R, Takayama M, Hagiya K, Saji M, Mahara K, Takamisawa I, Shimizu J, Tobaru T, Iguchi N, Takanashi S. Prolonged Intensive Care Unit Stay Following Transcatheter Aortic Valve Replacement. J Intensive Care Med 2017; 35:154-160. [PMID: 28931366 DOI: 10.1177/0885066617732290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Postoperative intensive care unit (ICU) stay after cardiac surgeries has been extensively studied, but little attention has been given to ICU stay following transcatheter aortic valve replacement (TAVR). This study examined ICU stay after TAVR. METHODS Two hundred and forty-five patients who underwent TAVR between April 2010 and October 2016 were studied retrospectively. We investigated the status of ICU stay, the predictors of prolonged ICU stay (PICUS), and its impact on short- and long-term outcomes. Prolonged ICU stay was defined as post-TAVR ICU stay longer than 2 days (day of TAVR + 1 day). RESULTS Length of ICU stay was 2.6 ± 4.9 days, and PICUS was identified in 14.7% of the patients. The predominant reason for PICUS was congestive heart failure or circulatory failure (41.7%). Pulmonary dysfunction and nontransfemoral approach were independent predictors of PICUS (pulmonary dysfunction: odds ratio = 2.64, 95% confidence interval [CI]: 1.05-7.35; nontransfemoral approach: odds ratio = 2.81, 95% CI: 1.15-6.89). Prolonged ICU stay was associated with higher rate of 30-day combined end point (PICUS vs non-PICUS: 44.4% vs 3.3%, P < .0001), longer postoperative hospital stay (49.9 ± 141.9 days vs 12.0 ± 6.0 days, P < .0001), and lower rate of discharge home (77.8% vs 95.2%, P = .0002). Patients with PICUS had worse long-term survival (P < .0001), and PICUS was a predictor of mortality (hazard ratio: 4.21, 95% CI: 2.09-8.22). CONCLUSION Prolonged ICU stay following TAVR was found in 14.7%, and pulmonary dysfunction and nontransfemoral approach were associated with PICUS. Short- and long-term prognoses were worse in patients with PICUS than those without.
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Affiliation(s)
- Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Morimasa Takayama
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Kenichi Hagiya
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Keitaro Mahara
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Jun Shimizu
- Department of Anesthesiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Tetsuya Tobaru
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
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172
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Editorial commentary: TAVR-Is there a path to an all-surgical-risk indication? Trends Cardiovasc Med 2017; 28:184-186. [PMID: 28882365 DOI: 10.1016/j.tcm.2017.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 08/22/2017] [Indexed: 11/21/2022]
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173
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Ando T, Takagi H, Grines CL. Transfemoral, transapical and transcatheter aortic valve implantation and surgical aortic valve replacement: a meta-analysis of direct and adjusted indirect comparisons of early and mid-term deaths. Interact Cardiovasc Thorac Surg 2017; 25:484-492. [PMID: 28549125 DOI: 10.1093/icvts/ivx150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/06/2017] [Indexed: 11/13/2022] Open
Abstract
Clinical outcomes of transfemoral-transcatheter aortic valve implantation (TF-TAVI) versus surgical aortic valve replacement (SAVR) or transapical (TA)-TAVI are limited to a few randomized clinical trials (RCTs). Because previous meta-analyses only included a limited number of adjusted studies or several non-adjusted studies, our goal was to compare and summarize the outcomes of TF-TAVI vs SAVR and TF-TAVI vs TA-TAVI exclusively with the RCT and propensity-matched cohort studies with direct and adjusted indirect comparisons to reach more precise conclusions. We hypothesized that TF-TAVI would offer surgical candidates a better outcome compared with SAVR and TA-TAVI because of its potential for fewer myocardial injuries. A literature search was conducted through PUBMED and EMBASE through June 2016. Only RCTs and propensity-matched cohort studies were included. A direct meta-analysis of TF-TAVI vs SAVR, TA-TAVI vs SAVR and TF-TAVI vs TA-TAVI was conducted. Then, the effect size of an indirect meta-analysis was calculated from the direct meta-analysis. The effect sizes of direct and indirect meta-analyses were then combined. A random-effects model was used to calculate the hazards ratio and the odds ratio with 95% confidence intervals. Early (in-hospital or 30 days) and mid-term (≥1 year) all-cause mortality rates were assessed. Our search resulted in 4 RCTs (n = 2319) and 14 propensity-matched cohort (n = 7217) studies with 9536 patients of whom 3471, 1769 and 4296 received TF, TA and SAVR, respectively. Direct meta-analyses and combined direct and indirect meta-analyses of early and mid-term deaths with TF-TAVI and SAVR were similar. Early deaths with TF-TAVI vs TA-TAVI were comparable in direct meta-analyses (odds ratio 0.64, P = 0.35) and direct and indirect meta-analyses combined (odds ratio 0.73, P = 0.24). Mid-term deaths with TF-TAVI vs TA-TAVI were increased (hazard ratio 0.83, P = 0.07) in a direct meta-analysis and became significant after addition of the indirect meta-analysis (hazard ratio 0.78, 95% confidence interval 0.67-0.92, P = 0.003). In conclusion, TF-TAVI was associated with similar early and mid-term deaths compared with SAVR. The number of early deaths was not significantly different between TF-TAVI and TA-TAVI, whereas there were fewer mid-term deaths with TF-TAVI than with TA-TAVI.
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Affiliation(s)
- Tomo Ando
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center, Detroit, MI, USA
| | - Hisato Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Cindy L Grines
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center, Detroit, MI, USA
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Kirker EB, Hodson RW, Spinelli KJ, Korngold EC. The Carotid Artery as a Preferred Alternative Access Route for Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2017; 104:621-629. [DOI: 10.1016/j.athoracsur.2016.12.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/03/2016] [Accepted: 12/13/2016] [Indexed: 10/20/2022]
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175
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Holy EW, Abdel-Wahab M. Shifting paradigms for treatment of symptomatic aortic stenosis in lower risk populations: role of a newer generation balloon-expandable transcatheter aortic valve implantation device. Cardiovasc Diagn Ther 2017; 7:S57-S62. [PMID: 28748148 DOI: 10.21037/cdt.2016.11.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Erik Walter Holy
- Heart Center, Segeberger Kliniken, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Heart Center, Segeberger Kliniken, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany
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Jones BM, Krishnaswamy A, Tuzcu EM, Mick S, Jaber WA, Svensson LG, Kapadia SR. Matching patients with the ever-expanding range of TAVI devices. Nat Rev Cardiol 2017; 14:615-626. [DOI: 10.1038/nrcardio.2017.82] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Auffret V, Lefevre T, Van Belle E, Eltchaninoff H, Iung B, Koning R, Motreff P, Leprince P, Verhoye JP, Manigold T, Souteyrand G, Boulmier D, Joly P, Pinaud F, Himbert D, Collet JP, Rioufol G, Ghostine S, Bar O, Dibie A, Champagnac D, Leroux L, Collet F, Teiger E, Darremont O, Folliguet T, Leclercq F, Lhermusier T, Olhmann P, Huret B, Lorgis L, Drogoul L, Bertrand B, Spaulding C, Quilliet L, Cuisset T, Delomez M, Beygui F, Claudel JP, Hepp A, Jegou A, Gommeaux A, Mirode A, Christiaens L, Christophe C, Cassat C, Metz D, Mangin L, Isaaz K, Jacquemin L, Guyon P, Pouillot C, Makowski S, Bataille V, Rodés-Cabau J, Gilard M, Le Breton H, Le Breton H, Eltchaninoff H, Gilard M, Iung B, Le Breton H, Lefevre T, Van Belle E, Laskar M, Leprince P, Iung B, Bataille V, Chevalier B, Garot P, Hovasse T, Lefevre T, Donzeau Gouge P, Farge A, Romano M, Cormier B, Bouvier E, Bauchart JJ, Bodart JC, Delhaye C, Houpe D, Lallemant R, Leroy F, Sudre A, Van Belle E, Juthier F, Koussa M, Modine T, Rousse N, Auffray JL, Richardson M, Berland J, Eltchaninoff H, Godin M, Koning R, Bessou JP, Letocart V, Manigold T, Roussel JC, Jaafar P, Combaret N, Souteyrand G, D’Ostrevy N, Innorta A, Clerfond G, Vorilhon C, Auffret V, Bedossa M, Boulmier D, Le Breton H, Leurent G, Anselmi A, Harmouche M, Verhoye JP, Donal E, Bille J, Joly P, Houel R, Vilette B, Abi Khalil W, Delepine S, Fouquet O, Pinaud F, Rouleau F, Abtan J, Himbert D, Urena M, Alkhoder S, Ghodbane W, Arangalage D, Brochet E, Goublaire C, Barthelemy O, Choussat R, Collet JP, Lebreton G, Leprince P, Mastrioanni C, Isnard R, Dauphin R, Dubreuil O, Durand De Gevigney G, Finet G, Harbaoui B, Ranc S, Rioufol G, Farhat F, Jegaden O, Obadia JF, Pozzi M, Ghostine S, Brenot P, Fradi S, Azmoun A, Deleuze P, Kloeckner M, Bar O, Blanchard D, Barbey C, Chassaing S, Chatel D, Le Page O, Tauran A, Bruere D, Bodson L, Meurisse Y, Seemann A, Amabile N, Caussin C, Dibie A, Elhaddad S, Drieu L, Ohanessian A, Philippe F, Veugeois A, Debauchez M, Zannis K, Czitrom D, Diakov C, Raoux F, Champagnac D, Lienhart Y, Staat P, Zouaghi O, Doisy V, Frieh JP, Wautot F, Dementhon J, Garrier O, Jamal F, Leroux PY, Casassus F, Leroux L, Seguy B, Barandon L, Labrousse L, Peltan J, Cornolle C, Dijos M, Lafitte S, Bayet G, Charmasson C, Collet F, Vaillant A, Vicat J, Giacomoni MP, Teiger E, Bergoend E, Zerbib C, Darremont O, Louis Leymarie J, Clerc P, Choukroun E, Elia N, Grimaud JP, Guibaud JP, Wroblewski S, Abergel E, Bogino E, Chauvel C, Dehant P, Simon M, Angioi M, Lemoine J, Lemoine S, Popovic B, Folliguet T, Maureira P, Huttin O, Selton Suty C, Cayla G, Delseny D, Leclercq F, Levy G, Macia JC, Maupas E, Piot C, Rivalland F, Robert G, Schmutz L, Targosz F, Albat B, Dubar A, Durrleman N, Gandet T, Munos E, Cade S, Cransac F, Bouisset F, Lhermusier T, Grunenwald E, Marcheix B, Fournier P, Morel O, Ohlmann P, Kindo M, Hoang MT, Petit H, Samet H, Trinh A, Huret B, Lecoq G, Morelle JF, Richard P, Derieux T, Monier E, Joret C, Lorgis L, Bouchot O, Eicher JC, Drogoul L, Meyer P, Lopez S, Tapia M, Teboul J, Elbeze JP, Mihoubi A, Bertrand B, Vanzetto G, Wittenberg O, Bach V, Martin C, Sauier C, Casset C, Castellant P, Gilard M, Bezon E, Choplain JN, Kallifa A, Nasr B, Jobic Y, Blanchard D, Lafont A, Pagny JY, Spaulding C, Abi Akar R, Fabiani JN, Zegdi R, Berrebi A, Puscas T, Desveaux B, Ivanes F, Quilliet L, Saint Etienne C, Bourguignon T, Aupy B, Perault R, Bonnet JL, Cuisset T, Lambert M, Grisoli D, Jaussaud N, Salaun E, Delomez M, Laghzaoui A, Savoye C, Beygui F, Bignon M, Roule V, Sabatier R, Ivascau C, Saplacan V, Saloux E, Bouchayer D, Claudel JP, Tremeau G, Diab C, Lapeze J, Pelissier F, Sassard T, Matz C, Monsarrat N, Carel I, Hepp A, Sibellas F, Curtil A, Dambrin G, Favereau X, Jegou A, Ghorayeb G, Guesnier L, Khoury W, Kucharski C, Pouzet B, Vaislic C, Cheikh-Khelifa R, Hilpert L, Maribas P, Gommeaux A, Hannebicque G, Hochart P, Paris M, Pecheux M, Fabre O, Guesnier L, Leborgne L, Mirode A, Peltier M, Trojette F, Carmi D, Tribouilloy C, Christiaens L, Mergy J, Corbi P, Raud Raynier P, Carillo S, Christophe C, Hueber A, Moulin F, Pinelli G, Cassat C, Darodes N, Pesteil F, Metz D, Aludaat C, Torossian F, Belle L, Mangin L, Chavanis N, Akret C, Cerisier A, Isaaz K, Favre JP, Fuzellier JF, Pierrard R, Jacquemin L, Roth O, Wiedemann JY, Bischoff N, Gavra G, Bourrely N, Digne F, Guyon P, Najjari M, Stratiev V, Bonnet N, Mesnildrey P, Attias D, Dreyfus J, Karila Cohen D, Laperche T, Nahum J, Scheuble A, Pouillot C, Rambaud G, Brauberger E, Ah Hot M, Allouch P, Beverelli F, Makowski S, Rosencher J, Aubert S, Grinda JM, Waldman T. Temporal Trends in Transcatheter Aortic Valve Replacement in France. J Am Coll Cardiol 2017; 70:42-55. [DOI: 10.1016/j.jacc.2017.04.053] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 04/05/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
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Elbaz-Greener G, Zivkovic N, Arbel Y, Radhakrishnan S, Fremes SE, Wijeysundera HC. Use of Two-Dimensional Ultrasonographically Guided Access to Reduce Access-Related Complications for Transcatheter Aortic Valve Replacement. Can J Cardiol 2017; 33:918-924. [DOI: 10.1016/j.cjca.2017.03.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 03/30/2017] [Accepted: 03/30/2017] [Indexed: 12/13/2022] Open
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Gilard M, Eltchaninoff H, Donzeau-Gouge P, Chevreul K, Fajadet J, Leprince P, Leguerrier A, Lievre M, Prat A, Teiger E, Lefevre T, Tchetche D, Carrié D, Himbert D, Albat B, Cribier A, Sudre A, Blanchard D, Rioufol G, Collet F, Houel R, Dos Santos P, Meneveau N, Ghostine S, Manigold T, Guyon P, Grisoli D, Le Breton H, Delpine S, Didier R, Favereau X, Souteyrand G, Ohlmann P, Doisy V, Grollier G, Gommeaux A, Claudel JP, Bourlon F, Bertrand B, Laskar M, Iung B. Late Outcomes of Transcatheter Aortic Valve Replacement in High-Risk Patients: The FRANCE-2 Registry. J Am Coll Cardiol 2017; 68:1637-1647. [PMID: 27712776 DOI: 10.1016/j.jacc.2016.07.747] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/30/2016] [Accepted: 07/12/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has revolutionized management of high-risk patients with severe aortic stenosis. However, survival and the incidence of severe complications have been assessed in relatively small populations and/or with limited follow-up. OBJECTIVES This report details late clinical outcome and its determinants in the FRANCE-2 (FRench Aortic National CoreValve and Edwards) registry. METHODS The FRANCE-2 registry prospectively included all TAVRs performed in France. Follow-up was scheduled at 30 days, at 6 months, and annually from 1 to 5 years. Standardized VARC (Valve Academic Research Consortium) outcome definitions were used. RESULTS A total of 4,201 patients were enrolled between January 2010 and January 2012 in 34 centers. Approaches were transarterial (transfemoral 73%, transapical 18%, subclavian 6%, and transaortic or transcarotid 3%) or, in 18% of patients, transapical. Median follow-up was 3.8 years. Vital status was available for 97.2% of patients at 3 years. The 3-year all-cause mortality was 42.0% and cardiovascular mortality was 17.5%. In a multivariate model, predictors of 3-year all-cause mortality were male sex (p < 0.001), low body mass index, (p < 0.001), atrial fibrillation (p < 0.001), dialysis (p < 0.001), New York Heart Association functional class III or IV (p < 0.001), higher logistic EuroSCORE (p < 0.001), transapical or subclavian approach (p < 0.001 for both vs. transfemoral approach), need for permanent pacemaker implantation (p = 0.02), and post-implant periprosthetic aortic regurgitation grade ≥2 of 4 (p < 0.001). Severe events according to VARC criteria occurred mainly during the first month and subsequently in <2% of patients/year. Mean gradient, valve area, and residual aortic regurgitation were stable during follow-up. CONCLUSIONS The FRANCE-2 registry represents the largest database available on late results of TAVR. Late mortality is largely related to noncardiac causes. Incidence rates of severe events are low after the first month. Valve performance remains stable over time.
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Affiliation(s)
- Martine Gilard
- Department of Cardiology, Brest University Hospital, Brest, France.
| | | | - Patrick Donzeau-Gouge
- Department of Cardiology and Surgery, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Karine Chevreul
- Department of URC-ECO and Cardiology, Creteil University Hospital, Paris, France
| | - Jean Fajadet
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Pascal Leprince
- Department of Surgery, Pitié Salpetrière University Hospital, Paris, France
| | - Alain Leguerrier
- Department of Cardiology and Surgery, Rennes University Hospital, Rennes, France
| | - Michel Lievre
- UMR and Department of Cardiology, Lyon University Hospital, Lyon, France
| | - Alain Prat
- Department of Cardiology and Surgery, Lille University Hospital, Lille, France
| | - Emmanuel Teiger
- Department of URC-ECO and Cardiology, Creteil University Hospital, Paris, France
| | - Thierry Lefevre
- Department of Cardiology and Surgery, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Didier Tchetche
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | | | - Bernard Albat
- Department of Surgery, Montpellier University Hospital, Montpellier, France
| | - Alain Cribier
- Department of Cardiology, Rouen University Hospital, Rouen, France
| | - Arnaud Sudre
- Department of Cardiology and Surgery, Lille University Hospital, Lille, France
| | | | - Gilles Rioufol
- UMR and Department of Cardiology, Lyon University Hospital, Lyon, France
| | | | - Remi Houel
- Department of Surgery, Hospital Saint Joseph, Marseille, France
| | - Pierre Dos Santos
- Department of Cardiology, Bordeaux University Hospital, Bordeaux, France
| | - Nicolas Meneveau
- Department of Cardiology, Besancon University Hospital, Besancon, France
| | - Said Ghostine
- Department of Cardiology, Centre Cardiologique Marie Lannelongue, Le Plessis Robinson, France
| | - Thibaut Manigold
- Department of Cardiology, Nantes University Hospital, Nantes, France
| | - Philippe Guyon
- Department of Cardiology, Centre Cardiologique du Nord, Saint Denis, France
| | - Dominique Grisoli
- Department of Surgery, Marseille University Hospital, Marseille, France
| | - Herve Le Breton
- Department of Cardiology and Surgery, Rennes University Hospital, Rennes, France
| | - Stephane Delpine
- Department of Cardiology, Angers University Hospital, Angers, France
| | - Romain Didier
- Department of Cardiology, Brest University Hospital, Brest, France
| | - Xavier Favereau
- Department of Cardiology, Parly 2 Hospital, Le Chesnay, France
| | - Geraud Souteyrand
- Department of Cardiology, Clermont Ferrand University Hospital, Clermont Ferrand, France
| | - Patrick Ohlmann
- Department of Cardiology, Strasbourg University Hospital, Strasbourg, France
| | - Vincent Doisy
- Department of Surgery, Clinique du Tonkin, Lyon, France
| | - Gilles Grollier
- Department of Cardiology, Caen University Hospital, Caen, France
| | - Antoine Gommeaux
- Department of Cardiology, Hôpital Bois Bernard, Bois Bernard, France
| | | | | | - Bernard Bertrand
- Department of Cardiology, Grenoble University Hospital, Grenoble, France
| | - Marc Laskar
- Department of Surgery, Limoges University Hospital, Limoges, France
| | - Bernard Iung
- Department of Cardiology, Bichat University Hospital, Paris, France
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Murashita T. Collaboration between Interventional Cardiologists and Cardiac Surgeons in the Era of Heart Team Approach. Interv Cardiol 2017. [DOI: 10.5772/67788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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181
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McCarthy FH, Spragan DD, Savino D, Dibble T, Hoedt AC, McDermott KM, Bavaria JE, Herrmann HC, Anwaruddin S, Giri J, Szeto WY, Groeneveld PW, Desai ND. Outcomes, readmissions, and costs in transfemoral and alterative access transcatheter aortic valve replacement in the US Medicare population. J Thorac Cardiovasc Surg 2017; 154:1224-1232.e1. [PMID: 28712578 DOI: 10.1016/j.jtcvs.2017.04.090] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 03/13/2017] [Accepted: 04/08/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To comprehensively evaluate and compare utilization, outcomes, and especially costs of transfemoral (TF), transapical (TA), and transaortic (TAO) transcatheter aortic valve replacement (TAVR). METHODS All Medicare fee-for-service patients undergoing TF (n = 4065), TA (n = 691), or TAO (n = 274) TAVR between January 1, 2011, and November 30, 2012, were identified using Health Care Procedure Classification Codes present on Medicare claims. Hospital charges from Medicare claims were converted to costs using hospital-specific Medicare cost-to-charge ratios. RESULTS TA and TAO patients were similar in age, race, and common comorbidities. Compared with TF patients, TA and TAO patients were more likely to be female and to have peripheral vascular disease, chronic lung disease, and renal failure. Thirty-day mortality rates were higher among TA and TAO patients than among TF patients (TA, 9.6%; TAO, 8.0%; TF, 5.0%; P < .001). Adjusted mortality beyond 1 year did not differ by access. TA patients were more likely to require cardiopulmonary bypass (CPB). Increased adjusted mortality was associated with CPB (hazard ratio, 2.13; P < .01) and increased 30-day cost ($62,000 [interquartile range (IQR)], $45,100-$86,400 versus $48,800 [IQR, $38,100-$62,900]; P < .01). Cost at 30 days was lowest for TF ($48,600) compared with TA ($49,800; P < .01) and TAO ($53,200; P = .03). CONCLUSIONS For patients ineligible to receive TF TAVR, TAO and TA approaches offer similar clinical outcomes at similar cost with acceptable operative and 1-year survival, except for higher rates of CPB use in TA patients. CPB was associated with worse survival and increased costs.
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Affiliation(s)
- Fenton H McCarthy
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pa; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Danielle D Spragan
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Danielle Savino
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Taylor Dibble
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Ashley C Hoedt
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | | | - Joseph E Bavaria
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Howard C Herrmann
- Division of Cardiology, University of Pennsylvania, Philadelphia, Pa
| | - Saif Anwaruddin
- Division of Cardiology, University of Pennsylvania, Philadelphia, Pa
| | - Jay Giri
- Division of Cardiology, University of Pennsylvania, Philadelphia, Pa
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Peter W Groeneveld
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pa; Department of Medicine, University of Pennsylvania, Philadelphia, Pa; Philadelphia Veterans Affairs Medical Center's Center for Health Equity Research and Promotion, Philadelphia, Pa
| | - Nimesh D Desai
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pa; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
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Amrane H, Porta F, Van Boven AV, Kappetein AP, Head SJ. A meta-analysis on clinical outcomes after transaortic transcatheter aortic valve implantation by the Heart Team. EUROINTERVENTION 2017; 13:e168-e176. [PMID: 28374676 DOI: 10.4244/eij-d-16-00103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to perform a meta-analysis on transaortic (TAo) transcatheter aortic valve implantation (TAVI) in order to gain more insight into the safety and efficacy of the approach in addition to the data available from selected centres with small numbers of patients. METHODS AND RESULTS PubMed and EMBASE were searched on 31 August 2016. The search yielded 251 studies, of which 16 with 1,907 patients were included in the meta-analysis. All were observational, single-arm studies. The rate of conversion to sternotomy was 3.2% (95% CI: 2.3-3.5%; I2=0) among nine studies. Device success among 10 studies was 91% (95% CI: 86.7-94.0%; I2=25.5). Major vascular complications occurred at a rate of 3.1% (95% CI: 1.6-6.0%; I2=60.8). Moderate or severe paravalvular leakage/aortic valve regurgitation (PVL/AR) was reported to be 6.7% (95% CI: 4.3-10.1%; I2=58.9). Permanent pacemaker implantation was required in 11.7% (95% CI: 9.2-14.8%; I2=26.5) of patients. Pooled 30-day post-TAVI complication rates were 9.9% (95% CI: 8.6-11.3%; I2=0) for mortality, 3.7% (95% CI: 2.4-5.6%; I2=28.7) for all stroke, and 1.0% for myocardial infarction (95% CI: 0.5-1.7%; I2=0). The Valve Academic Research Consortium-2 (VARC-2) composite safety endpoint occurred at a pooled rate of 16.7% (95% CI: 10.6-25.3%; I2=58.7). CONCLUSIONS In this meta-analysis of observational studies, transaortic TAVI appears to be a safe procedure with low complication rates.
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Affiliation(s)
- Hafid Amrane
- Department of Cardiothoracic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, the Netherlands
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McNeely C, Zajarias A, Robbs R, Markwell S, Vassileva CM. Transcatheter Aortic Valve Replacement Outcomes in Nonagenarians Stratified by Transfemoral and Transapical Approach. Ann Thorac Surg 2017; 103:1808-1814. [PMID: 28450135 DOI: 10.1016/j.athoracsur.2017.02.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Survival and other outcomes of nonagenarians undergoing transcatheter aortic valve replacement (TAVR) in the Medicare population are unclear. METHODS Patients aged 65 years and older who underwent TAVR from November 2011 through 2013 were considered for inclusion. RESULTS The study consisted of 18,283 patients and 19.3% were aged 90 years or older. Compared with patients younger than 90 years, patients 90 years or older were less likely to have a number of comorbidities, including previous myocardial infarction (17.5% versus 21.8%), previous coronary artery bypass grafting (20.0% versus 35.0%), and chronic obstructive pulmonary disease (25.4% versus 39.0%) among others. The 30-day and 1-year mortality rates were 8.4% versus 5.9% (p = 0.0001) and 25.4% versus 21.5% (p = 0.0001) in the older and younger groups, respectively (odds ratio [OR] 1.47, 95% confidence interval [CI]: 1.28 to 1.70, p = 0.0001). Patients 90 years and older were more likely to undergo pacemaker insertion (11.1% versus 8.3%, p = 0.0001). Among nonagenarians, compared with the transapical group, patients undergoing transfemoral TAVR had lower 30-day (7.2% versus 13.6%, p = 0.0001) and 1-year (23.8% versus 31.6%, p = 0.0001) mortality rates, were more likely to be discharged home (54.4% versus 34.1%, p = 0.0001), and had lower 30-day readmission rates (23.8% versus 31.8%, p = 0.0001). After adjustment for patient characteristics, transapical TAVR was an independent predictor of 30-day mortality rate (OR 1.94, 95% CI: 1.48 to 2.56, p = 0.0001) and readmission (OR 1.46, 95% CI: 1.19 to 1.80, p = 0.0003). CONCLUSIONS In patients undergoing TAVR, although 30-day and 1-year mortality rates were slightly worse for nonagenarians than their younger counterparts, long-term survival was still encouraging, with 75% of nonagenarians living to 1 year. Transapical TAVR was associated with worse outcomes in nonagenarians.
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Affiliation(s)
- Christian McNeely
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - Alan Zajarias
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - Randall Robbs
- Department of Surgery, Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Stephen Markwell
- Department of Surgery, Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Christina M Vassileva
- Division of Cardiac Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
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Terzian Z, Urena M, Himbert D, Gardy-Verdonk C, Iung B, Bouleti C, Brochet E, Ghodbane W, Depoix JP, Nataf P, Vahanian A. Causes and temporal trends in procedural deaths after transcatheter aortic valve implantation. Arch Cardiovasc Dis 2017; 110:607-615. [PMID: 28411108 DOI: 10.1016/j.acvd.2016.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 09/10/2016] [Accepted: 12/16/2016] [Indexed: 10/19/2022]
Abstract
BACKGROUND The causes of procedural deaths after transcatheter aortic valve implantation (TAVI) have been scarcely detailed. AIMS To assess these causes and their temporal trends since the beginning of the TAVI era. METHODS From October 2006 to April 2014, 601 consecutive high-risk/inoperable patients with severe aortic stenosis underwent TAVI using the Edwards SAPIEN or SAPIEN XT or the Medtronic CoreValve. The transfemoral route was the default approach; the transapical or left subclavian approaches were alternative options. Patients were divided into three tertiles according to the date of the procedure. RESULTS Procedural death occurred in 45 patients (7.5%), with a median±standard deviation age of 83±7 years; 23 were men (51%) and the mean logistic EuroSCORE was 26±16%. The main cause of death was heart failure (n=19, 42%), followed by cardiac rupture (n=12, 27%), intensive care complications (n=9, 20%) and vascular complications (n=5, 11%). The mortality rate was higher after transapical than transfemoral TAVI (17% vs. 5%; P<0.001). The mortality rate decreased over time (11.9% in the first tertile, 6.0% in the second and 4.5% in the third [P=0.007]), driven by a reduction in heart failure-related deaths (6.5% in the first tertile vs. 1.5% in the third; P=0.011). Vascular complication-related deaths disappeared in the third tertile. However, there was no decrease in deaths related to cardiac ruptures and intensive care complications. CONCLUSIONS The procedural mortality rate of TAVI decreased over time, driven by the decrease in heart failure-related deaths. However, efforts should continue to prevent cardiac ruptures and improve the outcomes of patients requiring intensive care after TAVI.
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Affiliation(s)
- Zaven Terzian
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Marina Urena
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Dominique Himbert
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France.
| | | | - Bernard Iung
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Claire Bouleti
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Eric Brochet
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Walid Ghodbane
- Cardiac Surgery Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Jean-Pol Depoix
- Anaesthesiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Patrick Nataf
- Cardiac Surgery Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Alec Vahanian
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
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Michel J, Frangieh AH, Ott I, Kasel AM. Bending the Rules in Transfemoral TAVI With the SAPIEN 3: Overcoming Severe Iliac Tortuosity. Heart Lung Circ 2017; 26:e50-e53. [PMID: 28377229 DOI: 10.1016/j.hlc.2017.02.007] [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: 11/03/2016] [Revised: 02/02/2017] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
Abstract
Whilst the worldwide uptake of transcatheter aortic valve implantation (TAVI) over the last 10 years has been dramatic, iliac tortuosity remains a potential barrier to the most commonly chosen access route via the femoral artery. We describe the challenges posed by severe iliac tortuosity during transfemoral TAVI and contrast a difficult procedure - at the limit of the capability of current device delivery technology - with a straightforward implantation. The use of pre-procedural multi-detector computed tomography to assess the vasculature and a bilateral stiff wire technique for managing iliofemoral tortuosity are discussed.
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Affiliation(s)
| | | | - Ilka Ott
- Deutsches Herzzentrum München, Munich, Bavaria, Germany
| | - A M Kasel
- Deutsches Herzzentrum München, Munich, Bavaria, Germany
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187
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Learning Curves Among All Patients Undergoing Transcatheter Aortic Valve Implantation in Germany: A Retrospective Observational Study. Int J Cardiol 2017; 235:17-21. [PMID: 28274581 DOI: 10.1016/j.ijcard.2017.02.138] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 02/23/2017] [Accepted: 02/27/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is a rapidly evolving technique for therapy of aortic stenosis. Previous studies report learning curves with respect to in-hospital mortality and clinical complications. We aim to determine whether observed improvements of in-hospital outcomes after TAVI are the result of improvements in procedures or due to a change in the patient population, and whether improvements differ between the transfemoral (TF) and the transapical (TA) approach. METHODS Data was analyzed using risk-adjusted regression analyses in order to track the development of clinical outcomes of all isolated TAVI procedures performed in Germany from 2008 to 2013 (N=32.436) in all German hospitals performing TAVI. Measurements include in-hospital mortality, stroke, bleeding, and mechanical ventilation. RESULTS Unadjusted mortality rates decrease over time for both TA-TAVI and TF-TAVI. Reductions in mortality were smaller for TA-TAVI than for TF-TAVI. These trends could also be observed for risk-adjusted (standardized) mortality rates, indicating that time trends and differences between TA-TAVI (around 7% in 2013) and TF-TAVI (around 4% in 2013) cannot be explained by changes in the risk factor composition of the patient populations. Bleeding complications decreased for both access routes. Both unadjusted and standardized bleeding rates were substantially higher for TA-TAVI. In addition, TA-TAVI procedures were associated with an increased likelihood of requiring >48h of mechanical ventilation. CONCLUSIONS Observed improvements in TAVI-related in-hospital mortality are not due to a change in patient population. The results indicate the superiority of a TF-first approach.
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188
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Czarnecki A, Qiu F, Koh M, Prasad TJ, Cantor WJ, Cheema AN, Chu MW, Feindel C, Fremes SE, Kingsbury K, Natarajan MK, Peterson MD, Ruel M, Strauss BH, Wijeysundera HC, Ko DT. Clinical outcomes after trans-catheter aortic valve replacement in men and women in Ontario, Canada. Catheter Cardiovasc Interv 2017; 90:486-494. [DOI: 10.1002/ccd.26906] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 12/05/2016] [Accepted: 12/12/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Andrew Czarnecki
- Schulich Heart Centre; Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto; Ontario Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto; Ontario Canada
- Institute for Clinical Evaluative Sciences (ICES); Toronto Ontario Canada
| | - Feng Qiu
- Institute for Clinical Evaluative Sciences (ICES); Toronto Ontario Canada
| | - Maria Koh
- Institute for Clinical Evaluative Sciences (ICES); Toronto Ontario Canada
| | - Treesa J. Prasad
- Institute for Clinical Evaluative Sciences (ICES); Toronto Ontario Canada
| | | | - Asim N. Cheema
- St Michael's Hospital, University of Toronto; Ontario Canada
| | - Michael W.A. Chu
- London Health Sciences Centre, University of Western Ontario; London Ontario Canada
| | | | - Stephen E. Fremes
- Schulich Heart Centre; Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto; Ontario Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto; Ontario Canada
| | | | | | - Mark D. Peterson
- St Michael's Hospital, University of Toronto; Ontario Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital; Toronto Ontario Canada
| | - Marc Ruel
- Ottawa Heart Institute; Ottawa Ontario Canada
| | - Bradley H. Strauss
- Schulich Heart Centre; Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto; Ontario Canada
| | - Harindra C. Wijeysundera
- Schulich Heart Centre; Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto; Ontario Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto; Ontario Canada
- Institute for Clinical Evaluative Sciences (ICES); Toronto Ontario Canada
| | - Dennis T. Ko
- Schulich Heart Centre; Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto; Ontario Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto; Ontario Canada
- Institute for Clinical Evaluative Sciences (ICES); Toronto Ontario Canada
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189
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D’Onofrio A, Besola L, Rizzoli G, Bizzotto E, Manzan E, Tessari C, Bianco R, Tarantini G, Badano LP, Napodano M, Fraccaro C, Pittarello D, Gerosa G. Impact of Changes in Left Ventricular Ejection Fraction on Survival After Transapical Aortic Valve Implantation. Ann Thorac Surg 2017; 103:559-566. [DOI: 10.1016/j.athoracsur.2016.06.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 05/31/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
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190
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Branny M, Branny P, Hudec M, Billka M, Škňouřil L, Chovančík J, Kluzová K, Kufová P, Januška J, Jarkovský J, Blaha M. Alternative access routes for transcatheter aortic valve implantation (TAVI. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2017.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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191
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Etiologies and Predictors of 30-Day Readmission and In-Hospital Mortality During Primary and Readmission After Transcatheter Aortic Valve Implantation. Am J Cardiol 2016; 118:1705-1711. [PMID: 27677388 DOI: 10.1016/j.amjcard.2016.08.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/18/2016] [Accepted: 08/18/2016] [Indexed: 11/22/2022]
Abstract
There are sparse data on the etiologies and predictors of readmission after transcatheter aortic valve implantation (TAVI). The study cohort was derived from the National Readmission Data 2013, a subset of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. TAVI was identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification codes. The coprimary outcomes were 30-day readmissions and in-hospital mortality during primary admission and readmission. Hierarchical 2-level logistic models were used to evaluate study outcomes. Our analysis included 5,702 (weighted n = 12,703) TAVI procedures. About 1,215 patients were readmitted (weighted n = 2,757) within 30 days during the study year. Significant predictors of readmission included transapical access (OR, 95% CI, p value) (1.23, 1.10 to 1.38, <0.01), diabetes (1.18, 1.06 to 1.32, p 0.004), chronic lung disease (1.32, 1.18 to 1.47, <0.01), renal failure (1.43, 1.24 to 1.65, <0.01), patients discharged to facilities (1.28, 1.14 to 1.43, <0.01), and those who had lengthier hospital stays during primary admission (length of stay >10 days: 3.06, 2.22 to 4.22, <0.01). Female gender (1.39, 1.16 to 1.68, <0.01), blood transfusion (1.88, 1.55 to 2.29, <0.01), use of vasopressors (3.63, 2.50 to 5.28, <0.01), hemodynamic support (6.39, 5.20 to 7.85, <0.01) and percutaneous coronary intervention (1.89, 1.30 to 2.74, 0.01) during primary admission were significant predictors of in-hospital mortality. Age and transapical access were significant predictors of in-hospital mortality during readmission. In conclusion, heart failure, pneumonia, and bleeding complications are among important etiologies of readmission in patients after TAVI. Patients who underwent transapical TAVI and those with slower in-hospital recovery and co-morbidities such as chronic lung disease and renal failure are more likely to be readmitted to the hospital.
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192
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Bruschi G, Asrress KN, Colombo P, Bapat VN. Transthoracic Aortic Valve Implantation. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Giuseppe Bruschi
- Department of Cardiology and Cardiothoracic Surgery; Niguarda Ca’ Granda Hospital; Milan Italy
| | - Kaleab N. Asrress
- Department of Cardiology and Cardiothoracic Surgery; St Thomas’ Hospital; King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas’ Hospital; London UK
| | - Paola Colombo
- Department of Cardiology and Cardiothoracic Surgery; Niguarda Ca’ Granda Hospital; Milan Italy
| | - Vinayak N. Bapat
- Department of Cardiology and Cardiothoracic Surgery; St Thomas’ Hospital; King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas’ Hospital; London UK
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193
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Tomey MI, Kini AS, Sharma SK, Kovacic JC. Aortic Valvuloplasty and Large-Bore Percutaneous Arterial Access. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Matthew I. Tomey
- The Zena and Michael A. Wiener Cardiovascular Institute, and The Marie-Josée and Henry R. Kravis Cardiovascular Health Center; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Annapoorna S. Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, and The Marie-Josée and Henry R. Kravis Cardiovascular Health Center; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Samin K. Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, and The Marie-Josée and Henry R. Kravis Cardiovascular Health Center; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Jason C. Kovacic
- The Zena and Michael A. Wiener Cardiovascular Institute, and The Marie-Josée and Henry R. Kravis Cardiovascular Health Center; Icahn School of Medicine at Mount Sinai; New York NY USA
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194
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Frequency of and Prognostic Significance of Atrial Fibrillation in Patients Undergoing Transcatheter Aortic Valve Implantation. Am J Cardiol 2016; 118:1527-1532. [PMID: 27666171 DOI: 10.1016/j.amjcard.2016.08.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 11/21/2022]
Abstract
The prognostic implications of preexisting atrial fibrillation (AF) and new-onset AF (NOAF) in transcatheter aortic valve implantation (TAVI) remain uncertain. This study assesses the epidemiology of AF in patients treated with TAVI and evaluates their outcomes according to the presence of preexisting AF or NOAF. A retrospective analysis of 708 patients undergoing TAVI from 2 heart hospitals was performed. Patients were divided into 3 study groups: sinus rhythm (n = 423), preexisting AF (n = 219), and NOAF (n = 66). Primary outcomes of interest were all-cause death and stroke both at 30-day and at 1-year follow-up. Preexisting AF was present in 30.9% of our study population, whereas NOAF was observed in 9.3% of patients after TAVI. AF and NOAF patients showed a higher rate of 1-year all-cause mortality compared with patients in sinus rhythm (14.6% vs 6.5% for preexisting AF and 16.3% vs 6.5% for NOAF, p = 0.007). No differences in 30-day mortality were observed between groups. In patients with AF (either preexisting and new-onset), those discharged with single antiplatelet therapy displayed higher mortality rates at 1 year (42.9% vs 11.7%, p = 0.006). Preexisting AF remained an independent predictor of mortality at 1-year follow-up (hazard ratio [HR] 2.34, 95% CI 1.22 to 4.48, p = 0.010). Independent predictors of NOAF were transapical and transaortic approach as well as balloon postdilatation (HR 3.48, 95% CI 1.66 to 7.29, p = 0.001; HR 5.08, 95% CI 2.08 to 12.39, p <0.001; HR 2.76, 95% CI 1.25 to 6.08, p = 0.012, respectively). In conclusion, preexisting AF is common in patients undergoing TAVI and is associated with a twofold increased risk of 1-year mortality. This negative effect is most pronounced in patients discharged with single antiplatelet therapy compared with other antithrombotic regimens.
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195
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D’Errigo P, Ranucci M, Covello RD, Biancari F, Rosato S, Barbanti M, Onorati F, Tamburino C, Santoro G, Grossi C, Santini F, Bontempi K, Fusco D, Seccareccia F. Outcome After General Anesthesia Versus Monitored Anesthesia Care in Transfemoral Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2016; 30:1238-43. [DOI: 10.1053/j.jvca.2016.05.034] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Indexed: 11/11/2022]
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196
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Patel JS, Krishnaswamy A, Svensson LG, Tuzcu EM, Mick S, Kapadia SR. Access Options for Transcatheter Aortic Valve Replacement in Patients with Unfavorable Aortoiliofemoral Anatomy. Curr Cardiol Rep 2016; 18:110. [DOI: 10.1007/s11886-016-0788-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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197
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Lee M, Modine T, Piazza N, Mylotte D. TAVI device selection: time for a patient-specific approach. EUROINTERVENTION 2016; 12:Y37-41. [PMID: 27640029 DOI: 10.4244/eijv12sya9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Individualised, patient-centred care is a central tenet of modern medicine. The variety of transcatheter heart valves currently available affords the opportunity to select the most appropriate device for each individual patient. Prosthesis selection should be based on operator experience and pre-procedural multimodal three-dimensional imaging. Herein, we outline a number of clinical scenarios where specific transcatheter heart valve technologies have the potential to optimise clinical outcome.
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Affiliation(s)
- Marcus Lee
- Department of Cardiology, University Hospital Galway, Galway, Ireland
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198
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Mahidhar R, Resar JR. Transcatheter aortic valve replacement: favorable clinical outcomes support role in intermediate risk surgical patients. J Thorac Dis 2016; 8:2411-2414. [PMID: 27746990 DOI: 10.21037/jtd.2016.08.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ravilla Mahidhar
- Division of Cardiology, Department of Medicine, The Johns Hopkins Hospital and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jon R Resar
- Division of Cardiology, Department of Medicine, The Johns Hopkins Hospital and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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199
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Kapadia S, Agarwal S, Miller DC, Webb JG, Mack M, Ellis S, Herrmann HC, Pichard AD, Tuzcu EM, Svensson LG, Smith CR, Rajeswaran J, Ehrlinger J, Kodali S, Makkar R, Thourani VH, Blackstone EH, Leon MB. Insights Into Timing, Risk Factors, and Outcomes of Stroke and Transient Ischemic Attack After Transcatheter Aortic Valve Replacement in the PARTNER Trial (Placement of Aortic Transcatheter Valves). Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.115.002981. [DOI: 10.1161/circinterventions.115.002981] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 04/27/2016] [Indexed: 11/16/2022]
Abstract
Background—
Prior studies of stroke and transient ischemic attack (TIA) after transcatheter aortic valve replacement (TAVR) are limited by reporting and follow-up variability. This is a comprehensive analysis of time-related incidence, risk factors, and outcomes of these events.
Methods and Results—
From April 2007 to February 2012, 2621 patients, aged 84±7.2 years, underwent transfemoral (TF; 1521) or transapical (TA; 1100) TAVR in the PARTNER trial (Placement of Aortic Transcatheter Valves; as-treated), including the continued access registry. Stroke and TIA were identified by protocol and adjudicated by a Clinical Events Committee. Within 30 days of TAVR, 87 (3.3%) patients experienced a stroke (TF 58 [3.8%]; TA 29 [2.7%];
P
=0.09), 85% within 1 week. Instantaneous stroke risk peaked on day 2, then fell to a low prolonged risk of 0.8% by 1 to 2 weeks. Within 30 days, 13 (0.50%) patients experienced a TIA (TF 10 [0.67%]; TA 3 [0.27%];
P
>0.17). Stroke and TIA were associated with lower 1-year survival than expected (TF 47% after stroke versus 82%, and 64% after TIA versus 83%; TA 53% after stroke versus 80%, and 64% after TIA versus 83%). Risk factors for early stroke after TA-TAVR included more postdilatations, pure aortic stenosis without regurgitation, and possibly more pacing runs, earlier date of procedure, and no dual antiplatelet therapy; high pre-TAVR aortic peak gradient was a risk factor for stroke early after TF-TAVR.
Conclusions—
Risk of stroke or TIA is highest early after TAVR and is associated with increased 1-year mortality. Modifications of TAVR, emboli-prevention devices, and better intraprocedural pharmacological protection may mitigate this risk.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00530894.
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Affiliation(s)
- Samir Kapadia
- From the Cleveland Clinic, OH (S. Kapadia, S.A., S.E., E.M.T., L.G.S., J.R., J.E., E.H.B.); Stanford University Medical School, CA (D.C.M.); St. Paul’s Hospital, University of British Columbia, Vancouver (J.G.W.); Baylor Scott and White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); MedStar Washington Hospital Center, DC (A.D.P.); Columbia University Medical Center/New York-Presbyterian Hospital (C.R.S., S. Kodali, M.B.L.); Cedars Sinai Medical Center,
| | - Shikhar Agarwal
- From the Cleveland Clinic, OH (S. Kapadia, S.A., S.E., E.M.T., L.G.S., J.R., J.E., E.H.B.); Stanford University Medical School, CA (D.C.M.); St. Paul’s Hospital, University of British Columbia, Vancouver (J.G.W.); Baylor Scott and White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); MedStar Washington Hospital Center, DC (A.D.P.); Columbia University Medical Center/New York-Presbyterian Hospital (C.R.S., S. Kodali, M.B.L.); Cedars Sinai Medical Center,
| | - D. Craig Miller
- From the Cleveland Clinic, OH (S. Kapadia, S.A., S.E., E.M.T., L.G.S., J.R., J.E., E.H.B.); Stanford University Medical School, CA (D.C.M.); St. Paul’s Hospital, University of British Columbia, Vancouver (J.G.W.); Baylor Scott and White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); MedStar Washington Hospital Center, DC (A.D.P.); Columbia University Medical Center/New York-Presbyterian Hospital (C.R.S., S. Kodali, M.B.L.); Cedars Sinai Medical Center,
| | - John G. Webb
- From the Cleveland Clinic, OH (S. Kapadia, S.A., S.E., E.M.T., L.G.S., J.R., J.E., E.H.B.); Stanford University Medical School, CA (D.C.M.); St. Paul’s Hospital, University of British Columbia, Vancouver (J.G.W.); Baylor Scott and White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); MedStar Washington Hospital Center, DC (A.D.P.); Columbia University Medical Center/New York-Presbyterian Hospital (C.R.S., S. Kodali, M.B.L.); Cedars Sinai Medical Center,
| | - Michael Mack
- From the Cleveland Clinic, OH (S. Kapadia, S.A., S.E., E.M.T., L.G.S., J.R., J.E., E.H.B.); Stanford University Medical School, CA (D.C.M.); St. Paul’s Hospital, University of British Columbia, Vancouver (J.G.W.); Baylor Scott and White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); MedStar Washington Hospital Center, DC (A.D.P.); Columbia University Medical Center/New York-Presbyterian Hospital (C.R.S., S. Kodali, M.B.L.); Cedars Sinai Medical Center,
| | - Stephen Ellis
- From the Cleveland Clinic, OH (S. Kapadia, S.A., S.E., E.M.T., L.G.S., J.R., J.E., E.H.B.); Stanford University Medical School, CA (D.C.M.); St. Paul’s Hospital, University of British Columbia, Vancouver (J.G.W.); Baylor Scott and White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); MedStar Washington Hospital Center, DC (A.D.P.); Columbia University Medical Center/New York-Presbyterian Hospital (C.R.S., S. Kodali, M.B.L.); Cedars Sinai Medical Center,
| | - Howard C. Herrmann
- From the Cleveland Clinic, OH (S. Kapadia, S.A., S.E., E.M.T., L.G.S., J.R., J.E., E.H.B.); Stanford University Medical School, CA (D.C.M.); St. Paul’s Hospital, University of British Columbia, Vancouver (J.G.W.); Baylor Scott and White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); MedStar Washington Hospital Center, DC (A.D.P.); Columbia University Medical Center/New York-Presbyterian Hospital (C.R.S., S. Kodali, M.B.L.); Cedars Sinai Medical Center,
| | - Augusto D. Pichard
- From the Cleveland Clinic, OH (S. Kapadia, S.A., S.E., E.M.T., L.G.S., J.R., J.E., E.H.B.); Stanford University Medical School, CA (D.C.M.); St. Paul’s Hospital, University of British Columbia, Vancouver (J.G.W.); Baylor Scott and White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); MedStar Washington Hospital Center, DC (A.D.P.); Columbia University Medical Center/New York-Presbyterian Hospital (C.R.S., S. Kodali, M.B.L.); Cedars Sinai Medical Center,
| | - E. Murat Tuzcu
- From the Cleveland Clinic, OH (S. Kapadia, S.A., S.E., E.M.T., L.G.S., J.R., J.E., E.H.B.); Stanford University Medical School, CA (D.C.M.); St. Paul’s Hospital, University of British Columbia, Vancouver (J.G.W.); Baylor Scott and White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); MedStar Washington Hospital Center, DC (A.D.P.); Columbia University Medical Center/New York-Presbyterian Hospital (C.R.S., S. Kodali, M.B.L.); Cedars Sinai Medical Center,
| | - Lars G. Svensson
- From the Cleveland Clinic, OH (S. Kapadia, S.A., S.E., E.M.T., L.G.S., J.R., J.E., E.H.B.); Stanford University Medical School, CA (D.C.M.); St. Paul’s Hospital, University of British Columbia, Vancouver (J.G.W.); Baylor Scott and White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); MedStar Washington Hospital Center, DC (A.D.P.); Columbia University Medical Center/New York-Presbyterian Hospital (C.R.S., S. Kodali, M.B.L.); Cedars Sinai Medical Center,
| | - Craig R. Smith
- From the Cleveland Clinic, OH (S. Kapadia, S.A., S.E., E.M.T., L.G.S., J.R., J.E., E.H.B.); Stanford University Medical School, CA (D.C.M.); St. Paul’s Hospital, University of British Columbia, Vancouver (J.G.W.); Baylor Scott and White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); MedStar Washington Hospital Center, DC (A.D.P.); Columbia University Medical Center/New York-Presbyterian Hospital (C.R.S., S. Kodali, M.B.L.); Cedars Sinai Medical Center,
| | - Jeevanantham Rajeswaran
- From the Cleveland Clinic, OH (S. Kapadia, S.A., S.E., E.M.T., L.G.S., J.R., J.E., E.H.B.); Stanford University Medical School, CA (D.C.M.); St. Paul’s Hospital, University of British Columbia, Vancouver (J.G.W.); Baylor Scott and White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); MedStar Washington Hospital Center, DC (A.D.P.); Columbia University Medical Center/New York-Presbyterian Hospital (C.R.S., S. Kodali, M.B.L.); Cedars Sinai Medical Center,
| | - John Ehrlinger
- From the Cleveland Clinic, OH (S. Kapadia, S.A., S.E., E.M.T., L.G.S., J.R., J.E., E.H.B.); Stanford University Medical School, CA (D.C.M.); St. Paul’s Hospital, University of British Columbia, Vancouver (J.G.W.); Baylor Scott and White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); MedStar Washington Hospital Center, DC (A.D.P.); Columbia University Medical Center/New York-Presbyterian Hospital (C.R.S., S. Kodali, M.B.L.); Cedars Sinai Medical Center,
| | - Susheel Kodali
- From the Cleveland Clinic, OH (S. Kapadia, S.A., S.E., E.M.T., L.G.S., J.R., J.E., E.H.B.); Stanford University Medical School, CA (D.C.M.); St. Paul’s Hospital, University of British Columbia, Vancouver (J.G.W.); Baylor Scott and White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); MedStar Washington Hospital Center, DC (A.D.P.); Columbia University Medical Center/New York-Presbyterian Hospital (C.R.S., S. Kodali, M.B.L.); Cedars Sinai Medical Center,
| | - Raj Makkar
- From the Cleveland Clinic, OH (S. Kapadia, S.A., S.E., E.M.T., L.G.S., J.R., J.E., E.H.B.); Stanford University Medical School, CA (D.C.M.); St. Paul’s Hospital, University of British Columbia, Vancouver (J.G.W.); Baylor Scott and White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); MedStar Washington Hospital Center, DC (A.D.P.); Columbia University Medical Center/New York-Presbyterian Hospital (C.R.S., S. Kodali, M.B.L.); Cedars Sinai Medical Center,
| | - Vinod H. Thourani
- From the Cleveland Clinic, OH (S. Kapadia, S.A., S.E., E.M.T., L.G.S., J.R., J.E., E.H.B.); Stanford University Medical School, CA (D.C.M.); St. Paul’s Hospital, University of British Columbia, Vancouver (J.G.W.); Baylor Scott and White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); MedStar Washington Hospital Center, DC (A.D.P.); Columbia University Medical Center/New York-Presbyterian Hospital (C.R.S., S. Kodali, M.B.L.); Cedars Sinai Medical Center,
| | - Eugene H. Blackstone
- From the Cleveland Clinic, OH (S. Kapadia, S.A., S.E., E.M.T., L.G.S., J.R., J.E., E.H.B.); Stanford University Medical School, CA (D.C.M.); St. Paul’s Hospital, University of British Columbia, Vancouver (J.G.W.); Baylor Scott and White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); MedStar Washington Hospital Center, DC (A.D.P.); Columbia University Medical Center/New York-Presbyterian Hospital (C.R.S., S. Kodali, M.B.L.); Cedars Sinai Medical Center,
| | - Martin B. Leon
- From the Cleveland Clinic, OH (S. Kapadia, S.A., S.E., E.M.T., L.G.S., J.R., J.E., E.H.B.); Stanford University Medical School, CA (D.C.M.); St. Paul’s Hospital, University of British Columbia, Vancouver (J.G.W.); Baylor Scott and White Health, Plano, TX (M.M.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); MedStar Washington Hospital Center, DC (A.D.P.); Columbia University Medical Center/New York-Presbyterian Hospital (C.R.S., S. Kodali, M.B.L.); Cedars Sinai Medical Center,
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Reardon MJ, Kleiman NS. Highway to the heart or one more for the road? The continued life of direct aortic access for transcatheter aortic valve replacement. J Thorac Cardiovasc Surg 2016; 152:1616-1617. [PMID: 27566890 DOI: 10.1016/j.jtcvs.2016.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 07/12/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Tex.
| | - Neal S Kleiman
- Department of Cardiology, Houston Methodist Hospital, Houston, Tex
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