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Chiabrando JG, Lombardi M, Seropian IM, Valle Raleigh JM, Vergallo R, Larribau M, Agatiello CR, Trani C, Burzotta F. Chronic systemic glucocorticoid therapy is associated with increased risk of major vascular complications and cardiac tamponade after transcatheter aortic valve implantation: a systematic review and meta-analysis. Minerva Cardiol Angiol 2024; 72:284-291. [PMID: 37822235 DOI: 10.23736/s2724-5683.23.06347-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION TAVI-related complications, such as conduction disturbances, vascular complications or death may be related to increased inflammatory response. The aim of this study was to elucidate the efficacy and safety of the systemic glucocorticoid therapy regarding the adverse events after TAVI deployment. EVIDENCE ACQUISITION We conducted a systemic search of PubMed, a reference list of relevant articles, and Medline. The main efficacy outcomes of interest were all-cause death, cardiac and non-cardiac death, permanent pacemaker implantation (PPM), new left bundle branch block (LBBB), stroke, and myocardial infarction (MI). Safety endpoints were major vascular complications, major bleeding events, and cardiac tamponade. EVIDENCE SYNTHESIS A total of 7 studies including data from 3439 patients with a median follow-up was 30 days. Systemic glucocorticoid compared to the control group were associated with an increased risk of non-cardiac death (Relative Risk [RR] 5.90 95%CI [2.95; 11.80], P<0.001) major vascular complications (RR 1.78, 95%CI [1.22 - 2.61], P=0.003) and cardiac tamponade (RR 3.42, 95%CI [1.69 - 6.92], P<0.001). However, there were no differences in all-cause death, cardiac death, new LBBB, stroke, MI, or major bleeding events (all P values >0.05). CONCLUSIONS Glucocorticoid therapy before the TAVI procedure was associated with an increase in non-cardiac death, major vascular events and cardiac tamponade. There were no differences in the risk of all-cause death, cardiac death, PPM or LBBB, stroke, or MI.
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Affiliation(s)
- Juan G Chiabrando
- Unit of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina -
- Unit of Interventional Cardiology, Spanish Hospital of Mendoza, Mendoza, Argentina -
| | - Marco Lombardi
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Ignacio M Seropian
- Unit of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Juan M Valle Raleigh
- Unit of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Rocco Vergallo
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
- Cardiothoracic and Vascular Department (DICATOV), IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Miguel Larribau
- Unit of Interventional Cardiology, Spanish Hospital of Mendoza, Mendoza, Argentina
| | - Carla R Agatiello
- Unit of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Carlo Trani
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
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Tiago C, Dias Vaz M, Marques A, Barata M, Braga JP, Boa A, Carvalho AF. Intraoperative Corticosteroids and Pacemaker Implantation After Transcatheter Aortic Valve Replacement. Cureus 2024; 16:e56824. [PMID: 38654777 PMCID: PMC11037441 DOI: 10.7759/cureus.56824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis. However, conduction disturbances leading to pacemaker implantation remain a common complication, increasing morbidity and mortality in these patients. Hence, measures to lower its incidence should be taken, and corticosteroid therapy could be effective by reducing inflammation caused by direct mechanical trauma to the conduction system. METHODS A retrospective cohort study was conducted at the Centro Hospitalar de Vila Nova de Gaia/Espinho, analyzing the medical records of patients with native severe aortic stenosis who underwent transfemoral TAVR in 2022. The Chi-square test was used to compare the rate of pacemaker implantation in patients who received corticosteroids with patients who didn't. The statistical significance was considered for a p-value <0.05. RESULTS A total of 341 patients were included in this study. Monitored anesthesia care was the preferred anesthetic technique (99.1%). Sixty-three point three percent (63.3%) of patients received corticosteroids at the beginning of the procedure. Corticosteroid administration did not significantly affect the incidence of permanent pacemaker implantation (p=0.277), vascular complications on the access site (p=0.765), or in-hospital mortality (p=0.909). Male gender, 1st-degree atrioventricular block, and right branch block were the only identified predictors of permanent pacemaker implantation after transfemoral TAVR (p=0.041 <0.001 and <0.001, respectively). CONCLUSION Corticosteroid administration at the beginning of TAVR doesn't seem to influence the incidence of permanent pacemaker implantation, which can suggest that other factors play a more important role in the development of conduction disturbances leading to pacemaker implantation.
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Affiliation(s)
- Catarina Tiago
- Anesthesiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
| | - Marta Dias Vaz
- Anesthesiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
| | - Ana Marques
- Anesthesiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
| | - Melanie Barata
- Anesthesiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
| | - José Pedro Braga
- Cardiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
| | - Ana Boa
- Anesthesiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
| | - Ana Filipa Carvalho
- Anesthesiology, Centro Hospitalar de Vila Nova de Gaia - Espinho, Porto, PRT
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Ang SP, Chia JE, Jaiswal V, Hanif M, Vadhera A, Gautam S, Raut A, Rafaqat S, Borra VR, Khandait H, Shrestha AB, Iglesias J. Vascular Complications and Outcomes Following Transcatheter Aortic Valve Replacement in Patients on Chronic Steroid Therapy. A meta-analysis. Int J Surg 2024; 110:01279778-990000000-01024. [PMID: 38320107 PMCID: PMC11020145 DOI: 10.1097/js9.0000000000001132] [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: 08/07/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Chronic steroid (CS) therapy was reportedly linked to increased vascular complications following percutaneous coronary intervention. However, its association with vascular complications after transcatheter aortic valve replacement (TAVR) remained uncertain, with conflicting results being reported. OBJECTIVE We aimed to compare the rate of vascular complications and outcomes between patients with and without (CS) use after TAVR. METHODS We conducted a comprehensive literature search in PubMed, Embase and Cochrane databases from their inception until 18th April 2022 for relevant studies. Endpoints were described according to Valve Academic Research Consortium-2 definitions. Effect sizes were pooled using DerSimonian and Laird random-effects model as risk ratio (RR) with 95% confidence intervals (CI). RESULTS 5 studies with 6136 patients undergoing TAVR were included in the analysis. The included studies were published between 2015 and 2022. The mean ages of patients in both study groups were similar, with the CS group averaging 80 years and the non-steroid group averaging 82 years. Notably, a higher proportion of patients in the CS group were female (56%) compared to the non-steroid group (54%). CS use was associated with a significantly higher risk of major vascular complications (12.5% vs. 6.7%, RR 2.32, 95% CI 1.73-3.11, P<0.001), major bleeding (16.8% vs. 13.1%, RR 1.61, 95% CI 1.27-2.05, P<0.001), and aortic annulus rupture (2.3% vs. 0.6%, RR 4.66, 95% CI 1.67-13.01, P<0.001). There was no significant difference in terms of minor vascular complications (RR 1.43, 95% CI 1.00-2.04, P=0.05), in-hospital mortality (2.3% vs. 1.4%, RR 1.86, 95% CI 0.74-4.70, P=0.19), and 30-day mortality (2.9% vs. 3.1%, RR 1.14, 95% CI 0.53-2.46, P=0.74) between both groups. CONCLUSION Our study showed that CS therapy is associated with increased major vascular complications, major bleeding, and annulus rupture following TAVR. Further large multicenter studies or randomized controlled trials are warranted to validate these findings.
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Affiliation(s)
- Song Peng Ang
- Department of Internal Medicine, Rutgers Health/Community Medical Center, Toms River, NJ, USA
| | - Jia Ee Chia
- Department of Medicine, International Medical University, Malaysia
| | | | - Muhammed Hanif
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Ananya Vadhera
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Sudarshan Gautam
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn NY, USA
| | - Anuradha Raut
- Department of Internal Medicine, Nepal Medical College, Nepal
| | - Saira Rafaqat
- Department of Zoology (Molecular Physiology), Lahore College for Women University, Lahore, Pakistan
| | | | - Harshwardhan Khandait
- Department of Internal Medicine, Trinitas Regional Medical Center/RWJ Barnabas Health, Elizabeth, NJ, USA
| | - Abhigan Babu Shrestha
- Department of Internal Medicine, M Abdur Rahim Medical College, Dinajpur, Bangladesh
| | - Jose Iglesias
- Department of Critical Care, Rutgers Health/Community Medical Center, Toms River, NJ, USA
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Simforoosh N, Nayebzade A, Dadpour M, Rohani S. Corticosteroid Dose in Kidney Transplantation and Its Effect on Surgical Complication: A Systematic Review. EXP CLIN TRANSPLANT 2023; 21:631-638. [PMID: 37698397 DOI: 10.6002/ect.2023.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
OBJECTIVES Although several studies have explored the connection between corticosteroids and renal transplant surgical complications, these studies have overlooked several factors. In addition, no review of the literature, to our knowledge, has been conducted to evaluate corticosteroid dose and incidence of posttransplant surgical complications in these patients. Thus, our objective was to carry out a systematic investigation ofthe correlationbetween corticosteroids and surgical complications in renaltransplant patients. MATERIALS AND METHODS A systematic search was conducted on the PubMed and Embase databases from their inception until April 2023. Retrospective and prospective cohort studies were included if they met the association between corticosteroids and surgical complications. The search strategy was performed using MeSH and non-MeSH key words. Terms used in the electronic search included kidney transplant* OR kidney transplant(mesh) AND steroid* OR steroids(mesh) AND complication* OR intraoperative complications(mesh). RESULTS From 3274 articles, 8 articles were included in the systematic review. Six studies were conducted as retrospective cohorts and 2 studies as prospective cohorts. The mean age of patients included in the studies was 42.1 years. The studies were conducted between 1981 and 2023. Findings suggested that decreasing the postoperative corticosteroid dosage was associated with a lower incidence of various postoperative surgical complications. CONCLUSIONS We investigated the potential benefits of reducing the dose of corticosteroids following kidney transplant. Findings suggested thatreducing the dose of corticosteroids following kidney transplant might be a viable strategy for minimizing the risk of surgical complications. However, it is essential to note that the optimal dosage and duration of corticosteroid therapy after kidney transplant may vary for each patient and should be carefully determined by the health care provider.
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Affiliation(s)
- Nasser Simforoosh
- >From the Shahid Labbafinejad Medical Center, Center of Excellence in Urology, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
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Evbayekha EO, Alugba G, Akewe TO, Obadare OO, Agberien VO, Omogunwa AE, Willie A, Nwafor JN, Okafor AT, Okobi OE. Impact of Long-Term Steroid Use on the Disposition of Patients Undergoing Transcatheter Aortic Valve Replacement: A Retrospective Nationwide Sample Analysis. Cureus 2023; 15:e38048. [PMID: 37228551 PMCID: PMC10207841 DOI: 10.7759/cureus.38048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Background Chronic steroid use is debilitating to health, but, in some cases, it is necessary. We examined the effect of chronic steroid use on the discharge disposition of people undergoing transcatheter aortic valve replacement (TAVR). Methods We queried the National Inpatient Sample Database (NIS) from 2016 to 2019. We identified patients with current chronic steroid use with the International Classification of Diseases for the Tenth (ICD-10) code Z7952. Furthermore, we used the ICD-10 procedure codes for TAVR 02RF3. Outcomes were the length of hospitalization (LOS), Charlson Comorbidity Index (CCI), disposition, in-hospital mortality, and total hospital charges (THC). Results Between 2016 and 2019, we identified 44,200 TAVR hospitalizations, and 382,497 were on current long-term steroid therapy. Of these, 934 had current chronic steroid use and underwent TAVR (STEROID) with a mean age of 78 (SD=8.4). About 50% were female, 89% were Whites, 3.7% were Blacks, 4.2% were Hispanics, and 1.3% were Asians. Disposition was 'home,' 'home with home health' (HWHH), 'skilled nursing home' (SNF), 'short-term inpatient therapy' (SIT), 'discharged against medical advice' (AMA), and 'died.' A total of 602 (65.5%) were discharged home, 206 ( 22%) were discharged to HWHH, 109 (11.7%) to SNF, and 12 (1.28%) died. In the SIT and AMA groups, there were only three and two patients, respectively, p=0.23. The group that underwent TAVR and was not on chronic steroid therapy (NOSTEROID) had a mean age of 79 (SD=8.5), with 28731 (66.4%) being discharged home, 8399 (19.4%) to HWHH, 5319 (12.3%) to SNF, and 617 (1.43%) died p=0.17. Comparing the STEROID vs. NONSTEROID group, according to the CCI, the STEROID group scored higher than the NOSTEROID group; 3.5 (SD=2) vs. 3 (SD=2) p=0.0001, while for LOS, it was 3.7 days (SD=4.3) vs. 4.1 days (SD=5.3), p=0.28, and the THC was $203,213 (SD=$110,476) vs. $215,858 (SD=$138,540), p=0.15. Conclusion The comorbidity burden of individuals on long-term steroids undergoing TAVR was slightly higher than those not on steroids undergoing TAVR. Despite this, there was no statistically significant difference in their hospital outcomes following TAVR with respect to dispositions.
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Affiliation(s)
| | | | - Theresa O Akewe
- Family Medicine, University of Benin, Benin City, NGA
- Family and Community Medicine, Milk River Community Health Center, Milk River, CAN
| | | | | | | | | | - Jane N Nwafor
- Internal Medicine, The University of District of Columbia, Silverspring, USA
| | - Adetoro T Okafor
- Epidemiology and Public Health, University of Minnesota School of Public Health, Minneapolis, USA
| | - Okelue E Okobi
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
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Bernhard B, Okuno T, Cicovic A, Stortecky S, Reichlin T, Lanz J, Praz F, Windecker S, Pilgrim T. Systemic corticosteroid exposure and atrioventricular conductance delays after transcatheter aortic valve implantation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:1-6. [PMID: 34238680 DOI: 10.1016/j.carrev.2021.06.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Atrioventricular conduction delays (AVCD) are common after transcatheter aortic valve implantation (TAVI) and frequently require implantation of a permanent pacemaker (PPM). Autopsy studies demonstrated the role of ischemia, inflammation, and oedema in the pathogenesis of AVCD. Corticosteroids (CS) reduce inflammation and oedema and hence might lead to a lower rate of AVCD. METHODS Based on a prospective single-center registry, we performed a propensity score (PS) matched analysis of subjects treated with or without systemic CS (>2.5 mg prednisolone-equivalent per day) at the time of TAVI. The primary endpoint was a composite of PPM-implantation and new-onset left bundle branch block (LBBB) within 30 days after TAVI. RESULTS Among 2213 consecutive patients undergoing TAVI (51.5% female, mean age 82.1 ± 6.1 years) 89 patients were treated with systemic CS, of which 87 were included in the PS matched analysis. At 30 days, rates of the composite of PPM and LBBB were comparable between patients with versus without CS both in the overall cohort (33.7% versus 33.0%, p = 0.89) and the PS matched cohort (34.5% versus 40.2%, p = 0.443). There were no differences in a composite of major or minor vascular complications and major or life-threatening bleeding events between patients with versus without CS in the overall cohort (34.8% versus 26.6%, p = 0.088) or the PS matched cohort (33.3% versus 33.3%, p ≥ 0.999). CONCLUSION In this exploratory study, intake of systemic CS among patients undergoing TAVI was not associated with differences in rates of AVCD, vascular complications, or bleeding events after TAVI.
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Affiliation(s)
- Benedikt Bernhard
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Taishi Okuno
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Aleksandar Cicovic
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
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Kaihara T, Izumo M, Kameshima H, Sato Y, Kuwata S, Koga M, Watanabe M, Okuyama K, Kamijima R, Ishibashi Y, Tanabe Y, Higuma T, Harada T, Akashi YJ. Effect of Immunosuppressive Therapy on Clinical Outcomes for Patients With Aortic Stenosis Following Transcatheter Aortic Valve Implantation. Circ J 2020; 84:2296-2301. [PMID: 33055458 DOI: 10.1253/circj.cj-20-0600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is an established treatment for symptomatic patients with severe aortic stenosis (AS). Sometimes patients with severe AS taking immunosuppressants are encountered. The effect of immunosuppressive therapy on clinical outcomes in patients with AS following TAVI were investigated.Methods and Results:In total, 282 consecutive patients with severe AS who underwent transfemoral TAVI from January 2016 to December 2018 at St. Marianna University School of Medicine were reviewed. They were divided into 2 groups: the immunosuppressants group (IM group) in which patients continually used immunosuppressive drugs (n=22) and the non-immunosuppressants group (non-IM group) (n=260). The composite endpoints of a major adverse cardiovascular and cerebrovascular event (MACCE) defined as non-lethal myocardial infarction, unstable angina pectoris, heart failure requiring hospitalization, stroke, and cardiovascular death were evaluated. There were no differences in the incidence of vascular access complications (32% vs. 20%, P=0.143) and the rate of procedure success (100% vs. 93%, P=0.377) between the IM and non-IM groups. During the median follow-up period of 567 (16-1,312) days after the TAVI procedure, there were no significant differences between the IM and non-IM groups in the incidence of infectious complications (14% vs. 9%, P=0.442) or MACCE (18% vs. 20%, respectively; P=0.845). CONCLUSIONS The use of IM after TAVI is not associated with increased vascular access complications or mid-term MACCE in patients with severe AS treated with TAVI.
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Affiliation(s)
- Toshiki Kaihara
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Haruka Kameshima
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Yukio Sato
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Shingo Kuwata
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Masashi Koga
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Mika Watanabe
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Kazuaki Okuyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Ryo Kamijima
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Yuki Ishibashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Yasuhiro Tanabe
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Takumi Higuma
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Tomoo Harada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
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Gautier A, Urena M, Chong-Nguyen C, Fischer Q, Abtan J, Carrasco JL, Brochet E, Iung B, Himbert D. Outcomes of Transcatheter Aortic Valve Implantation in Patients Receiving Chronic Systemic Corticosteroid Treatment. Am J Cardiol 2020; 130:108-114. [PMID: 32653084 DOI: 10.1016/j.amjcard.2020.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 01/08/2023]
Abstract
The aim of this study was to describe the effects of chronic systemic corticosteroid treatment (SCT) on early and late outcomes after transcatheter aortic valve implantation (TAVI). From October 2006 to November 2018, 1,299 patients underwent TAVI in our institution. Among them, 48 (3.7%) received chronic SCT at the time of procedure (SCT group). They were more frequently women (p = 0.08) and needed more often dialysis (p = 0.002). All other baseline characteristics were similar between both groups. At 30 days, there was no difference on mortality. However, after adjustment, the SCT group had more major vascular complications: 16.7% versus 7.4%, hazard ratio (HR) 2.52 (95% confidence interval [CI] 1.14 to 5.9, p = 0.023), major or life-threatening bleedings: 22.9% versus 12.4%, HR 2.02 (95% CI 1.00 to 4.08, p = 0.05), and tamponades: 8.3% versus 2.4%, HR 4.05 (95% CI 1.35 to 12.15, p <0.001) than the non-SCT group. One-year all-cause mortality was significantly higher in the SCT than in the non-SCT group (37.5% vs 12.5%, p <0.0001). Multivariate analysis confirmed that SCT use was an independent predictor of 1-year mortality (HR 2.29, 95% CI 1.16 to 4.50, p = 0.017). In conclusion, chronic use of SCT significantly increases the rates of early vascular complications, major or life-threatening bleedings and tamponade and is an independent predictor of 1-year all-cause mortality after TAVI.
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9
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Shah R, Pulton D, Wenger RK, Ha B, Feinman JW, Patel S, Lau C, Rong LQ, Weiss SJ, Augoustides JG, Daubenspeck D, Chaney MA. Aortic Dissection During Cardiac Surgery. J Cardiothorac Vasc Anesth 2020; 35:323-331. [PMID: 32928651 DOI: 10.1053/j.jvca.2020.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Ronak Shah
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Danielle Pulton
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert K Wenger
- Division of Cardiac Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bao Ha
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Division of Cardiac Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Saumil Patel
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Stuart J Weiss
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Danisa Daubenspeck
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
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10
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Koyama Y, Yamamoto M, Kagase A, Tsujimoto S, Kano S, Shimura T, Hosoba S, Watanabe Y, Tada N, Naganuma T, Araki M, Yamanaka F, Mizutani K, Tabata M, Ueno H, Takagi K, Higashimori A, Shirai S, Hayashida K. Prognostic impact and periprocedural complications of chronic steroid therapy in patients following transcatheter aortic valve replacement: Propensity‐matched analysis from the Japanese OCEAN registry. Catheter Cardiovasc Interv 2019; 95:793-802. [DOI: 10.1002/ccd.28332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/01/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Yutaka Koyama
- Department of Cardiovascular SurgeryNagoya Heart Center Nagoya Japan
| | - Masanori Yamamoto
- Department of CardiologyNagoya Heart Center Nagoya Japan
- Department of CardiologyToyohashi Heart Center Toyohashi Japan
| | - Ai Kagase
- Department of CardiologyNagoya Heart Center Nagoya Japan
| | | | - Seiji Kano
- Department of CardiologyToyohashi Heart Center Toyohashi Japan
| | - Tetsuro Shimura
- Department of CardiologyToyohashi Heart Center Toyohashi Japan
| | - Soh Hosoba
- Department of CardiologyToyohashi Heart Center Toyohashi Japan
| | - Yusuke Watanabe
- Department of CardiologyTeikyo University School of Medicine Tokyo Japan
| | - Norio Tada
- Department of CardiologySendai Kosei Hospital Sendai Japan
| | - Toru Naganuma
- Department of CardiologyNew Tokyo Hospital Chiba Japan
| | - Motoharu Araki
- Department of CardiologySaiseikai Yokohama City Eastern Hospital Yokohama Japan
| | - Futoshi Yamanaka
- Department of CardiologySyonan Kamakura General Hospital Kanagawa Japan
| | - Kazuki Mizutani
- Department of Cardiovascular MedicineOsaka City University Graduate School of Medicine Osaka Japan
| | - Minoru Tabata
- Department of Cardiovascular SurgeryTokyo Bay Urayasu‐Ichikawa Medical Center Chiba Japan
| | - Hiroshi Ueno
- Department of CardiologyToyama University Hospital Toyama Japan
| | | | | | - Shinichi Shirai
- Department of CardiologyKokura Memorial Hospital Kokura Japan
| | - Kentaro Hayashida
- Department of CardiologyKeio University School of Medicine Tokyo Japan
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Long-Term Outcomes of Iliofemoral Artery Stents after Transfemoral Aortic Valve Replacement. J Vasc Interv Radiol 2018; 29:1733-1740. [PMID: 30297312 DOI: 10.1016/j.jvir.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/01/2018] [Accepted: 06/03/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To report long-term results of iliofemoral stent placement after transcatheter aortic valve replacement (TAVR). MATERIALS AND METHODS TAVR access-related complications treated with iliofemoral stent placement were recorded in 56 patients (mean age, 81 years; range; 53-93 years; 48% male) of 648 patients who underwent TAVR at a single center. Fifty-six patients treated with stent placement (40 patients with stent grafts and 16 patients with bare metal stents) underwent clinical and ultrasonographic follow-up after a mean of 676 days (range, 60-1840 days). RESULTS During follow-up, none of the 56 patients who had stent placement underwent a vascular reintervention of the affected limb, and none suffered from limb claudication. No decrease was observed in ankle-brachial index (ABI) values to an abnormal value, except in 1 patient (mean preprocedural and postprocedural ABI of 1.2 ± 0.14, range, 0.97-1.4 and 1.19 ± 0.24, range, 0.65-1.54, respectively). Arterial duplex assessment showed normal stent flow velocity (mean, 168.7 ± 63.2 cm/sec; range, 80-345 cm/sec) in all but 1 patient. CONCLUSION Iliofemoral stent implantation is a safe and efficacious treatment for vascular access site and access-related complications during transfemoral TAVR.
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Kaluski E, Khan SU, Sattur S, Sporn D, Rogers G, Reitknecht F. Arteriotomy site complication during transcatheter aortic valve replacement: Ipsilateral wire protection and bailout. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018. [DOI: 10.1016/j.carrev.2018.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Regev E, Finkelstein A, Assali A, Barbash I, Fefer P, Ben-Shoshan J, Orvin K, Konigstein M, Guetta V, Kornowski R, Segev A. Comparison of Outcome of Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis in 3 Age Groups (≤70; 71 to 80, and ≥81 Years). Am J Cardiol 2017; 120:1607-1611. [PMID: 28888407 DOI: 10.1016/j.amjcard.2017.07.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/12/2017] [Accepted: 07/21/2017] [Indexed: 11/25/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has been widely used for the treatment of aortic stenosis. Most pivotal studies of TAVI included patients with a mean age of over 80 years old. Many young patients may also be considered for TAVI because of severe co-morbidities. We sought to describe a group of patients undergoing TAVI at an age below 70 and to compare them with older patients undergoing the procedure. This study included 1,324 consecutive patients from a 3-center TAVI registry from 2008 to 2014. Patients were divided according to age into 3 groups: patients aged 70 years and below, patients between the ages of 71 and 80, and patients 81 years and older. Patients in the younger group had higher body mass index (p <0.001), higher proportion of previous stroke (p = 0.05), peripheral vascular disease (p = 0.03), and diabetes mellitus (p <0.001). Thirty percent of patients in the younger group had functional class IV. Corticosteroids treatment was 5-fold higher in the younger group (p <0.001). Average valve area was lower in the older group (p = 0.004). Thirty-day mortality was similar between the 3 groups. We found no difference in the rate of in-hospital complications. One-year all-cause mortality rate of patients aged 70 years, 71 to 80 years, and >80 years was 7.6%, 7.5%, and 12.6%, respectively, p = 0.01. In conclusion, younger patients undergoing TAVI exhibited higher prevalence of risk factors and co-morbidities that probably explain the decision to perform TAVI rather than surgical aortic valve replacement. Nevertheless, the 1-year mortality of these patients was significantly lower than in older patients.
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Transcatheter aortic valve implantation in patients on corticosteroid therapy. Heart Vessels 2017; 32:1236-1243. [DOI: 10.1007/s00380-017-0996-1] [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: 02/20/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
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