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Apostolos A, Ktenopoulos N, Chlorogiannis DD, Katsaros O, Konstantinou K, Drakopoulou M, Tsalamandris S, Karanasos A, Synetos A, Latsios G, Aggeli C, Panoulas V, Tsioufis C, Toutouzas K. Mortality Rates in Patients Undergoing Urgent Versus Elective Transcatheter Aortic Valve Replacement: A Meta-analysis. Angiology 2024:33197241245733. [PMID: 38613209 DOI: 10.1177/00033197241245733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Patients with severe aortic stenosis (AoS) often present with acute heart failure and compensation, frequently leading to cardiogenic shock. Transcatheter Aortic Valve Replacement (TAVR) has been recently performed as a bailout treatment in such patients. The aim of our meta-analysis is to compare urgent TAVR with elective procedures. We systematically screened three databases searching for studies comparing urgent vs elective TAVR. Primary endpoint is the 30-days mortality. Secondary endpoints included in-hospital mortality, device success, periprocedural vascular complications, 30-days stroke, 30-days acute kidney injury (AKI), permanent pacemaker implantation (PPM), moderate or severe paravalvular leakage, and 30-days bleeding. Seventeen studies were included, with a total of 84,495 patients. Urgent TAVR was associated with an increased risk for 30-days mortality [Risk Ratio (RR): 2.53, 95% Confidence Intervals (CI): 1.81-3.54)], in-hospital mortality (RR: 2.67, 95% CI: 1.94-3.68), periprocedural vascular complications (RR: 1.91, 95% CI: 1.28-2.85) and AKI (RR: 2.83, 95% CI: 1.93-4.14), compared with elective procedure. No differences were observed in the other secondary endpoints. Urgent TAVR was associated with higher in-hospital and 30-days mortality, possibly driven by the increased incidence of AKI and vascular complications in urgent TAVR. The results highlight the importance of early TAVR in stable AoS patients.
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Affiliation(s)
- Anastasios Apostolos
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Ktenopoulos
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Odysseas Katsaros
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Konstantinou
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Maria Drakopoulou
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsalamandris
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Karanasos
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Synetos
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Latsios
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantina Aggeli
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Panoulas
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Costas Tsioufis
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Kitahara H, Kumamaru H, Kohsaka S, Yamashita D, Kanda T, Matsuura K, Shimamura K, Matsumiya G, Kobayashi Y. Clinical Outcomes of Urgent or Emergency Transcatheter Aortic Valve Implantation - Insights From the Nationwide Registry of Japan Transcatheter Valve Therapies. Circ J 2024; 88:439-447. [PMID: 36575039 DOI: 10.1253/circj.cj-22-0536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Limited data are available for clinical outcomes in patients who underwent urgent or emergency transcatheter aortic valve implantation (TAVI). This study investigated in-hospital and 1-year outcomes and explored prognostic covariates in urgent/emergency TAVI using nationwide registry data.Methods and Results: Among 26,775 patients who underwent TAVI between August 2013 and December 2019, 25,495 with 1-year follow-up information were analyzed in this study. Baseline and procedural characteristics, as well as clinical adverse events, were compared between the urgent/emergency and elective TAVI groups. The primary outcome was all-cause mortality within 1 year after TAVI. Multivariable Cox regression models were constructed to identify independent predictors after urgent or emergency TAVI. Urgent or emergency TAVI was performed in 578 (2.3%) patients. The Society of Thoracic Surgeons score was significantly higher in the urgent/emergency than elective TAVI group (13.3% vs. 6.0%; P<0.001). Device success rate was comparable between the 2 groups. All-cause death-free survival within 1 year was lower in the urgent/emergency than elective TAVI group (77.2% vs. 92.2%; log rank P<0.001). Malignancy, albumin and creatinine concentrations, ejection fraction, and mean pressure gradient were associated with 1-year mortality in the urgent/emergency TAVI group. CONCLUSIONS Despite higher surgical risk and more comorbidities, the procedure was successfully performed in patients undergoing urgent/emergency TAVI, although it should be noted that prognosis was worse than for elective TAVI.
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Affiliation(s)
- Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Daichi Yamashita
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Tomoyoshi Kanda
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine
| | - Kaoru Matsuura
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
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Bolakale-Rufai IK, Shinnerl A, Knapp SM, Johnson AE, Mohammed S, Brewer L, Torabi A, Addison D, Mazimba S, Breathett K. Association between social vulnerability index and admission urgency for transcatheter aortic valve replacement. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 39:100370. [PMID: 38469116 PMCID: PMC10927260 DOI: 10.1016/j.ahjo.2024.100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/19/2024] [Indexed: 03/13/2024]
Abstract
Background Transcatheter aortic valve replacement (TAVR) are not offered equitably to vulnerable population groups. Adequate levels of insurance may narrow gaps among patients with higher social vulnerability index (SVI). Among a national population of individuals with commercial or Medicare insurance, we sought to determine whether SVI was associated with urgency of receipt of TAVR for aortic stenosis. Methods and results Using Optum's de-identified Clinformatics Data Mart Database (CDM), we identified admissions for TAVR with aortic stenosis between January 2018 and March 2022. Admission urgency was identified by CDM claims codes. SVI was cross-referenced to patient zip codes and grouped into quintiles. Generalized linear mixed effects models were used to predict the probability of a TAVR admission being urgent based on SVI quintiles, adjusting for patient and hospital-level covariates. Results Among 6680 admissions for TAVR [median age 80 years (interquartile range 75-85), 43.9 % female], 8.5 % (n = 567) were classified as urgent. After adjusting for patient and hospital-level variables, there were no significant differences in the odds of urgent admission for TAVR according to SVI quintiles [OR 5th (greatest social vulnerability) vs 1st quintile (least social vulnerability): 1.29 (95 % CI: 0.90-1.85)]. Conclusions Among commercial or Medicare beneficiaries with aortic stenosis, SVI was not associated with admission urgency for TAVR. To clarify whether cardiovascular care delivery is improved across SVI with higher paying beneficiaries, future investigation should identify whether relationships between SVI and TAVR urgency vary for Medicaid beneficiaries compared to commercial beneficiaries.
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Affiliation(s)
- Ikeoluwapo Kendra Bolakale-Rufai
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN, United States of America
| | - Alexander Shinnerl
- School of Medicine, Indiana University, Indianapolis, IN, United States of America
| | - Shannon M. Knapp
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN, United States of America
| | - Amber E. Johnson
- Division of Cardiovascular Medicine, University of Chicago, Chicago, IL, United States of America
| | - Selma Mohammed
- Division of Cardiovascular Medicine, Creighton University, Omaha, NE, United States of America
| | - LaPrincess Brewer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Asad Torabi
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN, United States of America
| | - Daniel Addison
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville and AdventHealth, Orlando, FL, United States of America
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN, United States of America
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Patel KP, Mukhopadhyay S, Bedford K, Richards R, Queenan H, Jerrum M, Banton J, Ozkor M, Mathur A, Kennon S, Baumbach A, Mullen MJ. Rapid Assessment and Treatment In Decompensated Aortic Stenosis (ASTRID-AS study)- A pilot study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:724-730. [PMID: 36378116 PMCID: PMC10627808 DOI: 10.1093/ehjqcco/qcac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/01/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute decompensated aortic stenosis (ADAS) is common and associated with higher mortality, acute kidney injury (AKI) and longer hospital length of stay (LoS) compared with electively treated stable AS. The aim of this study was to assess the impact of a dedicated pathway that reduces time to transcatheter aortic valve implantation (TAVI) in ADAS, hypothesizing that LoS can be reduced without compromising patient safety. METHODS AND RESULTS Using a prospective, open label, cluster design, patients from 5 referring centres were allocated to the ASessment and TReatment In Decompensated Aortic Stenosis (ASTRID-AS) pathway where the diagnosis, referral, investigations and treatment of ADAS were prioritised and expedited. 15 hospitals remained on the conventional pathway that followed the same process, albeit according to a waiting list. The primary efficacy endpoint was hospital LoS and the secondary safety endpoint, a composite of death or AKI at 30 days post-TAVI. 58 conventional patients and 25 ASTRID-AS patients were included in this study. Time to TAVI in the conventional vs. ASTRID-AS cohort was 22 (15-30) vs. 10 (6-12) days; P < 0.001, respectively. Length of hospital stay was 24 (18-33) vs. 13 (8-18) days; P < 0.001, respectively. 13.4 bed days were saved per patient using the ASTRID-AS pathway. Secondary safety endpoint occurred in 12 (20.7%) vs. 1 (4.0%) patients; P = 0.093, respectively. Procedural complications were similar between the two cohorts. CONCLUSION A dedicated pathway for ADAS that shortens time to TAVI demonstrated reduced hospital LoS without compromising patient safety and a trend towards improving clinical outcomes.
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Affiliation(s)
- Kush P Patel
- Institute of Cardiovascular science, University College London, London, EC1E 6BT, UK
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | | | - Kerry Bedford
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Rhian Richards
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Helen Queenan
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Melanie Jerrum
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Judy Banton
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Mick Ozkor
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Anthony Mathur
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
- The William Harvey Research Institute, London, E1 4NS, UK
| | - Simon Kennon
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
| | - Andreas Baumbach
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
- The William Harvey Research Institute, London, E1 4NS, UK
- Yale University School of Medicine, New Haven, CT 06510. USA
| | - Michael J Mullen
- Institute of Cardiovascular science, University College London, London, EC1E 6BT, UK
- Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
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Kobayashi Y, Izumo M, Okuyama K, Uenomachi N, Shoji T, Kai T, Okuno T, Sato Y, Kuwata S, Koga M, Ishibashi Y, Tanabe Y, Miyairi T, Akashi YJ. Feasibility of Transcatheter Aortic Valve Implantation in Patients With Very Severe Aortic Stenosis. Circ Rep 2023; 5:358-364. [PMID: 37693232 PMCID: PMC10483111 DOI: 10.1253/circrep.cr-23-0063] [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: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 09/12/2023] Open
Abstract
Background: Very severe aortic stenosis (AS) has a poor prognosis even in asymptomatic patients, and asymptomatic very severe AS is a Class IIa indication for aortic valve replacement, although the safety and effectiveness of transcatheter aortic valve implantation (TAVI) for very severe AS is not well-established. Methods and Results: This study included 366 patients undergoing TAVI at a single center, with 85 and 281 patients in the very severe AS (peak velocity ≥5 m/s or mean pressure gradient (PG) ≥60 mmHg) and severe AS groups, respectively. Procedural and clinical outcomes at 1-year follow-up were compared between groups. The calcium scores were significantly higher in the very severe AS group (2,864.5 vs. 1,405.8 arbitrary units [AU] (P<0.001). Although the patient-prosthesis mismatch rate was higher in the very severe AS group (38.3% vs. 25.7%; P=0.029), there was no significant difference in the early safety and clinical efficacy between the groups (16.5% vs. 17.1% and 12.0% vs. 18.9%, respectively). Similarly, there was no significant difference in all-cause mortality at 1 year (4.8% vs. 9.8%). Conclusions: Despite a higher incidence of prosthesis-patient mismatch in those with very severe AS, the procedural and clinical outcomes were comparable to those in patients with severe AS. TAVI may be a reasonable treatment option for very severe AS.
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Affiliation(s)
- Yoshikuni Kobayashi
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Masaki Izumo
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Kazuaki Okuyama
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Nina Uenomachi
- Ultrasound Center, St. Marianna University School of Medicine Kawasaki Japan
| | - Tatsuro Shoji
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Takahiko Kai
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Taishi Okuno
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Yukio Sato
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Shingo Kuwata
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Masashi Koga
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Yuki Ishibashi
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Yasuhiro Tanabe
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Takeshi Miyairi
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine Kawasaki Japan
| | - Yoshihiro J Akashi
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
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Horinouchi H, Nagai T, Ohno Y, Miyamoto J, Murakami T, Kamioka N, Yoshioka K, Ikari Y. Short-term Outcomes of Urgent Transcatheter Aortic Valve Replacement in Symptomatic Aortic Stenosis That Requires Emergency Hospital Admission. Intern Med 2023; 62:2457-2463. [PMID: 36725049 PMCID: PMC10518535 DOI: 10.2169/internalmedicine.0638-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/13/2022] [Indexed: 02/03/2023] Open
Abstract
Objective This study retrospectively compared the outcomes of emergently admitted patients with aortic stenosis (AS) with or without urgent transcatheter aortic valve replacement (TAVR). Methods Patients hospitalized between February 2015 and December 2019 for symptomatic AS were retrospectively analyzed by comparing the received conservative management [continued medical therapy with or without elective surgical transcatheter replacement (SAVR) or TAVR scheduled after the index hospitalization] and urgent TAVR (TAVR during the index hospitalization). Results The cohort comprised 114 patients with symptomatic AS who required emergency admission. Urgent TAVR was performed for 37 patients, while conservative management was provided for 77 patients, including 1 who received urgent SAVR. Urgent TAVR was more likely to be performed in patients with a history of hospitalization for heart failure, high New York Heart Association class scores, a lower clinical frailty scale at admission, and a high aortic valve peak velocity (p=0.01, p<0.001, p<0.01 and p=0.02, respectively). Kaplan-Meier analyses with log-rank test revealed favorable outcomes of urgent TAVR in all-cause mortality and cardiovascular events within 60 days of admission (p<0.01, p<0.01, respectively). Conclusion Urgent TAVR had better short-term outcomes in patients with symptomatic AS who required emergency hospital admission than conservative management. When considering urgent TAVR, patients with typical heart failure symptoms due to AS with a history of heart failure hospitalization and relatively little frailty can be selected.
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Affiliation(s)
- Hitomi Horinouchi
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Tomoo Nagai
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Yohei Ohno
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Junichi Miyamoto
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Tsutomu Murakami
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Norihiko Kamioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Japan
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Castelo A, Teixeira B, Grazina A, Mendonça T, Rodrigues I, Garcia Brás P, Ferreira VV, Ramos R, Fiarresga A, Cruz Ferreira R, Cacela D. Urgent versus Non-Urgent Transcatheter Aortic Valve Implantation Outcomes. Cardiology 2023; 148:469-477. [PMID: 37429257 DOI: 10.1159/000531815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION There are limited data about the outcomes of nonelective transcatheter aortic valve implantation (TAVI). Some studies suggest that these patients (pts) have worst results. Our purpose was to compare outcomes in pts submitted to urgent versus elective TAVI. METHODS Retrospective analysis of 298 consecutive pts submitted to TAVI between 2018 and 2021 in a single tertiary center. Baseline characteristics and outcomes were collected and compared between elective and nonelective TAVI. RESULTS Pts submitted to urgent TAVI (79 pts) had worse baseline characteristics, with higher EuroScore risk (9.26 vs. 5.17%, p < 0.0001), STS score (7.09 vs. 4.4%, p < 0.0001), and NT pro-natriuretic peptide B (10,168 vs. 3,241 pg/mL, p = 0.001), lower left ventricle ejection fraction (45 vs. 52%, p = 0.003), more diabetes (46.8 vs. 32.4%, p = 0.0.22), peripheral artery disease (21.5 vs. 6.8%, p < 0.0001), and poor vascular accesses (18.4 vs. 7.4%, p = 0.007). Urgent TAVI was associated with higher mortality (25.3 vs. 15.1%, p = 0.043), 30-day cardiovascular mortality (17.5 vs. 4%, p = 0.001), life-threatening bleeding (11.5 vs. 4.1%, p = 0.018), vascular complications (11.5 vs. 4.6%, p = 0.031), and longer hospital stay (28 vs. 12 days, p < 0.0001), but not with intensive care unit or post-TAVI hospital stay (5 vs. 4 days, p = 0.197 and 11 vs. 10 days, p = 0.572). When adjusted to differences in baseline characteristics, urgent TAVI was only associated with longer hospital stay (p < 0.0001). CONCLUSION Pts submitted to urgent TAVI have worse short-term outcomes, but this seems to be attributable to the worse baseline characteristics instead of the urgent nature of the procedure.
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Affiliation(s)
- Alexandra Castelo
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Bárbara Teixeira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - André Grazina
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Tiago Mendonça
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Inês Rodrigues
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Pedro Garcia Brás
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Vera Vaz Ferreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Rúben Ramos
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - António Fiarresga
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Rui Cruz Ferreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Duarte Cacela
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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Yang T, Zhu G, Cai L, Yeo JH, Mao Y, Yang J. A benchmark study of convolutional neural networks in fully automatic segmentation of aortic root. Front Bioeng Biotechnol 2023; 11:1171868. [PMID: 37397959 PMCID: PMC10311214 DOI: 10.3389/fbioe.2023.1171868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/06/2023] [Indexed: 07/04/2023] Open
Abstract
Recent clinical studies have suggested that introducing 3D patient-specific aortic root models into the pre-operative assessment procedure of transcatheter aortic valve replacement (TAVR) would reduce the incident rate of peri-operative complications. Tradition manual segmentation is labor-intensive and low-efficient, which cannot meet the clinical demands of processing large data volumes. Recent developments in machine learning provided a viable way for accurate and efficient medical image segmentation for 3D patient-specific models automatically. This study quantitively evaluated the auto segmentation quality and efficiency of the four popular segmentation-dedicated three-dimensional (3D) convolutional neural network (CNN) architectures, including 3D UNet, VNet, 3D Res-UNet and SegResNet. All the CNNs were implemented in PyTorch platform, and low-dose CTA image sets of 98 anonymized patients were retrospectively selected from the database for training and testing of the CNNs. The results showed that despite all four 3D CNNs having similar recall, Dice similarity coefficient (DSC), and Jaccard index on the segmentation of the aortic root, the Hausdorff distance (HD) of the segmentation results from 3D Res-UNet is 8.56 ± 2.28, which is only 9.8% higher than that of VNet, but 25.5% and 86.4% lower than that of 3D UNet and SegResNet, respectively. In addition, 3D Res-UNet and VNet also performed better in the 3D deviation location of interest analysis focusing on the aortic valve and the bottom of the aortic root. Although 3D Res-UNet and VNet are evenly matched in the aspect of classical segmentation quality evaluation metrics and 3D deviation location of interest analysis, 3D Res-UNet is the most efficient CNN architecture with an average segmentation time of 0.10 ± 0.04 s, which is 91.2%, 95.3% and 64.3% faster than 3D UNet, VNet and SegResNet, respectively. The results from this study suggested that 3D Res-UNet is a suitable candidate for accurate and fast automatic aortic root segmentation for pre-operative assessment of TAVR.
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Affiliation(s)
- Tingting Yang
- School of Energy and Power Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Guangyu Zhu
- School of Energy and Power Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Li Cai
- School of Mathematics and Statistics, Northwestern Polytechnical University, Xi’an, China
| | - Joon Hock Yeo
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Yu Mao
- Department of Cardiac Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Jian Yang
- Department of Cardiac Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
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Al-Taweel O, Gill A, Al-Baghdadi Y, Mohammed S, Ji W, Houshmand N, Al-Tarawneh S, Ahsan C. In-hospital Outcomes and the Impact of Transfer Status in Nonelective vs Elective Transcatheter Aortic Valve Replacement. CJC Open 2023; 5:472-479. [PMID: 37397617 PMCID: PMC10314115 DOI: 10.1016/j.cjco.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/06/2023] [Indexed: 07/04/2023] Open
Abstract
Background Nonelective transcatheter aortic valve replacement (TAVR) requires additional research to be fully understood. Methods Using the National Inpatient Sample database (2016-2019), we conducted a retrospective cohort study comparing nonelective vs elective TAVR. The primary outcome of interest was the in-hospital mortality rate among patients undergoing nonelective TAVR, compared to that among patients undergoing elective TAVR. We matched patients in a greedy nearest-neighbor 1:1 model and multivariable logistic regression, which was adjusted for demographics, hospital factors, and comorbidities, and was used to compare mortality in our matched cohort. Results Each cohort had 4389 patients in each cohort. When adjusted for age, race, sex, and comorbidities, nonelective TAVR patients had 1.99 times higher odds of suffering in-hospital mortality compared to elective admissions (adjusted odds ratio 1.99, 95% confidence interval: 1.42-2.81; P < 0.001). When separated by transfer status, nonelective patients admitted as regular hospital admissions or transferred from other acute-care centres also had higher odds of suffering in-hospital mortality compared to elective admissions. Conclusions Our findings illustrate that nonelective TAVR patients are a vulnerable population that require additional medical support in the acute-care setting. As the demand for TAVR increases, further discussions regarding access to healthcare in underserved regions, the national physician shortage, and the future of the TAVR industry are imperative.
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Affiliation(s)
- Omar Al-Taweel
- Department of Cardiology, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Ahmad Gill
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Yousif Al-Baghdadi
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Salman Mohammed
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Wilbur Ji
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Nazanin Houshmand
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Saba Al-Tarawneh
- Department of Internal Medicine, Marshall University School of Medicine, Huntington, West Virginia, USA
| | - Chowdhury Ahsan
- Department of Cardiology, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, Nevada, USA
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10
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Avvedimento M, Angellotti D, Ilardi F, Leone A, Scalamogna M, Catiello DS, Manzo R, Mariani A, Molaro MI, Simonetti F, Spaccarotella CAM, Piccolo R, Esposito G, Franzone A. Acute advanced aortic stenosis. Heart Fail Rev 2023:10.1007/s10741-023-10312-7. [PMID: 37083966 PMCID: PMC10403405 DOI: 10.1007/s10741-023-10312-7] [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] [Accepted: 04/09/2023] [Indexed: 04/22/2023]
Abstract
Acute decompensation often represents the onset of symptoms associated with severe degenerative aortic stenosis (AS) and usually complicates the clinical course of the disease with a dismal impact on survival and quality of life. Several factors may derange the faint balance between left ventricular preload and afterload and precipitate the occurrence of symptoms and signs of acute heart failure (HF). A standardized approach for the management of this condition is currently lacking. Medical therapy finds very limited application in this setting, as drugs usually indicated for the control of acute HF might worsen hemodynamics in the presence of AS. Urgent aortic valve replacement is usually performed by transcatheter than surgical approach whereas, over the last decades, percutaneous balloon valvuloplasty gained renewed space as bridge to definitive therapy. This review focuses on the pathophysiological aspects of acute advanced AS and summarizes current evidence on its management.
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Affiliation(s)
- Marisa Avvedimento
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Domenico Angellotti
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Attilio Leone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Maria Scalamogna
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Domenico Simone Catiello
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Rachele Manzo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Andrea Mariani
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Maddalena Immobile Molaro
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Fiorenzo Simonetti
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | | | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy.
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11
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Tomii D, Pilgrim T, Windecker S. Emergency transcatheter aortic valve implantation: expanding indication and concern of delayed treatment of aortic stenosis. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:887-890. [PMID: 36345728 DOI: 10.1093/ehjacc/zuac142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Daijiro Tomii
- Department of Cardiology, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010, Bern, Switzerland
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12
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Steffen J, Stocker A, Scherer C, Haum M, Fischer J, Doldi PM, Theiss H, Braun D, Rizas K, Peterß S, Hausleiter J, Massberg S, Orban M, Deseive S. Emergency transcatheter aortic valve implantation for acute heart failure due to severe aortic stenosis in critically ill patients with or without cardiogenic shock. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:877-886. [PMID: 36210517 DOI: 10.1093/ehjacc/zuac131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/29/2022] [Accepted: 10/07/2022] [Indexed: 11/27/2022]
Abstract
AIMS Severe aortic stenosis can cause acute heart failure and cardiogenic shock (CS). Transcatheter aortic valve implantation (TAVI) is the standard therapy for aortic stenosis in inoperable patients. However, its role in this setting is poorly evaluated. The study purpose was to explore clinical characteristics of these patients and to assess predictors of mortality. METHODS AND RESULTS All 2930 patients undergoing transfemoral TAVI at our centre between 2013 and 2019 were screened for critically ill patients, receiving intensive care therapy and emergency TAVI. Selected patients were subdivided into two groups, according to the presence or absence of CS. Remaining patients undergoing elective TAVI served as a comparison. Primary outcome was 90-day mortality. Out of 179 critically ill patients, 47 fulfilled criteria of CS (shock group) and 132 did not despite a severe decompensation (no shock group). Shock patients were more often male and had higher Society of Thoracic Surgeons scores [15.6, interquartile range (8.0-32.1) vs. 5.5 (3.9-8.5), P < 0.01] compared with severely decompensated patients. Ninety-day mortality was: shock group, 42.6%, vs. no shock group, 15.9%, vs. elective group, 5.3% (P < 0.01). A landmark analysis from day 90 showed similar mortality (P = 0.29). Compared with elective patients, 30-day composite endpoint device failure was higher in critically ill groups [shock group, odds ratio, 2.86 (1.43-5.36), no shock group, odds ratio, 1.74 (1.09-2.69)]. Multivariable regression revealed mechanical ventilation, haemofiltration, elevated C-reactive protein or bilirubin, and hypotension before TAVI as 90-day mortality predictors. CONCLUSION Ninety-day mortality after TAVI in critically ill patients is increased but survivors have similar outcomes as elective patients.
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Affiliation(s)
- Julius Steffen
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Angelika Stocker
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Clemens Scherer
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Magda Haum
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Julius Fischer
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Philipp M Doldi
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Hans Theiss
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Daniel Braun
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Konstantinos Rizas
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Sven Peterß
- Departent of Heart Surgery, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Jörg Hausleiter
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Steffen Massberg
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Martin Orban
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Simon Deseive
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
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13
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Berkovitch A, Segev A, Guetta V, Finkelstein A, Kornowski R, Danenberg H, Fefer P, Assa HV, Konigstein M, Merdler I, Perlman G, Maor E, Carmiel R, Planer D, Banai A, Shuvy M, Assali AR, Orvin K, Barbash IM. Procedural and long-term outcome among patients undergoing expedited trans-catheter aortic valve replacement. Catheter Cardiovasc Interv 2022; 100:832-838. [PMID: 36116033 PMCID: PMC9826072 DOI: 10.1002/ccd.30386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 07/12/2022] [Accepted: 08/09/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Patients with rapidly deteriorating clinical status due to severe aortic stenosis are often referred for expedited transcatheter aortic valve replacement (TAVR). Data regarding the outcome of such interventions is limited. We aimed to evaluate the outcome of patients undergoing expedited TAVR. DESIGN AND SETTING Data were derived from the Israeli Multicenter Registry. SUBJECTS Subjects were divided into two groups based on procedure urgency: patients who were electively hospitalized for the procedure (N = 3140) and those who had an expedited TAVR (N = 142). Procedural and periprocedural complication rates were significantly higher among patients with an expedited indication for TAVR compared to those having an elective procedure: valve malposition 4.6% versus 0.6% (p < 0.001), procedural cardiopulmonary resuscitation 4.3% versus 1.0% (p = 0.007), postprocedure myocardial infarction 2.0% versus 0.4% (p = 0.002), and stage 3 acute kidney injury 3.0% versus 1.1%, (p < 0.001). Patients with expedited indication for TAVR had significantly higher in hospital mortality (5.6% vs. 1.4%, p = 0.003). Kaplan-Meier's survival analysis showed that patients undergoing expedited TAVR had higher 3-year mortality rates compared to patients undergoing an elective TAVR procedure (p < 0.001). Multivariate analysis found that patients with expedited indication had fourfolds increased risk of in-hospital mortality (odds ratio: 4.07, p = 0.001), and nearly twofolds increased risk of mortality at 3-year (hazard ratio: 1.69, p = 0.001) compared to those having an elective procedure. CONCLUSION Patients with expedited indications for TAVR suffer from poor short- and long-term outcomes. It is important to characterize and identify these patients before the deterioration to perform TAVR in a fast-track pathway to minimize their procedural risk.
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Affiliation(s)
- Anat Berkovitch
- Division of Cardiology, Leviev Heart and Vascular CenterChaim Sheba Medical CenterTel HashomerIsrael,Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - Amit Segev
- Division of Cardiology, Leviev Heart and Vascular CenterChaim Sheba Medical CenterTel HashomerIsrael,Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - Victor Guetta
- Division of Cardiology, Leviev Heart and Vascular CenterChaim Sheba Medical CenterTel HashomerIsrael,Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - Ariel Finkelstein
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael,Division of CardiologyTel Aviv Medical CenterTel AvivIsrael
| | - Ran Kornowski
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael,Division of CardiologyRabin Medical CenterPetach‐TikvaIsrael
| | - Haim Danenberg
- The Heart Institute, Hadassah Ein‐Karem Medical CenterThe Hebrew UniversityJerusalemIsrael
| | - Paul Fefer
- Division of Cardiology, Leviev Heart and Vascular CenterChaim Sheba Medical CenterTel HashomerIsrael,Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - Hana Vaknin Assa
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael,Division of CardiologyRabin Medical CenterPetach‐TikvaIsrael
| | - Maayan Konigstein
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael,Division of CardiologyTel Aviv Medical CenterTel AvivIsrael
| | - Ilan Merdler
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael,Division of CardiologyTel Aviv Medical CenterTel AvivIsrael
| | - Gidon Perlman
- The Heart Institute, Hadassah Ein‐Karem Medical CenterThe Hebrew UniversityJerusalemIsrael
| | - Elad Maor
- Division of Cardiology, Leviev Heart and Vascular CenterChaim Sheba Medical CenterTel HashomerIsrael,Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - Rivka Carmiel
- Division of Cardiology, Leviev Heart and Vascular CenterChaim Sheba Medical CenterTel HashomerIsrael,Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
| | - David Planer
- The Heart Institute, Hadassah Ein‐Karem Medical CenterThe Hebrew UniversityJerusalemIsrael
| | - Ariel Banai
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael,Division of CardiologyTel Aviv Medical CenterTel AvivIsrael
| | - Mony Shuvy
- The Heart Institute, Hadassah Ein‐Karem Medical CenterThe Hebrew UniversityJerusalemIsrael
| | - Abid R. Assali
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael,Division of CardiologyRabin Medical CenterPetach‐TikvaIsrael
| | - Katia Orvin
- Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael,Division of CardiologyRabin Medical CenterPetach‐TikvaIsrael
| | - Israel M. Barbash
- Division of Cardiology, Leviev Heart and Vascular CenterChaim Sheba Medical CenterTel HashomerIsrael,Sackler School of MedicineTel‐Aviv UniversityTel AvivIsrael
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14
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Acute Decompensated Aortic Stenosis: State of the Art Review. Curr Probl Cardiol 2022; 48:101422. [PMID: 36167225 DOI: 10.1016/j.cpcardiol.2022.101422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/21/2022]
Abstract
Aortic stenosis (AS) is a progressive disease that carries a poor prognosis. Patients are managed conservatively until satisfying an indication for transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) based on AS severity and the presence of symptoms or adverse impact on the myocardium. Up to 1 in 3 TAVIs are performed for patients with acute symptoms of dyspnoea at rest, angina, and/or syncope - termed acute decompensated aortic stenosis (ADAS) and require urgent aortic valve replacement. These patients have longer hospital length of stay, undergo physical deconditioning, have a higher rate of acute kidney injury and mortality compared to stable patients with less severe symptoms. There is an urgent need to prevent ADAS and to deliver pathways to manage and improve ADAS-related outcomes. We provide here a contemporary review on epidemiological and pathophysiological aspects of ADAS, with a focus on the impact of ADAS from clinical and economic perspectives. We will offer also a global overview of the available evidence for treatment of ADAS and with priorities suggested for addressing current gaps in the literature and unmet clinical needs to improve outcomes for AS patients.
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15
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Clinical outcomes of patients with hepatic insufficiency undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis. BMC Cardiovasc Disord 2022; 22:67. [PMID: 35196988 PMCID: PMC8864911 DOI: 10.1186/s12872-022-02510-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 02/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) is currently a common treatment in high-risk aortic stenosis patients, but the impact of hepatic insufficiency on prognosis after TAVI is debatable and whether TAVI is superior to surgical aortic valve replacement (SAVR) in patients with hepatic insufficiency is uncertain. Objective To investigate the effect of abnormal liver function on the outcome and safety after TAVI and whether TAVI is superior to SAVR in patients with hepatic insufficiency. Methods PubMed, Embase, the Cochrane Library and Web of Science were systematically searched from inception up to 26 November 2021. Studies were eligible if mortality and complications after TAVI in patients with and without hepatic insufficiency, or mortality and complications for TAVI versus SAVR in patients with hepatic insufficiency were reported. The Newcastle–Ottawa scale (NOS) was used to evaluate the quality of each study. This meta-analysis was registered with PROSPERO (CRD42021253423) and was carried out by using RevMan 5.3 and Stata 14.0. Results This meta-analysis of 21 studies assessed a total of 222,694 patients. Hepatic insufficiency was associated with higher short-term (in-hospital or 30-day) mortality [OR = 1.62, 95% CI (1.18 to 2.21), P = 0.003] and 1–2 years mortality [HR = 1.64, 95% CI (1.42 to 1.89), P < 0.00001] after TAVI. Between TAVI and SAVR in patients with hepatic insufficiency, there was a statistically significant difference in in-hospital mortality [OR = 0.46, 95% CI (0.27 to 0.81), P = 0.007], the occurrence rate of blood transfusions [OR = 0.29, 95% CI (0.22 to 0.38), P < 0.00001] and the occurrence rate of acute kidney injury [OR = 0.55, 95% CI (0.33 to 0.91), P = 0.02]. Conclusions TAVI patients with hepatic insufficiency may have negative impact both on short-term (in-hospital or 30-day) and 1–2-years mortality. For patients with hepatic insufficiency, TAVI could be a better option than SAVR. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02510-2.
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16
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Efficacy and Safety of Emergent Transcatheter Aortic Valve Implantation in Patients with Acute Decompensated Aortic Stenosis: Systematic Review and Meta-Analysis. J Interv Cardiol 2022; 2021:7230063. [PMID: 35024007 PMCID: PMC8719985 DOI: 10.1155/2021/7230063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/07/2021] [Accepted: 11/14/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction The aim of this systematic review and meta-analysis was to investigate the efficacy and safety of emergent transcatheter aortic valve implantation (TAVI) in patients with decompensated aortic stenosis (AS) by comparing the clinical outcomes with the patients who had received the elective TAVI. Methods By searching PubMed, EMBASE, and Cochrane databases, we obtained the studies comparing the clinical outcomes of emergent TAVI and elective TAVI. Finally, 14 studies were included. Results A total of 14 eligible articles with 73,484 patients were included in this meta-analysis. Emergent TAVI was associated with a higher mortality during hospitalization (HR 2.09, 95% CI [1.39 to 3.14]), 30 days (HR 2.29, 95% CI [1.69 to 3.10]), and 1 year (HR 1.96, 95% CI [1.55 to 2.49]). Consistently, the incidence of acute kidney injury (AKI) (RR 2.48, 95% CI [1.85 to 3.32]), dialysis (RR 2.37, 95% CI [1.95 to 2.88]), bleeding (RR 1.62, 95% CI [1.27 to 2.08]), major bleeding (RR 1.05, 95% CI [1.00 to 1.10]), and 30-day rehospitalization (RR 1.30, 95% CI [1.07, 1.58]) were more common in patients receiving emergent TAVI. No statistical differences were found in the occurrence rate of vascular complications (RR 1.11, 95% CI [0.90, 1.36]), major vascular complications (RR 1.14, 95% CI [0.52, 2.52]), permanent pacemaker (PPM) placement (RR 1.05, 95% CI [0.99, 1.11]), cerebrovascular events (RR 1.11, 95% CI [0.98, 1.25]), moderate to severe paravalvular leakage (PVL) (RR 1.23, 95% [CI 0.94 to 1.61]), and device success (RR 0.99, 95% CI [0.97, 1.01]). Conclusion Emergent TAVI is associated with some postoperative complications and increased mortality compared with elective TAVI. Emergent TAVI should be implemented cautiously and individually.
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17
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Modeling the Impact of Delaying TAVR for the Treatment of Aortic Stenosis in the Era of COVID-19. ACTA ACUST UNITED AC 2021; 7:63-71. [PMID: 34124697 PMCID: PMC8184875 DOI: 10.1016/j.xjon.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 06/02/2021] [Indexed: 01/16/2023]
Abstract
Objective The aim of this study was to model the short term and 2-year overall survival for intermediate- and low-risk patients with severe symptomatic AS undergoing timely or delayed transcatheter aortic valve replacement during the 2019 novel coronavirus pandemic. Methods We developed a decision analysis model to evaluate two treatment strategies for both low-risk and intermediate-risk patients with aortic stenosis during the 2019 novel coronavirus pandemic. Results Prompt transcatheter aortic valve replacement resulted in improved 2-year overall survival when compared to delayed intervention for intermediate-risk patients (0.81 versus 0.67) and low-risk patients (0.95 vs 0.85), due to the risk of death or the need for urgent/emergent transcatheter aortic valve replacement in the waiting period. However, if the probability of acquiring the 2019 novel coronavirus is greater than 55% (intermediate risk patients) or 47% (low risk patients), delayed transcatheter aortic valve replacement is favorable to prompt intervention (0.66 vs 0.67, intermediate risk; 0.84 vs 0.85, low risk). Conclusions and Relevance Prompt transcatheter aortic valve replacement for both intermediate-risk and low-risk patients with symptomatic severe aortic stenosis results in improved 2-year survival when local healthcare system resources are not significantly constrained by the 2019 novel coronavirus.
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18
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Bansal A, Kumar A, Jain V, Reed G, Puri R, Kalra A, Krishnaswamy A, Harb SC, Kapadia SR. Impact of Hospital Procedural Volume on Use and Outcomes of Urgent/Emergent Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2021; 10:e019670. [PMID: 33899503 PMCID: PMC8200767 DOI: 10.1161/jaha.120.019670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Agam Bansal
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Ashish Kumar
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Vardhmaan Jain
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Grant Reed
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Rishi Puri
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Ankur Kalra
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Serge C Harb
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Samir R Kapadia
- Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland OH
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19
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Chakraborty S, Patel N, Bandyopadhyay D, Hajra A, Amgai B, Zaid S, Sharedalal P, Ahmad H, Cohen MB, Abbott JD, Naidu SS. Readmission following urgent transcatheter aortic valve implantation versus urgent balloon aortic valvuloplasty in patients with decompensated heart failure or cardiogenic shock. Catheter Cardiovasc Interv 2021; 98:607-612. [PMID: 33817969 DOI: 10.1002/ccd.29690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/10/2021] [Accepted: 03/14/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Urgent transcatheter aortic valve implantation (TAVI) is a feasible option for aortic stenosis (AS) patients with decompensated heart failure (HF) and cardiogenic shock (CS) as compared to the more traditional urgent balloon aortic valvuloplasty (BAV). OBJECTIVES We conducted a retrospective analysis to compare risk and cause of readmission in these two high-risk groups. METHODS Nationwide Readmission Database (NRD) 2011-2014 was retrospectively analyzed to identify patients with AS having either urgent TAVI or urgent BAV using appropriate ICD-9 codes. Propensity scores were used to match patients with urgent TAVI as compared to patients with urgent BAV. Statistical analysis was performed using the Stata 15.1 software. RESULTS We identified a weighted sample of 6,670 patients with urgent BAV and 6,964 patients with urgent TAVI. The all-cause 30- and 90-day readmission was lower in the urgent TAVI group compared to urgent BAV (15.4 vs. 22.5%, (aHR): 0.92 [0.90-0.95] p < .001). 30-day readmission due to CV cause and HF was also lower in the urgent TAVI group (aHR, 0.93: p < .001 and aHR, 0.98: p = .040, respectively). The 30-day gastrointestinal (GI) bleed readmission rate was three times higher in urgent TAVI group (aHR, 3.00:95% CI (1.23-7.33), p = .016), but was not statistically significant at 90-days. Cardiac causes of readmission were the predominant cause of readmission in both groups, but more pronounced in urgent BAV group (60.3 vs. 40.5%, p < .001). CONCLUSION Urgent TAVI appears beneficial in patients with AS and decompensated HF or CS driven by roughly 10 and 25% reductions in overall readmissions at 30 and 90 days, and marked reductions in reintervention, although offset partially by higher risk of readmission due to GI bleeding at 30 days.
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Affiliation(s)
- Sandipan Chakraborty
- Division of Cardiology, Department of Medicine, Miami Valley Hospital, Dayton, Ohio, USA
| | - Neelkumar Patel
- Division of Cardiology, Department of Medicine, Interfaith Medical Center, New York, New York, USA
| | - Dhrubajyoti Bandyopadhyay
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai/Mount Sinai St Luke's Roosevelt Hospital, New York, New York, USA
| | - Adrija Hajra
- Division of Cardiology, Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Birendra Amgai
- Division of Cardiology, Department of Medicine, Interfaith Medical Center, New York, New York, USA
| | - Syed Zaid
- Division of Cardiology, Department of Medicine, Westchester Medical Center, New York, New York, USA
| | - Parija Sharedalal
- Division of Cardiology, Department of Medicine, Westchester Medical Center, New York, New York, USA
| | - Hasan Ahmad
- Division of Cardiology, Department of Medicine, Westchester Medical Center, New York, New York, USA
| | - Martin B Cohen
- Division of Cardiology, Department of Medicine, Westchester Medical Center, New York, New York, USA
| | - J Dawn Abbott
- Division of Cardiology, Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Srihari S Naidu
- Division of Cardiology, Department of Medicine, Westchester Medical Center, New York, New York, USA
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20
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Transcatheter Aortic Valve Implantation in Patients With Severe Aortic Stenosis Hospitalized With Acute Heart Failure. Am J Cardiol 2021; 144:100-110. [PMID: 33383005 DOI: 10.1016/j.amjcard.2020.12.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/13/2020] [Accepted: 12/15/2020] [Indexed: 12/28/2022]
Abstract
Optimal timing and outcomes of transcatheter aortic valve implantation (TAVI) in patients presenting with acute heart failure (AHF) remain unclear. In this consecutive cohort of 1,547 patients with severe aortic stenosis undergoing TAVI, the AHF status at admission was collected, and patients were classified into AHF and elective TAVI groups. In the AHF group, early TAVI was defined as TAVI performed ≤60 hours after emergency room arrival. The primary outcome was all-cause mortality at 30-day and 2-year after TAVI. There were 139 (9%) patients who underwent TAVI while hospitalized with AHF. At baseline, this group had higher rates of chronic kidney disease, higher Society of Thoracic Surgeons score, and lower left ventricular ejection fraction. After adjusting for baseline differences, the AHF group had significantly higher all-cause mortality at 30-day and 2-year than the elective TAVI group (8% vs 2%; p = 0.002, and 33% vs 18%; p = 0.002, respectively). In the AHF group, 43 (31%) patients underwent early treatment with TAVI. No significant difference in all-cause mortality at 30-day was observed between early and non-early TAVI groups (5% vs 10%; p = 0.617). All-cause mortality at 2-year was lower in the early TAVI groups (16% vs 40%, log-rank p = 0.022); however, after multivariable adjustment, the difference was barely statistically significant (p = 0.053). In conclusion, TAVI in patients with AHF was associated with worse short and long-term outcomes. In AHF setting, early TAVI did not significantly reduce all-cause mortality at 30-day; however, it showed a strong trend for lower all-cause mortality at 2-year.
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21
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Abstract
Despite advances in cardiovascular care, managing cardiogenic shock caused by structural heart disease is challenging. Patients with cardiogenic shock are critically ill upon presentation and require early disease recognition and rapid escalation of care. Temporary mechanical circulatory support provides a higher level of care than current medical therapies such as vasopressors and inotropes. This review article focuses on the role of hemodynamic monitoring, mechanical circulatory support, and device selection in patients who present with cardiogenic shock due to structural heart disease. Early initiation of appropriate mechanical circulatory support may reduce morbidity and mortality.
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22
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Affiliation(s)
- Amgad Mentias
- Division of Cardiology Department of Internal Medicine University of Iowa Iowa City IA
| | - Hani Jneid
- Division of Cardiology Baylor College of Medicine Houston TX
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