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Jahren SE, Demirel C, Bornemann KM, Corso P, Stortecky S, Obrist D. Altered blood flow due to larger aortic diameters in patients with transcatheter heart valve thrombosis. APL Bioeng 2023; 7:046120. [PMID: 38125699 PMCID: PMC10732696 DOI: 10.1063/5.0170583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
The etiology of transcatheter heart valve thrombosis (THVT) and the relevance of the aortic root geometry on the occurrence of THVT are largely unknown. The first aim of this pilot study is to identify differences in aortic root geometry between THVT patients and patients without THVT after transcatheter aortic valve implantation (TAVI). Second, we aim to investigate how the observed difference in aortic diameters affects the aortic flow using idealized computational geometric models. Aortic dimension was assessed using pre-TAVI multi-detector computed tomography scans of eight patients with clinical apparent THVT and 16 unaffected patients (two for each THVT patient with same valve type and size) from the Bern-TAVI registry. Among patients with THVT the right coronary artery height was lower (-40%), and sinotubular junction (STJ) and ascending aorta (AAo) diameters tended to be larger (9% and 14%, respectively) compared to the unaffected patients. Fluid-structure interaction (FSI) in two idealized aortic models with the observed differences in STJ and AAo diameter showed higher backflow rate at the STJ (+16%), lower velocity magnitudes in the sinus (-5%), and higher systolic turbulent dissipation rate in the AAo (+8%) in the model with larger STJ and AAo diameters. This pilot study suggests a direct effect of the aortic dimensions on clinically apparent THVT. The FSI study indicates that larger STJ and AAo diameters potentially favor thrombus formation by increased backflow rate and reduced wash-out efficiency of the sinus. The reported observations require clinical validation but could potentially help identifying patients at risk for THVT.
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Affiliation(s)
- Silje Ekroll Jahren
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Caglayan Demirel
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Pascal Corso
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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Kolar T, Lakič N, Kotnik A, Štubljar D, Fras Z, Bunc M. Similar clinical outcomes with transcatheter aortic valve implantation and surgical aortic valve replacement in octogenarians with aortic stenosis. Front Cardiovasc Med 2022; 9:947197. [DOI: 10.3389/fcvm.2022.947197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTranscatheter aortic valve implantation (TAVI) is the preferred treatment option for severe aortic stenosis in the elderly and in patients with comorbidities. We sought to compare outcomes after TAVI and surgical aortic valve replacement (SAVR) in octogenarians.MethodsIn this retrospective cohort study conducted at our tertiary center, clinical data were gathered before and after TAVI and SAVR procedures performed from January 2013 to May 2019; follow-up completed in March 2021. The primary outcome was 1-year mortality. Patients were stratified according to Society of Thoracic Surgeons (STS) score and procedure type. Propensity score-based matching was also performed.ResultsOf 542 patients who matched the inclusion criteria, 273 underwent TAVI and 269 SAVR. TAVI patients were older (85.8 ± 3.0 vs. 82.2 ± 2.2 years; P < 0.001) and had a higher mean STS score (5.0 ± 4.0 vs. 2.8 ± 1.3; P < 0.001) and EuroSCORE II (5.3 ± 4.1 vs. 2.8 ± 6.0; P < 0.001). Rates of postoperative permanent pacemaker insertion (15.0% vs. 9.3%; P = 0.040) and paravalvular leak (9.9% vs. 0.8%; P < 0.001) were higher and acute kidney injury lower (8.8% vs. 32.7%; P < 0.001) after TAVI, with no difference between treatment groups for major bleeding (11.0% vs. 6.7%; P = 0.130) or 30-day mortality (5.5% vs. 3.7%; P = 0.315). A statistically significant difference was found between TAVI and SAVR in low- and intermediate-risk groups when it came to occurrence of paravalvular leak, acute kidney injury, and new onset AF (all P < 0.001).ConclusionThis analysis of an octogenarian “real-life” population undergoing TAVI or SAVR (with a biological valve) showed similar outcomes regarding clinical endpoints in low- and medium-risk (STS score) groups.
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Corcione N, Testa A, Ferraro P, Morello A, Cimmino M, Albanese M, Giordano S, Bedogni F, Iadanza A, Berti S, Regazzoli D, Trani C, Pepe M, Frati G, Biondi Zoccai G, Giordano A. Baseline, procedural and outcome features of patients undergoing transcatheter aortic valve implantation according to different body mass index categories. Minerva Med 2021; 112:474-482. [PMID: 33576201 DOI: 10.23736/s0026-4806.21.07379-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has become first-line treatment for severe aortic valve stenosis in patients with moderate, high or prohibitive surgical risk. However, access site complications may occur more frequently in extreme body mass index (BMI) categories. The aim of this study was to describe the features and outcomes of patients undergoing TAVI in a comprehensive Italian prospective clinical registry, focusing on BMI classes. METHODS A national prospective database was queried for baseline, procedural, and outcome details of patients undergoing TAVI according to established BMI categories: underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), and obese (BMI≥30 kg/m2). Short- and long-term outcomes, including major adverse events (MAE), i.e. the composite of death, stroke, myocardial infarction, major vascular complication, major bleeding, or renal failure, were appraised with bivariate and multivariable analyses. RESULTS A total of 3075 subjects were included, 64 (2.1%) were underweight, 1319 (42.9%) were normal weight, 1152 (37.4%) were overweight, and 540 (17.6%) were obese. Several baseline differences were evident, including gender, diabetes mellitus, renal function, chronic obstructive pulmonary disease, surgical scores, and left ventricular ejection fraction (LVEF) (all P<0.05). Several procedural differences were also evident, including percutaneous approach, predilation, prosthesis type and size (all P<0.05), with postprocedural aortic regurgitation >2+ significantly more common in underweight patients (P<0.05). Nonetheless, unadjusted analysis for one-month outcomes showed similar rates for fatal and non-fatal outcomes, including MAE (all P>0.05), with the notable exception of permanent pacemaker implantation, which was more common in higher BMI classes (P=0.010) Unadjusted analysis for long-term events showed an increased rate of death in underweight patients (P=0.024). Multivariable adjusted analysis confirmed the increased risk of permanent pacemaker implantation in obese patients (P=0.015 when comparing obese vs. normal weight subjects), but disproved differences in long-term mortality and other outcomes (P>0.05 for all comparisons). CONCLUSIONS Irrespective of BMI class, TAVI is associated with favorable outcomes in surgical high-risk risk patients, with the notable exclusion of permanent pacemaker implantation, which is significantly more common in obese subjects.
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Affiliation(s)
- Nicola Corcione
- Unit of Cardiovascular Intervention, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | | | - Paolo Ferraro
- Unit of Hemodynamics, Santa Lucia Hospital, San Giuseppe Vesuviano, Naples, Italy
| | - Alberto Morello
- Unit of Cardiovascular Intervention, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Michele Cimmino
- Unit of Cardiovascular Intervention, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Michele Albanese
- Unit of Hemodynamics, Santa Lucia Hospital, San Giuseppe Vesuviano, Naples, Italy
| | - Salvatore Giordano
- Unit of Cardiovascular Intervention, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS San Donato Hospital, San Donato Milanese, Milan, Italy
| | - Alessandro Iadanza
- Division of Hemodynamics, Department of Cardiac, Thoracic and Vascular Sciences, Santa Maria alle Scotte Polyclinic, Siena, Italy
| | - Sergio Berti
- C.N.R. G. Monasterio Ospedale del Cuore Foundation, Massa, Massa Carrara, Italy
| | | | - Carlo Trani
- Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Martino Pepe
- Division of Cardiology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,IRCCS NEUROMED, Pozzilli, Isernia, Italy
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy - .,Mediterranea Cardiocentro, Naples, Italy
| | - Arturo Giordano
- Unit of Cardiovascular Intervention, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
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Carli AG, Perini P, Vignali L, Bianchini Massoni C, Fanelli M, Freyrie A. Loss of Prosthetic Aortic Valve during TAVI Procedure: Endovascular Treatment in Emergent Setting. Ann Vasc Surg 2021; 73:585-588. [PMID: 33556523 DOI: 10.1016/j.avsg.2020.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/04/2020] [Accepted: 12/30/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has proven over the years to be a viable alternative to open surgery. A rare but severe complication is represented by the valve migration. We report a case of TAVI complication due to the loss of the prosthetic valve in the abdominal aorta treated by endovascular approach. METHODS An 88-year-old patient with severe aortic valve stenosis, symptomatic for dyspnea was proposed for a TAVI because considered at high risk for surgery. During the TAVI procedure, the undeployed device (Edwards SAPIEN 3 - Edwards Lifesciences, Irvine, CA, USA) detached from its delivery system. Several attempts to withdraw the valve fluctuating in the aorta into its supporting system were performed without success. An emergency endovascular treatment was promptly planned to obtain the exclusion from the flow of the embolized valve. Under local anaesthesia, through the percutaneous femoral access already present, a tube aortic endograft (EndurantTM II, Medtronic, Santa Rosa, CA; ETTF2828C70EE) was successfully introduced and deployed in the infrarenal aorta without any related complications. The embolized valve was completely covered by the endgraft and thus fixed to the aortic wall. The first postoperative computer tomography angiography (CTA) confirmed the correct placement of the endograft, the exclusion of the valve from the flow and the patency of the great vessels. No perioperative or postoperative complications were recorded. The patient was discharged on the ninth postoperative day with the indication to a new attempt of TAVI, through transapical access. CONCLUSIONS In case of intraprocedural loss of an undeplyed valve during TAVI, the valve fixing through endograft deployment in infrarenal aorta is a possible solution.
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Affiliation(s)
- Anna Giulia Carli
- Vascular Surgery, Department of Medicine and Surgery, University of Parma Parma, Italy.
| | - Paolo Perini
- Vascular Surgery, Department of Medicine and Surgery, University of Parma Parma, Italy
| | - Luigi Vignali
- Interventional Cardiology, University Hospital of Parma, Parma, Italy
| | | | - Mara Fanelli
- Vascular Surgery, Department of Medicine and Surgery, University of Parma Parma, Italy
| | - Antonio Freyrie
- Vascular Surgery, Department of Medicine and Surgery, University of Parma Parma, Italy
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Early Valve Replacement for Severe Aortic Valve Disease: Effect on Mortality and Clinical Ramifications. J Clin Med 2020; 9:jcm9092694. [PMID: 32825345 PMCID: PMC7563468 DOI: 10.3390/jcm9092694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/23/2022] Open
Abstract
Timing of aortic valve intervention for chronic aortic regurgitation (AR) and/or aortic stenosis (AS) potentially affects long-term survival. The 2014 American Heart Association/American College of Cardiology (AHA/ACC) guidelines provide recommendations for the timing of intervention. Subsequent to the guidelines' release, several studies have been published that suggest a survival benefit from earlier timing of surgery for severe AR and/or AS. The aim of this review was to determine whether patients who have chronic aortic regurgitation (AR) and/or aortic stenosis (AS) have a survival benefit from earlier timing of aortic valve surgery. Medical databases were systematically searched from January 2015 to April 2020 for randomized controlled trials (RCTs) and observational studies that examined the timing of aortic valve replacement surgery for chronic AR and/or AS. For chronic AR, four observational studies and no RCTs were identified. For chronic AS, five observational studies, one RCT and one meta-analysis were identified. One observational study examining mixed aortic valve disease (MAVD) was identified. All of these studies, for AR, AS, and MAVD, found long-term survival benefit from timing of aortic valve surgery earlier than the current guidelines. Larger prospective RCTs are required to evaluate the benefit of earlier surgical intervention.
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Tzamalis P, Herzberger V, Bergmann J, Wuerth A, Bramlage P, Schroefel H, Schmitt C, Schymik G. The association of diabetes mellitus treated with oral antidiabetic drugs and insulin with mortality after transcatheter valve implantation: a 3-year follow-up of the TAVIK registry. Cardiovasc Diabetol 2019; 18:63. [PMID: 31138207 PMCID: PMC6540569 DOI: 10.1186/s12933-019-0873-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/22/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) on insulin is a patient-related factor in the assessment of surgical risk based on the EuroSCORE II and, as such, it confers additional risk on outcomes after transcatheter aortic valve implantation (TAVI). The aim of this study was to investigate the effect of diabetes mellitus treated with insulin and oral antidiabetic drugs on clinical outcomes after TAVI. METHODS This study is an analysis of 2000 patients who underwent TAVI between 2008 and 2015. Patients were stratified post hoc into the following categories: without diabetes (n = 1337), with diabetes treated with oral antidiabetic drugs (OAD; n = 387) and with diabetes treated using insulin (n = 276). RESULTS There was no significant difference in device success (89.5% vs 89.4% vs 88.8%, adjusted odds ratio (adjOR) 1.10 [95% confidence interval (CI) 0.64-1.91]) and VARC-2-defined major complications among the three groups of patients (without DM, OAD, and insulin, respectively). Minor but not major or disabling strokes (adjOR 2.19; 95% CI 1.11-4.3) and overall renal complications (but not stage 2/3 alone) (adjOR 1.46; 95% CI 1.18-1.81) were more common in patients with diabetes than in those without diabetes. Insulin-treated patients had a significantly lower survival rate than that of patients with orally treated diabetes and of those without diabetes at 1 year (75.7% vs. 84.5% vs 84.7%, pairwise p < 0.01) and 3 years (56.9% vs. 65.9% vs. 67.9%, adj. p < 0.05) after TAVI. However, insulin-treated diabetes was not identified as an independent risk factor for higher mortality in the first (HR 1.29; 95% CI 0.97-1.72, p = 0.084) and 3rd years (HR 1.21; 95% CI 0.98-1.49; p = 0.079) after multivariable adjustment. CONCLUSIONS Although insulin-dependent DM is an established component of surgical risk assessment, it was not identified as an independent factor associated with reduced survival in TAVI. DM treated with oral antidiabetic drugs or insulin may have less role in decision making of treatment in TAVI candidates.
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Affiliation(s)
- Panagiotis Tzamalis
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestr. 90, 76133, Karlsruhe, Germany.
| | - Valentin Herzberger
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestr. 90, 76133, Karlsruhe, Germany
| | - Jens Bergmann
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestr. 90, 76133, Karlsruhe, Germany
| | - Alexander Wuerth
- Medical Clinic III-Department of Cardiology, Vincentius Hospital Karlsruhe, Karlsruhe, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Holger Schroefel
- Department Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Claus Schmitt
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestr. 90, 76133, Karlsruhe, Germany
| | - Gerhard Schymik
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestr. 90, 76133, Karlsruhe, Germany
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Randhawa A, Gupta T, Singh P, Aggarwal A, Sahni D. Description of the aortic root anatomy in relation to transcatheter aortic valve implantation. Cardiovasc Pathol 2019; 40:19-23. [PMID: 30772639 DOI: 10.1016/j.carpath.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/05/2018] [Accepted: 01/12/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) has emerged as a less invasive treatment than surgical aortic valve replacement in patients with aortic stenosis. Understanding the anatomy of aortic valve complex may help in optimal positioning of prosthetic valve and circumvent complications that can arise during its implantation. MATERIAL AND METHODS The anatomy of aortic root was studied in 30 formalin-fixed cadavers. Aortic root and left ventricular cavity was opened to measure the diameter at the base of aortic root and sinotubular junction (STJ); distance of coronary ostia from base of aortic root and STJ; height and width of aortic valve leaflets; length and thickness of membranous septum (MS). RESULTS The diameter of aorta at the base of aortic root and STJ was 22.4±2.1 mm and 21.8±2.4 mm, respectively. The height of aortic leaflets was smaller than the width. The right and left coronary ostia were 10.7±1.9 mm and 10.5±1.9 mm above the base of aortic root. Membranous septum was 4.7±1.23 mm (range 2.9-6.1 mm) long and formed part of the wall of aortic root in 40% (12/30) cases. CONCLUSIONS Low lying coronary ostia speculate the use of a small prosthesis size to avoid or reduce the degree of coronary compression. Length of MS may help in deciding the extent of devise penetration into left ventricular outflow tract to avoid conduction block. Membranous septum forming wall of aortic root increases the risk of aortic root rupture and iatrogenic membranous defect during TAVI.
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Affiliation(s)
- Arpandeep Randhawa
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Tulika Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Parmod Singh
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Anjali Aggarwal
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Daisy Sahni
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Om SY, Ko E, Ahn JM, Kang DY, Lee K, Kwon O, Lee PH, Lee SW, Kim HJ, Kim JB, Choo SJ, Park DW, Park SJ. Relation of Body Mass Index to Risk of Death or Stroke in Patients Who Underwent Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 123:638-643. [PMID: 30528422 DOI: 10.1016/j.amjcard.2018.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 11/18/2022]
Abstract
Obesity and overweight have been associated with better clinical outcomes in different populations with a diverse spectrum of cardiovascular disease (obesity paradox). However, conflicting data exist about the relation between body mass index (BMI) and outcomes after transcatheter aortic valve implantation (TAVI). The aim of this study is to evaluate the association of body mass index with clinical outcomes in patients with severe aortic stenosis (AS) who underwent TAVI. The study cohort included 379 consecutive patients with symptomatic severe AS who underwent TAVI between March 2010 and February 2017 in 3 centers in East Asia. Patients were grouped into tertiles of baseline BMI (first tertile: ≤22.3 kg/m2, second tertile: 22.4 to 24.8 kg/m2, and third tertile: ≥24.9 kg/m2). The primary outcome was a composite of death from any causes or stroke at 1 year. The median (interquartile range) BMI was 23.5 (21.8 to 26.1) kg/m2. During the median follow-up of 18.4 months, there were 69 deaths and 23 strokes. At 1 year, the primary outcome occurred in 21.9% in the first tertile, 18.7% in the second tertile, and 7.8% in the third tertile, respectively (p = 0.009). After adjustment for confounding variables, an inverse relation was observed between BMI and primary outcome: with the third BMI tertile as the reference category, the adjusted hazard ratios were 2.51 (95% confidence interval, 1.20 to 5.26) for the second BMI tertile and 2.61 (95% confidence interval, 1.20 to 5.66) for the first BMI tertile. In conclusion, in patients with severe AS who underwent TAVI, an inverse association between BMI and the risk of death or stroke was observed.
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Affiliation(s)
- Sang Yong Om
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Euihong Ko
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jung-Min Ahn
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Do-Yoon Kang
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Kyusup Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Osung Kwon
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Pil Hyung Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Seung-Whan Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Duk-Woo Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
| | - Seung-Jung Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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O'Sullivan CJ, Montalbetti M, Zbinden R, Kurz DJ, Bernheim AM, Liew A, Meyer MR, Tüller D, Eberli FR. Screening For Pulmonary Hypertension With Multidetector Computed Tomography Among Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation. Front Cardiovasc Med 2018; 5:63. [PMID: 29951486 PMCID: PMC6008561 DOI: 10.3389/fcvm.2018.00063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/16/2018] [Indexed: 01/14/2023] Open
Abstract
Aim: To assess the accuracy of multi-detector computed tomography (MDCT) derived pulmonary vessel measurements in predicting pulmonary hypertension (PH) among patients with severe symptomatic aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Background: PH is common among patients with severe AS undergoing TAVI and is associated with adverse outcomes. MDCT is the imaging modality of choice to assess anatomical dimensions among patients selected for TAVI. Methods: One hundred and thirty-nine patients with severe AS undergoing TAVI with both CT scans and right heart catheterizations (RHC) were included. CT diameters of the main pulmonary artery (MPA), right (RPA) and left (LPA), and ascending aorta (AA) were measured. The relationship between CT measurements and PA pressures assessing using RHC was tested with linear regression. Results: The CT derived ratio of the diameter of the MPA to the diameter of the AA (PA/AAratio) correlated best with mean PA pressure (R2 = 0.48) and PA systolic pressure (R2 = 0.50). Receiver operating characteristic curve analysis showed that the PA/AAratio is a moderate predictor of PH (AUC 0.74, 95% CI 0.65–0.83, p < 0.0001) and that the optimal cut off point is 0.80 (sensitivity 56%, specificity 88%, positive predictive value 95.5%, negative predictive value 30.6% for PH). Conclusions: Elderly patients with severe AS and PA/AAratio values ≥ 0.80 on MDCT are more likely to have PH but PH cannot be reliably excluded among such patients with lower PA/AAratio values.
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Affiliation(s)
| | | | - Rainer Zbinden
- Department of Cardiology, Stadtspital Triemli, Zurich, Switzerland
| | - David J Kurz
- Department of Cardiology, Stadtspital Triemli, Zurich, Switzerland
| | - Alain M Bernheim
- Department of Cardiology, Stadtspital Triemli, Zurich, Switzerland
| | - Aaron Liew
- Department of Endocrinology, National University of Ireland, Galway, Ireland
| | - Matthias R Meyer
- Department of Cardiology, Stadtspital Triemli, Zurich, Switzerland
| | - David Tüller
- Department of Cardiology, Stadtspital Triemli, Zurich, Switzerland
| | - Franz R Eberli
- Department of Cardiology, Stadtspital Triemli, Zurich, Switzerland
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Hirji SA, Ramirez-Del Val F, Kolkailah AA, Ejiofor JI, McGurk S, Chowdhury R, Lee J, Shah PB, Sobieszczyk PS, Aranki SF, Pelletier MP, Shekar PS, Kaneko T. Outcomes of surgical and transcatheter aortic valve replacement in the octogenarians-surgery still the gold standard? Ann Cardiothorac Surg 2017; 6:453-462. [PMID: 29062740 DOI: 10.21037/acs.2017.08.01] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Contemporary options for aortic valve replacement (AVR) include transcatheter and surgical approaches (TAVR and SAVR). As evidence accrues for TAVR in high and intermediate risk patients, some clinicians advocate that all patients aged over 80 years should only receive TAVR. Our aim was to investigate the utility of SAVR and minimally invasive AVR (mAVR) among octogenarians in the current era of TAVR. METHODS From 2002 to 2015, 1,028 octogenarians underwent isolated AVR; 306 TAVR and 722 SAVR, of which 378 patients underwent mAVR. Logistic regression and Cox modeling were used to evaluate overall operative mortality and mid-term survival, respectively. Patients were stratified based on procedural approaches (mAVR or full sternotomy for SAVR, and transfemoral or alternate access for TAVR). Median follow-up was 35 [interquartile range (IQR) 14-65] months. RESULTS Compared to SAVR patients, TAVR patients were relatively older (86.2 versus 84.2 years) with co-morbidities such as chronic kidney disease (CKD), diabetes mellitus (DM), cerebrovascular disease (CVD), and prior myocardial infarction (MI), all P<0.05. The mean STS-PROM for the TAVR group was statistically higher, 6.81 versus 5.58 for the SAVR group (P<0.001). The median in-hospital LOS was statistically higher for the SAVR group (P<0.05). Cox proportional hazard modeling, adjusted for temporal differences in procedure and patient selection, identified age, New York Heart Association (NYHA) class III/IV, preoperative creatinine, severe chronic lung disease, prior cardiac surgery as significant predictors of decreased survival (all P<0.05), while type of intervention (approach) was non-contributory. Adjusted operative mortality stratified by procedure approaches was similar between full sternotomy SAVR and mAVR, and between alternative access and transfemoral TAVR. CONCLUSIONS After adjusting for confounders, TAVR (regardless of approach), SAVR, and mAVR had comparable operative mortality and mid-term survival. Treatment decisions should be individualized with consensus from a multi-disciplinary heart team, taking into account patient co morbidities, frailty, and quality of life. We believe certain patient groups will still benefit from SAVR even in this elderly population.
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Affiliation(s)
- Sameer A Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fernando Ramirez-Del Val
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ahmed A Kolkailah
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Julius I Ejiofor
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ritam Chowdhury
- Center for Surgery and Public Health (CSPH), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jiyae Lee
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pinak B Shah
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Piotr S Sobieszczyk
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sary F Aranki
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marc P Pelletier
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Prem S Shekar
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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11
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Pulignano G, Gulizia MM, Baldasseroni S, Bedogni F, Cioffi G, Indolfi C, Romeo F, Murrone A, Musumeci F, Parolari A, Patanè L, Pino PG, Mongiardo A, Spaccarotella C, Di Bartolomeo R, Musumeci G. ANMCO/SIC/SICI-GISE/SICCH Executive Summary of Consensus Document on Risk Stratification in elderly patients with aortic stenosis before surgery or transcatheter aortic valve replacement. Eur Heart J Suppl 2017; 19:D354-D369. [PMID: 28751850 PMCID: PMC5520760 DOI: 10.1093/eurheartj/sux012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aortic stenosis is one of the most frequent valvular diseases in developed countries, and its impact on public health resources and assistance is increasing. A substantial proportion of elderly people with severe aortic stenosis is not eligible to surgery because of the advanced age, frailty, and multiple co-morbidities. Transcatheter aortic valve implantation (TAVI) enables the treatment of very elderly patients at high or prohibitive surgical risk considered ineligible for surgery and with an acceptable life expectancy. However, a significant percentage of patients die or show no improvement in quality of life (QOL) in the follow-up. In the decision-making process, it is important to determine: (i) whether and how much frailty of the patient influences the risk of procedures; (ii) how the QOL and the individual patient's survival are influenced by aortic valve disease or from other associated conditions; and (iii) whether a geriatric specialist intervention to evaluate and correct frailty or other diseases with their potential or already manifest disabilities can improve the outcome of surgery or TAVI. Consequently, in addition to risk stratification with conventional tools, a number of factors including multi-morbidity, disability, frailty, and cognitive function should be considered, in order to assess the expected benefit of both surgery and TAVI. The pre-operative optimization through a multidisciplinary approach with a Heart Team can counteract the multiple damage (cardiac, neurological, muscular, respiratory, and kidney) that can potentially aggravate the reduced physiological reserves characteristic of frailty. The systematic application in clinical practice of multidimensional assessment instruments of frailty and cognitive function in the screening and the adoption of specific care pathways should facilitate this task.
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Affiliation(s)
- Giovanni Pulignano
- Cardiology Department 1, Ospedale San Camillo-Forlanini, Via O. Regnoli, 8 00152 Rome, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi" Catania, Italy
| | | | - Francesco Bedogni
- CCU-Cardiology Unit, IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy
| | - Giovanni Cioffi
- Cardiology and Medicine Unit, Casa di Cura Villa Bianca, Trento, Italy
| | - Ciro Indolfi
- Cardiology Unit- Campus Universitario, Azienda Ospedaliera Universitaria Mater Domini, Catanzaro, Italy
| | - Francesco Romeo
- Cardiology and Interventional Cardiology Department, Policlinico "Tor Vergata", Rome, Italy
| | - Adriano Murrone
- Cardiology and Cardiovascular Pathophysiology Department, Azienda Ospedaliera di Perugia, Perugia, Italy
| | | | - Alessandro Parolari
- Heart Surgery Unit, Centro Cardiologico Monzino IRCCS, Università degli Studi, Milano, Italy
| | - Leonardo Patanè
- Cardiology Cardiac Surgery Department (Centro Cuore), Centro Clinico Diagnostico G.B. Morgagni, Pedara (Catania), Italy
| | | | - Annalisa Mongiardo
- Cardiology Unit- Campus Universitario, Azienda Ospedaliera Universitaria Mater Domini, Catanzaro, Italy
| | - Carmen Spaccarotella
- Cardiology Unit- Campus Universitario, Azienda Ospedaliera Universitaria Mater Domini, Catanzaro, Italy
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12
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Qian Z, Lancellotti P, Vannan MA. Aortic root calcium burden and post-transcatheter aortic valve implantation paravalvular leak: Can’t Live Without It, Can’t Live With It. Eur Heart J Cardiovasc Imaging 2017; 18:654-656. [DOI: 10.1093/ehjci/jex032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/27/2017] [Indexed: 11/13/2022] Open
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13
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Abramowitz Y, Jilaihawi H, Pibarot P, Chakravarty T, Kashif M, Kazuno Y, Maeno Y, Kawamori H, Mangat G, Friedman J, Cheng W, Makkar RR. Severe aortic stenosis with low aortic valve calcification: characteristics and outcome following transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2017; 18:639-647. [DOI: 10.1093/ehjci/jex006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 01/16/2017] [Indexed: 11/14/2022] Open
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14
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O'Sullivan CJ, Wenaweser P. A Glimpse into the Future: In 2020, Which Patients will Undergo TAVI or SAVR? Interv Cardiol 2017; 12:44-50. [PMID: 29588730 DOI: 10.15420/icr.2016:24:2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has evolved into a safe and effective procedure to treat symptomatic patients with severe aortic stenosis (AS), with predictable and reproducible results. Rates of important complications such as vascular complications, strokes and paravalvular leaks are lower than ever, because of improved patient selection, systematic use of multidector computer tomography, increasing operator experience and device iteration. Accumulating data suggest that transfemoral TAVI with newer generation transcatheter heart valves and delivery systems is superior to conventional surgical aortic valve replacement among intermediate- and high-risk patients with severe symptomatic AS with regard to all-cause mortality and stroke. One can anticipate that by 2020, the majority of patients with severe symptomatic AS will undergo TAVI as first line therapy, regardless of surgical risk.
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Affiliation(s)
| | - Peter Wenaweser
- Department of Cardiology, University Hospital Bern, Inselspital, Switzerland.,Cardiovascular Center Zurich, Hirslanden Clinic im Park, Zurich, Switzerland
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15
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Careaga-Reyna G, Lázaro-Castillo JL, Lezama-Urtecho CA, Macías-Miranda E, Dosta-Herrera JJ, Galván Díaz J. [Transcatheter aortic valve implantation for aortic stenosis. Initial experience]. CIR CIR 2016; 85:375-380. [PMID: 27955854 DOI: 10.1016/j.circir.2016.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/17/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Aortic stenosis is a frequent disease in the elderly, and is associated with other systemic pathologies that may contraindicate the surgical procedure. Another option for these patients is percutaneous aortic valve implantation, which is less invasive. We present our initial experience with this procedure. MATERIAL AND METHODS Patients with aortic stenosis were included once selection criteria were accomplished. Under general anaesthesia and echocardiographic and fluosocopic control, a transcatheter aortic valve was implanted following s valvuloplasty. Once concluded the procedure, angiographic and pressure control was realized in order to confirm the valve function. RESULTS Between November 2014 and May 2015, 6 patients were treated (4 males and 2 females), with a mean age of 78.83±5.66 years-old. The preoperative transvalvular gradient was 90.16±28.53mmHg and posterior to valve implant was 3.33±2.92mmHg (P<.05). Two patients had concomitant coronary artery disease which had been treated previously. One patient presented with acute right coronary artery occlusion which was immediately treated. However due to previous renal failure, postoperative sepsis and respiratory failure, the patient died one month later. CONCLUSION It was concluded that our preliminary results showed that in selected patients percutaneous aortic valve implantation is a safe procedure with clinical improvement for treated patients.
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Affiliation(s)
- Guillermo Careaga-Reyna
- Dirección General, Unidad Médica de Alta Especialidad, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México.
| | - José Luis Lázaro-Castillo
- Unidad Médica de Alta Especialidad, Departamento de Hemodinamia y Terapia Endovascular, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Carlos Alberto Lezama-Urtecho
- Unidad Médica de Alta Especialidad, Departamento de Cirugía Cardiotorácica, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Enriqueta Macías-Miranda
- Unidad Médica de Alta Especialidad, Departamento de Anestesiología, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Juan José Dosta-Herrera
- Unidad Médica de Alta Especialidad, Departamento de Anestesiología, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - José Galván Díaz
- Unidad Médica de Alta Especialidad, Departamento de Cirugía Cardiotorácica, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
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16
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Arsalan M, Filardo G, Kim WK, Squiers JJ, Pollock B, Liebetrau C, Blumenstein J, Kempfert J, Van Linden A, Arsalan-Werner A, Hamm C, Mack MJ, Moellmann H, Walther T. Prognostic value of body mass index and body surface area on clinical outcomes after transcatheter aortic valve implantation. Clin Res Cardiol 2016; 105:1042-1048. [PMID: 27535139 DOI: 10.1007/s00392-016-1027-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/05/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Inverse associations between Body Mass Index (BMI) and Body Surface Area (BSA) with mortality in patients after Transcatheter Aortic Valve Implantation (TAVI) have been reported. This "obesity paradox" is controversial, and it remains unclear which parameter, BMI or BSA, is of greater prognostic value. The aim of this study was to investigate the association of BMI and BSA on short- and mid-term outcomes after TAVI. METHODS AND RESULTS This prospective, observational study consisted of 917 consecutive patients undergoing TAVI at our center from 2011 to 2014. The association between BMI/BSA and mortality (at 30 days and 1 year) was assessed using restricted cubic spline functions in propensity-adjusted (by Society of Thoracic Surgeons (STS) risk factors) logistic and Cox proportional models, respectively. The median age of the patients was 82.6 years, with a mean STS Predicted Risk of Mortality (STS-PROM) of 6.6 ± 4.3 %. Throughout the study period (mean follow-up time was 297 days), 150 (16.4 %) patients died; 72 (7.9 %) patients died within 30 days of TAVI. After risk adjustment, the association between body constitution and 30-day mortality was not significant for either measure (BMI p = 0.25; BSA p = 0.32). However, BMI (p = 0.01), but not BSA (p = 0.13), was significantly associated with 1-year survival. There was no association between stroke, vascular complications, or length of stay with BMI or BSA. CONCLUSIONS BMI was associated with survival at 1-year after TAVI. Despite the trend towards implementing BSA in risk score calculation, BMI may be more suitable for the assessment of TAVI patients.
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Affiliation(s)
- Mani Arsalan
- Department of Cardiac Surgery, Heart Center, Kerckhoff-Klinik, Benekestrasse 2-8, 61231, 06032-9960, Bad Nauheim, Germany.
| | - Giovanni Filardo
- Department of Epidemiology, Baylor Scott and White Health, Dallas, TX, USA
| | - Won-Keun Kim
- Department of Cardiology, Heart Center, Kerckhoff-Klinik, Bad Nauheim, Germany
| | | | - Benjamin Pollock
- Department of Epidemiology, Baylor Scott and White Health, Dallas, TX, USA
| | - Christoph Liebetrau
- Department of Cardiology, Heart Center, Kerckhoff-Klinik, Bad Nauheim, Germany
| | | | - Jörg Kempfert
- Department of Cardiac Surgery, Heart Center, Kerckhoff-Klinik, Benekestrasse 2-8, 61231, 06032-9960, Bad Nauheim, Germany
| | - Arnaud Van Linden
- Department of Cardiac Surgery, Heart Center, Kerckhoff-Klinik, Benekestrasse 2-8, 61231, 06032-9960, Bad Nauheim, Germany
| | - Annika Arsalan-Werner
- Department of Cardiac Surgery, Heart Center, Kerckhoff-Klinik, Benekestrasse 2-8, 61231, 06032-9960, Bad Nauheim, Germany
| | - Christian Hamm
- Department of Cardiology, Heart Center, Kerckhoff-Klinik, Bad Nauheim, Germany
| | | | - Helge Moellmann
- Department of Cardiology, Heart Center, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Heart Center, Kerckhoff-Klinik, Benekestrasse 2-8, 61231, 06032-9960, Bad Nauheim, Germany
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17
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O'Sullivan CJ, Wenaweser P, Ceylan O, Rat-Wirtzler J, Stortecky S, Heg D, Spitzer E, Zanchin T, Praz F, Tüller D, Huber C, Pilgrim T, Nietlispach F, Khattab AA, Carrel T, Meier B, Windecker S, Buellesfeld L. Effect of Pulmonary Hypertension Hemodynamic Presentation on Clinical Outcomes in Patients With Severe Symptomatic Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation: Insights From the New Proposed Pulmonary Hypertension Classification. Circ Cardiovasc Interv 2016; 8:e002358. [PMID: 26156149 DOI: 10.1161/circinterventions.114.002358] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) frequently coexists with severe aortic stenosis, and PH severity has been shown to predict outcomes after transcatheter aortic valve implantation (TAVI). The effect of PH hemodynamic presentation on clinical outcomes after TAVI is unknown. METHODS AND RESULTS Of 606 consecutive patients undergoing TAVI, 433 (71.4%) patients with severe aortic stenosis and a preprocedural right heart catheterization were assessed. Patients were dichotomized according to whether PH was present (mean pulmonary artery pressure, ≥25 mm Hg; n=325) or not (n=108). Patients with PH were further dichotomized by left ventricular end-diastolic pressure into postcapillary (left ventricular end-diastolic pressure, >15 mm Hg; n=269) and precapillary groups (left ventricular end-diastolic pressure, ≤15 mm Hg; n=56). Finally, patients with postcapillary PH were divided into isolated (n=220) and combined (n=49) subgroups according to whether the diastolic pressure difference (diastolic pulmonary artery pressure-left ventricular end-diastolic pressure) was normal (<7 mm Hg) or elevated (≥7 mm Hg). Primary end point was mortality at 1 year. PH was present in 325 of 433 (75%) patients and was predominantly postcapillary (n=269/325; 82%). Compared with baseline, systolic pulmonary artery pressure immediately improved after TAVI in patients with postcapillary combined (57.8±14.1 versus 50.4±17.3 mm Hg; P=0.015) but not in those with precapillary (49.0±12.6 versus 51.6±14.3; P=0.36). When compared with no PH, a higher 1-year mortality rate was observed in both precapillary (hazard ratio, 2.30; 95% confidence interval, 1.02-5.22; P=0.046) and combined (hazard ratio, 3.15; 95% confidence interval, 1.43-6.93; P=0.004) but not isolated PH patients (P=0.11). After adjustment, combined PH remained a strong predictor of 1-year mortality after TAVI (hazard ratio, 3.28; P=0.005). CONCLUSIONS Invasive stratification of PH according to hemodynamic presentation predicts acute response to treatment and 1-year mortality after TAVI.
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Affiliation(s)
- Crochan J O'Sullivan
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Peter Wenaweser
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Osman Ceylan
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Julie Rat-Wirtzler
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Stefan Stortecky
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Dik Heg
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Ernest Spitzer
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Thomas Zanchin
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Fabien Praz
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - David Tüller
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Christoph Huber
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Thomas Pilgrim
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Fabian Nietlispach
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Ahmed A Khattab
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Thierry Carrel
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Bernhard Meier
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Stephan Windecker
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Lutz Buellesfeld
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
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Kim WK, Meyer A, Möllmann H, Rolf A, Möllmann S, Blumenstein J, Van Linden A, Hamm CW, Walther T, Kempfert J. Cyclic changes in area- and perimeter-derived effective dimensions of the aortic annulus measured with multislice computed tomography and comparison with metric intraoperative sizing. Clin Res Cardiol 2016; 105:622-9. [PMID: 26887376 DOI: 10.1007/s00392-016-0971-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 02/08/2016] [Indexed: 11/27/2022]
Abstract
AIMS Multislice computed tomography (MSCT) is recommended for annular sizing prior to transcatheter aortic valve implantation (TAVI), but it remains unclear whether systolic or diastolic reconstructions should be used and whether the effective annular diameter should be derived by area or perimeter. In this study these different approaches were compared with intraoperative sizing. METHODS In 52 patients who were evaluated but deemed unsuitable for TAVI, the annulus was measured during conventional surgery using metric sizers (AnnOp) and compared with MSCT measurements (cross-sectional diameter derived by area [AnnAsys, AnnAdia; AnnAmean = (AnnAsys + AnnAdia)/2] and perimeter (AnnPsys, AnnPdia) in systole and diastole). Furthermore, TAVI was simulated based on AnnOp and the impact of the various MSCT approaches on sizing strategy was determined. RESULTS The best agreement with AnnOp [mean difference (limits of agreement)] was shown for AnnAmean [0.03 mm (-1.9 to 1.96)], whereas the strongest deviation was noted for AnnPsys [-1.08 mm (-3.01 to 0.86)]. Mean differences between systole and diastole were significant but small: 0.82 mm (3.5 %) for area- and 0.81 mm (3.3 %) for perimeter-derived measurements. Simulation of TAVI revealed the least change of strategy for AnnAmean (76.9 %) as compared with AnnPsys (53.8 %); between AnnAsys and AnnAdia sizing would have been deviant in 17.3 % due to relatively large intraindividual cyclic differences. CONCLUSIONS AnnAmean demonstrated the best agreement with AnnOp, whereas perimeter-derived measurements were somewhat overestimated. Despite a negligible average difference between systolic and diastolic annular values, in a subset of patients the intraindividual cyclic variability was relatively large and potentially of clinical impact.
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Affiliation(s)
- Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Lung Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.
- Department of Cardiac Surgery, Kerckhoff Heart and Lung Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.
| | - Alexander Meyer
- Department of Cardiac Surgery, Kerckhoff Heart and Lung Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Helge Möllmann
- Department of Cardiology, Kerckhoff Heart and Lung Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Heart and Lung Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Susanne Möllmann
- Department of Cardiology, Kerckhoff Heart and Lung Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Johannes Blumenstein
- Department of Cardiology, Kerckhoff Heart and Lung Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Arnaud Van Linden
- Department of Cardiac Surgery, Kerckhoff Heart and Lung Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Lung Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Kerckhoff Heart and Lung Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Jörg Kempfert
- Department of Cardiac Surgery, Kerckhoff Heart and Lung Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
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O’Sullivan CJ, Wenaweser P. Can We Predict Quality of Life and Survival After Transcatheter Aortic Valve Replacement? Circ Cardiovasc Interv 2015; 8:e003347. [DOI: 10.1161/circinterventions.115.003347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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O'Sullivan CJ, Wenaweser P. Optimizing clinical outcomes of transcatheter aortic valve implantation patients with comorbidities. Expert Rev Cardiovasc Ther 2015; 13:1419-32. [PMID: 26479904 DOI: 10.1586/14779072.2015.1102056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) has revolutionized the management of high-risk or inoperable patients presenting with symptomatic severe aortic stenosis (AS). There are several factors to consider to optimize patient outcomes from TAVI. Before TAVI, patient selection is key and an understanding the effects of common comorbidities on outcomes after TAVI is critical. Some comorbidities share common risk factors with AS (e.g. coronary artery disease), others are directly or indirectly caused or exacerbated by severe AS (e.g. atrial fibrillation, pulmonary hypertension, mitral regurgitation, tricuspid regurgitation and right ventricular dysfunction), whereas others are not directly related to severe AS (e.g. chronic kidney disease and chronic lung disease). Choice of transcatheter heart valve prosthesis, vascular access route and mode of anesthesia are important considerations during TAVI. New onset conduction disturbances and arrhythmias remain a vexing issue after TAVI. The aim of the present review is to provide an overview of these issues.
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Affiliation(s)
| | - Peter Wenaweser
- b Department of Cardiology , Bern University Hospital , Bern , Switzerland
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21
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Transfemoral transcatheter aortic valve implantation in patients with small diseased peripheral vessels. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:326-30. [DOI: 10.1016/j.carrev.2015.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/24/2015] [Accepted: 05/28/2015] [Indexed: 12/20/2022]
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22
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Impact of left ventricular conduction defect with or without need for permanent right ventricular pacing on functional and clinical recovery after TAVR. Clin Res Cardiol 2015; 104:964-74. [DOI: 10.1007/s00392-015-0865-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
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23
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The impact of transcatheter aortic valve implantation on quality of life: results from the German transcatheter aortic valve interventions registry. Clin Res Cardiol 2015; 104:877-86. [DOI: 10.1007/s00392-015-0857-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 04/14/2015] [Indexed: 12/16/2022]
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Silent ischemic brain lesions after transcatheter aortic valve replacement: lesion distribution and predictors. Clin Res Cardiol 2015; 104:430-8. [PMID: 25596724 DOI: 10.1007/s00392-014-0798-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 11/21/2014] [Indexed: 10/24/2022]
Abstract
AIMS Silent ischemic brain lesions and ischemic stroke are known complications of transcatheter aortic valve replacement (TAVR). We aimed to investigate the occurrence and distribution of TAVR-related silent ischemic brain lesions using diffusion-weighted magnetic resonance imaging (DWI). METHODS Consecutive patients with severe aortic valve stenosis treated with TAVR underwent cerebral DWI within 5 days after the index procedure. DWI scans were analyzed for the occurrence and distribution of new ischemic lesions post-TAVR. RESULTS Forty-two patients were enrolled in this study. After TAVR, a total of 276 new cerebral ischemic lesions were detected in 38 (90 %) patients, with a median of 4.5 (interquartile range 2.0-7.0) lesions per patient. A total of 129 (47 %) lesions were detected in the cortical regions, 97 (35 %) in the subcortical regions, and 50 (18 %) in the cerebellum or brainstem. The median lesion volume was 20.2 µl (10.0, 42.7) and the total ischemic lesion volume was 132.3 µl (42.8, 336.9). The new ischemic brain lesions were clinically silent in 37 (97 %) patients; the other patient had a transient ischemic attack. Age (B = 0.528, p = 0.015), hyperlipidaemia (B = 5.809, p = 0.028) and post-dilatation of the implanted prosthesis (B = 7.196, p = 0.029) were independently associated with the number of post-TAVR cerebral DWI lesions. In addition, peak transaortic gradient was independently associated with post-procedural total infarct volume. CONCLUSION Clinically silent cerebral infarcts occurred in 90 % of patients following TAVR, most of which were small (<20 μl) and located in the cortical regions of the cerebral hemispheres. An independent association was found between age, hyperlipidaemia and balloon post-dilatation and the number of post-TAVR ischemic brain lesions. Only peak transaortic gradient was independently associated with post-procedural total infarct volume.
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Opolski MP, Kim WK, Liebetrau C, Walther C, Blumenstein J, Gaede L, Kempfert J, Van Linden A, Walther T, Hamm CW, Möllmann H. Diagnostic accuracy of computed tomography angiography for the detection of coronary artery disease in patients referred for transcatheter aortic valve implantation. Clin Res Cardiol 2015; 104:471-80. [PMID: 25559245 DOI: 10.1007/s00392-014-0806-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/23/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We aimed to investigate the diagnostic accuracy of a standardized computed tomography angiography (CTA) for the identification of significant coronary artery disease (CAD) in patients evaluated for transcatheter aortic valve implantation (TAVI). BACKGROUND The diagnostic performance of CTA for the detection of CAD in patients with aortic stenosis referred for TAVI has thus far not been validated. METHODS A consecutive series of 475 patients (194 male, mean age: 82 ± 6 years) with CTA data sets obtained during the routine diagnostic work-up before TAVI were included. A total of 6,603 coronary segments in 1,899 coronary arteries ≥ 1.5 mm in diameter and 271 grafts were evaluated for the presence of significant CAD defined as ≥ 50% luminal narrowing. Results were compared with invasive coronary angiography as the standard of reference. RESULTS Prevalence of significant CAD was 57% (270/475), and 5,925 coronary segments (90%) and 257 bypass grafts (95%) were evaluable by CTA. In the per-patient analysis, sensitivity (Se), specificity, and positive and negative predictive values (NPV) were 98, 37, 67 and 94%, respectively. CTA showed satisfactory ability to exclude significant CAD in the following subgroups: (1) patients (221/475) without prior known CAD (Se: 97%, NPV: 97%), (2) patients (13/475) without prior known CAD and absent coronary calcification (NPV: 100%) and (3) bypass grafts (Se: 97%, NPV: 99%). CONCLUSIONS Comprehensive evaluation of a pre-TAVI CTA could prove to be a useful rule-out test for significant CAD in selected subgroups of patients.
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Affiliation(s)
- Maksymilian P Opolski
- Department of Cardiology, Kerckhoff Heart Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
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Akhtar S, Morris B, Roy R, Balogun SA. Case 3-2015: preventing adverse outcomes in the very elderly cardiac surgical patients. J Cardiothorac Vasc Anesth 2014; 29:510-21. [PMID: 25440648 DOI: 10.1053/j.jvca.2014.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Shamsuddin Akhtar
- Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut.
| | - Benjamin Morris
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Raymond Roy
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Seki A Balogun
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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O’Sullivan CJ, Praz F, Stortecky S, Windecker S, Wenaweser P. Assessment of low-flow, low-gradient, severe aortic stenosis: an invasive evaluation is required for decision making. EUROINTERVENTION 2014; 10 Suppl U:U61-8. [DOI: 10.4244/eijv10sua9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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D'Onofrio A, Salizzoni S, Agrifoglio M, Lucchetti V, Musumeci F, Esposito G, Magagna P, Aiello M, Savini C, Cassese M, Glauber M, Punta G, Alfieri O, Gabbieri D, Mangino D, Agostinelli A, Livi U, Di Gregorio O, Minati A, Faggian G, Filippini C, Rinaldi M, Gerosa G. When does transapical aortic valve replacement become a futile procedure? An analysis from a national registry. J Thorac Cardiovasc Surg 2014; 148:973-9; discussion 979-80. [DOI: 10.1016/j.jtcvs.2014.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/28/2014] [Accepted: 06/05/2014] [Indexed: 11/26/2022]
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Alsara O, Alsarah A, Laird-Fick H. Advanced age and the clinical outcomes of transcatheter aortic valve implantation. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2014; 11:163-70. [PMID: 25009568 PMCID: PMC4076458 DOI: 10.3969/j.issn.1671-5411.2014.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 04/28/2014] [Accepted: 05/07/2014] [Indexed: 11/18/2022]
Abstract
Aortic valve stenosis (AS) is common in the elderly. Although surgical replacement of the valve has been the gold standard of management, many patients have been excluded from surgery because they were very old, frail, or had co-morbidities that increased operative risks. In the last decade, transcatheter aortic valve implantation (TAVI) has emerged as a new treatment option suitable for these patients. This article reviews the available literature on the role of TAVI in elderly patients with severe aortic stenosis. Published studies showed that elderly individuals who underwent TAVI experienced better in-hospital recovery, and similar short and mid-term mortality compared to those underwent surgical treatment of AS. However, long-term outcomes of TAVI in elderly patients are still unknown. The available data in the literature on the effect of advanced age on clinical outcomes of TAVI are limited, but the data that are available suggest that TAVI is a beneficial and tolerable procedure in very old patients. Some of the expected complications after TAVI are reported more in the oldest patients such as vascular injures. Other complications were comparable in TAVI patients regardless of their age group. However, very old patients may need closer monitoring to avoid further morbidities and mortality.
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Affiliation(s)
- Osama Alsara
- Department of Internal Medicine, Michigan State University, B-301 Clinical Center, East Lansing, MI 48824, USA
| | - Ahmad Alsarah
- Department of Internal Medicine, Michigan State University, B-301 Clinical Center, East Lansing, MI 48824, USA
| | - Heather Laird-Fick
- Department of Internal Medicine, Michigan State University, B-301 Clinical Center, East Lansing, MI 48824, USA
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Schymik G, Heimeshoff M, Bramlage P, Wondraschek R, Süselbeck T, Gerhardus J, Luik A, Posival H, Schmitt C, Schröfel H. Ruptures of the device landing zone in patients undergoing transcatheter aortic valve implantation: an analysis of TAVI Karlsruhe (TAVIK) patients. Clin Res Cardiol 2014; 103:912-20. [PMID: 24908338 DOI: 10.1007/s00392-014-0729-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 05/21/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Aortic rupture of the device landing zone is a rare complication of transcatheter aortic valve implantation (TAVI) and it is associated with significant mortality. METHODS This study reports on the experience of a single-center in a case series of more than 1,000 implants. We explored patient and procedural characteristics aiming at identifying variables that increase the risk for aortic root rupture. RESULTS Among a total of 1,000 TAVI procedures, six patients (0.6 %) had a rupture of the device landing zone. Five of these patients received the balloon-expandable Edwards SAPIEN valve (5/813; 0.62 %) of which four had a supraannular and one a subannular rupture. One patient received the self-expanding Medtronic CoreValve (1/199; 0.5 %; p = n.s. vs. SAPIEN) and had an annular rupture. Factors that were associated with aortic rupture were: (1) the relative size of the valve compared with the aortic annulus and its geometric form; (2) the need for post-dilation of the new valve because of paravalvular leakage; and (3) the location and severity of calcification. We determined, to avoid aortic rupture, caution may be necessary in the presence of the following conditions: (1) flat sinuses of Valsalva and severe calcifications of either the body or the free edge of the aortic cusps (supraannular rupture); (2) an ellipsoid annulus and bulky calcifications on either the base of the cusps or the rim of the annulus (annular rupture); and (3) a narrow left-ventricular outflow tract (LVOT) and bulky calcification of the LVOT (subannular rupture). After considering these precautions, we observed no case of aortic root rupture in the following 600 cases. CONCLUSION The data indicate that to reduce the frequency of aortic rupture, a careful pre-procedural planning appears essential to avoid this serious and potentially deleterious complication.
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Affiliation(s)
- Gerhard Schymik
- Medical Clinic IV, Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestrasse 90, 76133, Karlsruhe, Germany,
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Geis NA, Chorianopoulos E, Kallenbach K, André F, Pleger ST, Karck M, Katus HA, Bekeredjian R. Feasibility of sheathless transfemoral aortic valve implantation in patients with small access vessel diameters. Clin Res Cardiol 2014; 103:775-80. [PMID: 24748131 DOI: 10.1007/s00392-014-0713-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/04/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We intended to show feasibility of sheathless transfemoral aortic valve implantation in patients with small access vessel diameters. BACKGROUND Transcatheter aortic valve implantation (TAVI) has emerged as a valid treatment option in patients with aortic valve stenosis who are poor candidates for surgical aortic valve replacement. Few patients, who cannot undergo transfemoral or transsubclavian aortic valve implantation due to small access vessel diameters, are not suitable for transapical or direct aortic valve implantation, either. METHODS In more than 700 transcatheter aortic valve implantations since 2008 we identified 17 patients who had to be excluded from transfemoral valve implantation due to vessel diameters <6 mm and who were no candidates for transapical or direct aortic implantation. We performed CoreValve™ implantations in these patients without the required 18F sheath to cross the vessels despite their small size (4.6-5.9 mm). RESULTS Sixteen sheathless implantations were successful. In all 17 patients, bleeding during the procedure due to the smaller delivery catheter was minimal. Sixteen patients had a successful access site closure at the end of the procedure. CONCLUSIONS Sheathless implantation of a self-expanding aortic valve can be safely considered in selected patients with access vessel diameters below 6 mm, if transapical or direct aortic implantation is not suitable.
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Affiliation(s)
- Nicolas A Geis
- Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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