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Romano M, Daprati A, Saitto G, Tizzano F, Le Houérou D, Donzeau-Gouge P, Farge A, Lefèvre T, Hovasse T, Garatti A. Safety and effectiveness of a transaortic approach for TAVI: procedural and midterm outcomes of 265 consecutive patients in a single centre. Interact Cardiovasc Thorac Surg 2019; 30:400-407. [DOI: 10.1093/icvts/ivz269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 09/17/2019] [Accepted: 10/20/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
OBJECTIVES
Transcatheter aortic valve implantation with a transaortic approach (TAo-TAVI) is an alternative to transapical or femoral access. We studied the procedural and midterm efficacy and safety of TAo-TAVI with Edwards Sapien XT and Medtronic CoreValve devices.
METHODS
Among 901 patients receiving TAVI since 2006, 265 consecutive patients underwent TAo-TAVI between January 2011 and September 2014. Procedural and midterm results were evaluated according to Valve Academic Research Consortium-2 criteria.
RESULTS
The mean age was 83 ± 5 years. Sapien XT and CoreValve were used in 191 (72.1%) and 74 (27.9%) patients, respectively. Full sternotomy made elective concomitant off-pump coronary artery bypass grafting possible in 38 patients (14.3%) with severe coronary artery disease unsuitable for percutaneous coronary intervention. The device success rate was 95.5%. Postprocedural paravalvular leak ≥2/4 was observed in 16 patients (6.4%). Emergency open chest surgery was required in 10 patients (3.8%) (3 aortic dissections, 3 valve embolizations, 2 LMCA occlusions, 1 aortic annulus rupture and 1 aortic rupture). Cerebrovascular accidents occurred in 3 patients (1.1%). Transfusions ≥4 units were required in 36 patients (13.6%). New pacemakers were implanted in 26 patients (9.8%). Thirty-day and 1-year mortality were 8.7% and 16.2%, respectively. Mean follow-up duration was 24 ± 6 months. At 3 years, freedom from all-cause death was 80% ± 4%. New York Heart Association class <III included 81% (n = 172) of patients alive and without prosthetic echocardiographic dysfunction at follow-up (mean gradient 10.5 ± 5.6 mmHg).
CONCLUSION
The TAo-TAVI approach confirms its safety and effectiveness with satisfactory procedural and midterm outcomes with both currently available devices.
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Affiliation(s)
- Mauro Romano
- Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Andrea Daprati
- Department of Cardiac Surgery, Policlinico S. Donato Hospital, S. Donato Milanese, Milan, Italy
| | - Guglielmo Saitto
- Department of Cardiac Surgery, Policlinico S. Donato Hospital, S. Donato Milanese, Milan, Italy
| | - Francesco Tizzano
- Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Daniel Le Houérou
- Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Patrick Donzeau-Gouge
- Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Arnaud Farge
- Department of Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Thierry Lefèvre
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Thomas Hovasse
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Andrea Garatti
- Department of Cardiac Surgery, Policlinico S. Donato Hospital, S. Donato Milanese, Milan, Italy
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Backhaus SJ, Staab W, Steinmetz M, Ritter CO, Lotz J, Hasenfuß G, Schuster A, Kowallick JT. Fully automated quantification of biventricular volumes and function in cardiovascular magnetic resonance: applicability to clinical routine settings. J Cardiovasc Magn Reson 2019; 21:24. [PMID: 31023305 PMCID: PMC8059518 DOI: 10.1186/s12968-019-0532-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/12/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) represents the clinical gold standard for the assessment of biventricular morphology and function. Since manual post-processing is time-consuming and prone to observer variability, efforts have been directed towards automated volumetric quantification. In this study, we sought to validate the accuracy of a novel approach providing fully automated quantification of biventricular volumes and function in a "real-world" clinical setting. METHODS Three-hundred CMR examinations were randomly selected from the local data base. Fully automated quantification of left ventricular (LV) mass, LV and right ventricular (RV) end-diastolic and end-systolic volumes (EDV/ESV), stroke volume (SV) and ejection fraction (EF) were performed overnight using commercially available software (suiteHEART®, Neosoft, Pewaukee, Wisconsin, USA). Parameters were compared to manual assessments (QMass®, Medis Medical Imaging Systems, Leiden, Netherlands). Sub-group analyses were further performed according to image quality, scanner field strength, the presence of implanted aortic valves and repaired Tetralogy of Fallot (ToF). RESULTS Biventricular automated segmentation was feasible in all 300 cases. Overall agreement between fully automated and manually derived LV parameters was good (LV-EF: intra-class correlation coefficient [ICC] 0.95; bias - 2.5% [SD 5.9%]), whilst RV agreement was lower (RV-EF: ICC 0.72; bias 5.8% [SD 9.6%]). Lowest agreement was observed in case of severely altered anatomy, e.g. marked RV dilation but normal LV dimensions in repaired ToF (LV parameters ICC 0.73-0.91; RV parameters ICC 0.41-0.94) and/or reduced image quality (LV parameters ICC 0.86-0.95; RV parameters ICC 0.56-0.91), which was more common on 3.0 T than on 1.5 T. CONCLUSIONS Fully automated assessments of biventricular morphology and function is robust and accurate in a clinical routine setting with good image quality and can be performed without any user interaction. However, in case of demanding anatomy (e.g. repaired ToF, severe LV hypertrophy) or reduced image quality, quality check and manual re-contouring are still required.
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Affiliation(s)
- Sören J. Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Wieland Staab
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Michael Steinmetz
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Christian O. Ritter
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Nothern Clinical School, University of Sydney, Sydney, Australia
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
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Varghese J, Sandmann S, Dugas M. Web-Based Information Infrastructure Increases the Interrater Reliability of Medical Coders: Quasi-Experimental Study. J Med Internet Res 2018; 20:e274. [PMID: 30322834 PMCID: PMC6231825 DOI: 10.2196/jmir.9644] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 05/03/2018] [Accepted: 06/28/2018] [Indexed: 01/05/2023] Open
Abstract
Background Medical coding is essential for standardized communication and integration of clinical data. The Unified Medical Language System by the National Library of Medicine is the largest clinical terminology system for medical coders and Natural Language Processing tools. However, the abundance of ambiguous codes leads to low rates of uniform coding among different coders. Objective The objective of our study was to measure uniform coding among different medical experts in terms of interrater reliability and analyze the effect on interrater reliability using an expert- and Web-based code suggestion system. Methods We conducted a quasi-experimental study in which 6 medical experts coded 602 medical items from structured quality assurance forms or free-text eligibility criteria of 20 different clinical trials. The medical item content was selected on the basis of mortality-leading diseases according to World Health Organization data. The intervention comprised using a semiautomatic code suggestion tool that is linked to a European information infrastructure providing a large medical text corpus of >300,000 medical form items with expert-assigned semantic codes. Krippendorff alpha (Kalpha) with bootstrap analysis was used for the interrater reliability analysis, and coding times were measured before and after the intervention. Results The intervention improved interrater reliability in structured quality assurance form items (from Kalpha=0.50, 95% CI 0.43-0.57 to Kalpha=0.62 95% CI 0.55-0.69) and free-text eligibility criteria (from Kalpha=0.19, 95% CI 0.14-0.24 to Kalpha=0.43, 95% CI 0.37-0.50) while preserving or slightly reducing the mean coding time per item for all 6 coders. Regardless of the intervention, precoordination and structured items were associated with significantly high interrater reliability, but the proportion of items that were precoordinated significantly increased after intervention (eligibility criteria: OR 4.92, 95% CI 2.78-8.72; quality assurance: OR 1.96, 95% CI 1.19-3.25). Conclusions The Web-based code suggestion mechanism improved interrater reliability toward moderate or even substantial intercoder agreement. Precoordination and the use of structured versus free-text data elements are key drivers of higher interrater reliability.
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Affiliation(s)
- Julian Varghese
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Sarah Sandmann
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Martin Dugas
- Institute of Medical Informatics, European Research Center for Information Systems, Münster, Germany
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Zinsser D, Baumann AB, Winter KS, Bamberg F, Lange P, Nikolaou K, Reiser M, Kupatt C, Kröncke T, Schwarz F. Semi-automatic CT-angiography based evaluation of the aortic annulus in patients prior to TAVR: interchangeability with manual measurements. Int J Cardiovasc Imaging 2018; 34:1657-1667. [PMID: 29869759 DOI: 10.1007/s10554-018-1377-2] [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: 03/23/2018] [Accepted: 05/21/2018] [Indexed: 10/14/2022]
Abstract
To compare a semi-automatic software tool for the measurement of aortic annulus dimensions with manual measurements by expert readers and to analyze whether and to what extent interchangeability exists between semi-automatic and manual measurements. We retrospectively included 374 consecutive patients with high-grade aortic stenosis who had undergone CT-angiography of the heart prior to trans-catheter aortic valve replacement (TAVR). In independent analyses, two expert readers manually measured aortic annulus dimensions (long axis, short axis, circumference, area) as well as the distance of the coronary ostia from the annulus plane. A third independent reader performed annulus evaluation using a software tool for semi-automatic detection and measurement of the annulus plane. Intraclass correlation coefficients (ICC) and Bland-Altman analysis was used to compare both manual measurements as well as manual and semi-automatic measurements of annulus parameters. Using the respective measurements we simulated size selection for a Sapien XT transcatheter heart valve (THV). Interchangeability of methods was addressed by calculation of the estimated individual equivalence index γ. There was excellent agreement between both expert observers in manual measurements of the annulus with ICC's in the range 0.89-0.94 for all anatomic parameters. Similar high agreements were observed between semi-automatic and manual measurements, with ICC's in the range of 0.89-0.95. THV size recommendation based on manual versus semiautomatic measurements agreed in 80.7% of cases while agreement between both expert readers concerning THV size recommendation was 80.6%. Semi-automatic measurements of anatomic parameters of the aortic root show high agreement and interchangeability with manual measurements in CT-angiography prior to TAVR.
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Affiliation(s)
- Dominik Zinsser
- Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Alena B Baumann
- Klinik und Poliklinik für Radiologie, LMU München, Munich, Germany
| | | | - Fabian Bamberg
- Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Philipp Lange
- Medizinische Klinik und Poliklinik I, LMU München, Munich, Germany
| | - Konstantin Nikolaou
- Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | | | - Christian Kupatt
- Klinik und Poliklinik für Innere Medizin I, TU München, Munich, Germany
| | - Thomas Kröncke
- Klinik für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Florian Schwarz
- Klinik für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
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Bapat V, Frank D, Cocchieri R, Jagielak D, Bonaros N, Aiello M, Lapeze J, Laine M, Chocron S, Muir D, Eichinger W, Thielmann M, Labrousse L, Rein KA, Verhoye JP, Gerosa G, Baumbach H, Bramlage P, Deutsch C, Thoenes M, Romano M. Transcatheter Aortic Valve Replacement Using Transaortic Access: Experience From the Multicenter, Multinational, Prospective ROUTE Registry. JACC Cardiovasc Interv 2017; 9:1815-22. [PMID: 27609256 DOI: 10.1016/j.jcin.2016.06.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/08/2016] [Accepted: 06/20/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The Registry of the Utilization of the TAo-TAVR approach using the Edwards SAPIEN Valve (ROUTE) was established to assess the effectiveness and safety of the use of transaortic (TAo) access for transcatheter aortic valve replacement (TAVR) procedures (NCT01991431). BACKGROUND TAVR represents an alternative to surgical valve replacement in high-risk patients. Whereas the transfemoral access route is used commonly as the first-line approach, transapical access is an option for patients not suitable for transfemoral treatment mainly due to anatomic conditions. TAo-TAVR has been shown to be a viable alternative surgical access route; however, only limited data on its effectiveness and safety has been published. METHODS ROUTE is a multicenter, international, prospective, observational registry; data were collected from 18 centers across Europe starting in February 2013. Patients having severe calcific aortic stenosis were documented if they were scheduled to undergo TAo-TAVR using an Edwards SAPIEN XT or a SAPIEN 3 valve. The primary endpoint was 30-day mortality. Secondary endpoints were intraprocedural or in hospital and 30-day complication rates. RESULTS A total of 301 patients with a mean age of 81.7 ± 5.9 years and an Society of Thoracic Surgeons score of 9.0 ± 7.6% were included. Valve success was documented in 96.7%. The 30-day mortality was 6.1% (18/293) (procedure-related mortality: 3.1%; 9 of 293). The Valve Academic Research Consortium-2 defined complications included myocardial infarction (1.0%), stroke (1.0%), transient ischemic attack (0.3%), major vascular complications (3.4%), life-threatening bleeding (3.4%), and acute kidney injury (9.5%). In 3.3% of patients, paravalvular regurgitation was classified as moderate or severe (10 of 300). Twenty-six patients (8.8%) required permanent pacemaker implantation. CONCLUSIONS TAo access for TAVR seems to be a safe alternative to the transapical procedure.
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Affiliation(s)
| | - Derk Frank
- Department of Internal Medicine III (Cardiology and Angiology) UKSH, Campus Kiel, Germany
| | - Ricardo Cocchieri
- Heart Center, Academic Medical Center, University of Amsterdam, Netherlands
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Poland
| | - Nikolaos Bonaros
- University Hospital for Cardiac Surgery, Medical University Innsbruck, Austria
| | - Marco Aiello
- Department of Cardiothoracic Surgery, Foundation IRCCS Policlinico S. Matteo, Pavia University School of Medicine, Pavia, Italy
| | - Joel Lapeze
- Department of Cardiovascular Surgery, Hospital Louis Pradel, Lyon, France
| | - Mika Laine
- Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Sidney Chocron
- Cardiothoracic Surgery, Hospital Jean Minjoz, University Hospital of Besancon, France
| | - Douglas Muir
- Cardiothoracic Division, James Cook Hospital, Middlesbrough, United Kingdom
| | - Walter Eichinger
- Department of Cardiothoracic Surgery, Klinikum Bogenhausen, Munich, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University Hospital Essen, Germany
| | - Louis Labrousse
- Department of Cardiovascular Surgery, CHU Hospital of Bordeaux, France
| | - Kjell Arne Rein
- Department of Cardiothoracic Surgery, Rikshospital Oslo, Norway
| | | | - Gino Gerosa
- Department of Cardiac Surgery, University of Padova, Italy
| | - Hardy Baumbach
- Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus Stuttgart, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Martin Thoenes
- Edwards Lifesciences, Medical Affairs/Professional Education, Nyon, Switzerland
| | - Mauro Romano
- Institut Hospitalier Jacques Cartier, Massy, France
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Romano M, Frank D, Cocchieri R, Jagielak D, Bonaros N, Aiello M, Lapeze J, Laine M, Chocron S, Muir D, Eichinger W, Thielmann M, Labrousse L, Arne Rein K, Verhoye JP, Gerosa G, Baumbach H, Deutsch C, Bramlage P, Thoenes M, Bapat V. Transaortic transcatheter aortic valve implantation using SAPIEN XT or SAPIEN 3 valves in the ROUTE registry†. Interact Cardiovasc Thorac Surg 2017; 25:757-764. [DOI: 10.1093/icvts/ivx159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 04/14/2017] [Indexed: 11/12/2022] Open
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Gomes B, Katus HA, Bekeredjian R. Repositionable self-expanding aortic bioprosthesis. Expert Rev Med Devices 2017; 14:565-576. [PMID: 28571486 DOI: 10.1080/17434440.2017.1338136] [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: 10/19/2022]
Abstract
INTRODUCTION Transcatheter aortic valve implantation/replacement (TAVI or TAVR) has been established as a first line therapy in patients with symptomatic severe aortic stenosis (AS) at high or prohibitive surgical risk and as an alternative in elderly patients with intermediate surgical risk. Since its first-in-human procedure in 2002, the past 15-years have shown rapid developments in TAVI technology with the introduction and further improvement of new transcatheter heart valves (THV). Areas covered: There are currently several THV systems available, based on balloon-expandable, self-expandable or other technologies. Some of these are repositionable and retrievable even after partial or full deployment, potentially reducing the risk of malpositioning. The aim of this review is to describe such repositionable self-expandable THV systems. Expert commentary: Repositionability potentially represents a crucial step towards higher safety and efficacy of TAVI. It is unclear if full self-expandability or a combination of self and mechanical expansion will be more advantageous.
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Affiliation(s)
- Bruna Gomes
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
| | - Hugo A Katus
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
| | - Raffi Bekeredjian
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
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Petrini L, Dordoni E, Allegretti D, Pott D, Kütting M, Migliavacca F, Pennati G. Simplified Multistage Computational Approach to Assess the Fatigue Behavior of a Niti Transcatheter Aortic Valve During In Vitro Tests: A Proof-of-Concept Study. J Med Device 2017. [DOI: 10.1115/1.4035791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Nowadays, transcatheter aortic valve (TAV) replacement is an alternative to surgical therapy in selected high risk patients for the treatment of aortic stenosis. However, left ventricular contraction determines a severe cyclic loading for the implanted stent-frame, undermining its long-term durability. Technical standards indicate in vitro tests as a suitable approach for the assessment of TAV fatigue behavior: generally, they do not specify test methods but require to test TAV in the worst loading conditions. The most critical conditions could be different according to the specific valve design, hence the compartment where deploying the valve has to be properly identified. A fast and reliable computational methodology could significantly help to face this issue. In this paper, a numerical approach to analyze Nickel-Titanium TAV stent-frame behavior during in vitro durability tests is proposed. A simplified multistage strategy was adopted where, in each stage, only two of the three involved components are considered. As a proof-of-concept, the method was applied to a TAV prototype. Despite its simplifications, the developed computational framework gave useful insights into the stent-frame failures behavior during a fatigue test. Numerical results agree with experimental findings. In particular, the most dangerous condition was identified among a number of experimental tests, where different compartments and pressure gradients were investigated. The specific failure location was also correctly recognized. In conclusion, the presented methodology provides a tool to support the choice of proper testing conditions for the in vitro assessment of TAV fatigue behavior.
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Affiliation(s)
- Lorenza Petrini
- Department of Civil and Environmental Engineering, Politecnico di Milano, Milano 20133, Italy
| | - Elena Dordoni
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,” Politecnico di Milano, Milano 20133, Italy
| | - Dario Allegretti
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,” Politecnico di Milano, Milano 20133, Italy
| | - Desiree Pott
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen 52062, Germany
| | - Maximilian Kütting
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen 52062, Germany
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,” Politecnico di Milano, Milano 20133, Italy
| | - Giancarlo Pennati
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,” Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano 20133, Italy e-mail:
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Mohd Sulaiman I, Karlsson D, Koch S. Mapping Acute Coronary Syndrome Registries to SNOMED CT. A Comparative Study between Malaysia and Sweden. Methods Inf Med 2017; 56:330-338. [PMID: 28361156 DOI: 10.3414/me16-02-0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/27/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Malaysia and Sweden have mapped their acute coronary syndrome registries using SNOMED CT. Since similar-purposed patient registries can be expected to collect similar data, these data should be mapped to the same SNOMED CT codes despite the different languages used. Previous studies have however shown variations in mapping between different mappers but the reasons behind these variations and the influence of different mapping approaches are still unknown. OBJECTIVES To analyze similar-purposed registries and their registry-to-SNOMED CT maps, using two national acute coronary syndrome registries as examples, to understand the reasons for mapping similarities and differences as well as their implications. METHODS The Malaysian National Cardiovascular Disease - Acute Coronary Syndrome (NCVD-ACS) registry was compared to the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA). The structures of NCVD-ACS and RIKS-HIA registry forms and their distributions of headings, variables and values were studied. Data items with equivalent meaning (EDIs) were paired and their mappings were categorized into match, mismatch, and non-comparable mappings. Reasons for match, mismatch and non-comparability of each paired EDI were seen as factors that contributed to the similarities and differences between the maps. RESULTS The registries and their respective maps share a similar distribution pattern regarding the number of headings, variables and values. The registries shared 101 EDIs, whereof 42 % (42) were mapped to SNOMED CT. 45 % (19) of those SNOMED CT coded EDIs had matching codes. The matching EDIs occurred only in pre-coordinated SNOMED CT expressions. Mismatches occurred due to challenges arising from the mappers themselves, limitations in SNOMED CT, and complexity of the registries. Non-comparable mappings appeared due to the use of other coding systems, unmapped data items, as well as requests for new SNOMED CT concepts. CONCLUSIONS To ensure reproducible and reusable maps, the following three actions are recommended: (i) develop a specific mapping guideline for patient registries; (ii) openly share maps; and (iii) establish collaboration between clinical research societies and the SNOMED CT community.
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Affiliation(s)
- Ismat Mohd Sulaiman
- Ismat Mohd Sulaiman, Health Informatics Centre, Planning Division, Ministry of Health Malaysia, Blok E7 Level 6 Complex E, Federal Government Administration Centre, 62950 Putrajaya, Malaysia, E-mail:
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Schirmer SH, Mahfoud F, Fries P, Scheller B. Thrombosis of TAVI prosthesis—cause for concern or innocent bystander? A comment and review of currently available data. Clin Res Cardiol 2016; 106:79-84. [DOI: 10.1007/s00392-016-1061-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 12/21/2022]
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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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Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients. Clin Res Cardiol 2015; 105:508-17. [PMID: 26646556 DOI: 10.1007/s00392-015-0946-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 11/26/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE The risk of neurological damage following transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) in severe aortic stenosis patients deemed to be at intermediate surgical risk is unknown. In this target population, the degree of neurological damage was compared using brain diffusion-weighted magnetic resonance imaging (DW-MRI) and cognitive testing. METHODS Forty-six consecutive patients undergoing TAVI (78.0 ± 8.3 years; STS score 4.4 ± 1.7) and 37 patients undergoing SAVR (78.9 ± 6.2 years, STS score 4.7 ± 1.7) were compared. DW-MRI was performed in 67 patients (40 in TAVI vs. 27 in SAVR group) within the first 15 days post-procedure. A cognitive assessment was performed at baseline and at 3 months follow-up. The occurrence of potential cognitive impairment post-intervention was determined using the reliable change index (RCI). RESULTS Baseline characteristics were comparable in TAVI and SAVR groups except for the presence of severe calcified aorta, which occurred more frequently in the TAVI group [17 (37 %) vs. 0 (0 %), p < 0.001]. Three patients presented a clinical stroke: 1 (2.2 %) in TAVI group vs. 2 (5.4 %) in SAVR group, (p = 0.58). No differences were observed in the rate of acute ischemic cerebral lesions detected by DWI in patients undergoing TAVI vs. SAVR [18 (45 %) in TAVI vs. 11 (40.7 %) in SAVR, adjusted OR 0.95; 95 % CI 0.25-3.65; p = 0.94]. TAVI was associated with a lower number of DWI lesions (adjusted OR 0.54; 95 % IC 0.37-0.79; p = 0.02). An older age was a predictor of the occurrence of acute lesions (OR 1.13; 95 % CI 1.03-1.23; p = 0.01), and the use of vitamin-K antagonist therapy had a protective effect (OR 0.25; 95 % CI 0.07-0.92; p = 0.037) regardless the type of intervention. Overall no significant changes were observed in global cognitive scores post-intervention (p = 0.23). The RCI showed mild cognitive decline in nine patients undergoing TAVI (26.4 %) and in six patients in the SAVR group (30.0 %) (p = 0.96). There was no association between the number and total volume of lesions and the occurrence of cognitive decline (CC Spearman 0.031, p = 0.85 and -0.011, p = 0.97, respectively). CONCLUSIONS TAVI and SAVR were associated with a similar rate of acute silent ischemic cerebral lesions in intermediate risk patients. Although acute lesions occurred very frequently in both strategies, their cognitive impact was not clinically relevant.
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13
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Tan JS, Leipsic J, Perlman G, Stub D, Dvir D, Hansson NC, Norgaard BL, Blanke P, Cheung A, Ye J, Thompson CR, Moss RR, Lauck S, Wood D, Webb J. A Strategy of Underexpansion and Ad Hoc Post-Dilation of Balloon-Expandable Transcatheter Aortic Valves in Patients at Risk of Annular Injury. JACC Cardiovasc Interv 2015; 8:1727-32. [DOI: 10.1016/j.jcin.2015.08.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/03/2015] [Accepted: 08/03/2015] [Indexed: 10/22/2022]
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14
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Comparison of transcatheter aortic valve and surgical bioprosthetic valve durability: A fatigue simulation study. J Biomech 2015; 48:3026-34. [PMID: 26294354 DOI: 10.1016/j.jbiomech.2015.07.031] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/22/2015] [Accepted: 07/24/2015] [Indexed: 11/23/2022]
Abstract
Transcatheter aortic valve (TAV) intervention is now the standard-of-care treatment for inoperable patients and a viable alternative treatment option for high-risk patients with symptomatic aortic stenosis. While the procedure is associated with lower operative risk and shorter recovery times than traditional surgical aortic valve (SAV) replacement, TAV intervention is still not considered for lower-risk patients due in part to concerns about device durability. It is well known that bioprosthetic SAVs have limited durability, and TAVs are generally assumed to have even worse durability, yet there is little long-term data to confirm this suspicion. In this study, TAV and SAV leaflet fatigue due to cyclic loading was investigated through finite element analysis by implementing a computational soft tissue fatigue damage model to describe the behavior of the pericardial leaflets. Under identical loading conditions and with identical leaflet tissue properties, the TAV leaflets sustained higher stresses, strains, and fatigue damage compared to the SAV leaflets. The simulation results suggest that the durability of TAVs may be significantly reduced compared to SAVs to about 7.8 years. The developed computational framework may be useful in optimizing TAV design parameters to improve leaflet durability, and assessing the effects of underexpanded, elliptical, or non-uniformly expanded stent deployment on TAV durability.
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15
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Influence of non-cardiac comorbidities on outcome after percutaneous mitral valve repair: results from the German transcatheter mitral valve interventions (TRAMI) registry. Clin Res Cardiol 2015; 104:1044-53. [DOI: 10.1007/s00392-015-0872-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/20/2015] [Indexed: 11/25/2022]
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16
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Ciuca C, Tarantini G, Latib A, Gasparetto V, Savini C, Di Eusanio M, Napodano M, Maisano F, Gerosa G, Sticchi A, Marzocchi A, Alfieri O, Colombo A, Saia F. Trans-subclavian versus transapical access for transcatheter aortic valve implantation: A multicenter study. Catheter Cardiovasc Interv 2015; 87:332-8. [PMID: 26010724 DOI: 10.1002/ccd.26012] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 04/07/2015] [Accepted: 04/11/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To compare the outcomes of trans-subclavian (TS) and transapical (TA) access for transcatheter aortic valve implantation (TAVI). BACKGROUND A considerable proportion of patients undergoing TAVI are not eligible for transfemoral approach. To date, there are few data to guide the choice between alternative vascular access routes. METHODS Among 874 consecutive patients who underwent TAVI, 202 procedures were performed through TA (n = 142, 70.3%) or TS (n = 60, 29.7%) access. Medtronic Corevalve (CV, Medtronic, Minneapolis, MN) was implanted in 17.3% of the patients, the Edwards-Sapien (ES, Edwards Lifesciences Inc., Irvine, CA) in 81.2% and other prostheses in 0.1%. In-hospital and long-term outcome were assessed using the Valve Academic Research Consortium (VARC)-2 definitions. RESULTS Mean age was 82 ± 6 years, STS score 9.3 ± 7.9%. The 2 groups showed a relevant imbalance in baseline characteristics. In hospital mortality was 6.4% (1.7% TS vs. 8.4% TA, P = 0.06), stroke 2.0%, acute myocardial infarction 1.0%, acute kidney injury 39.4%, sepsis 4.0% with no significant differences between groups, while bleeding was more frequent in TA patients (53.5% vs. 11.7% TS, P < 0.001). One- and 2-year survival was 85.2% and 73.2% in TS patients, and 83.9% and 74.9% in TA patients (P = ns for both). Access site was not an independent predictor of mortality at multivariable analysis. CONCLUSION Transapical compared with trans-subclavian access for TAVI was associated with a nonsignificant trend to increased periprocedural events. However, 1- and 2-year survival appears similar.
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Affiliation(s)
- Cristina Ciuca
- Cardiovascular Department, Institute of Cardiology, University of Bologna, Policlinico S, Orsola-Malpighi, Bologna, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Valeria Gasparetto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Carlo Savini
- Department of Cardiac Surgery, University of Bologna, Bologna, Italy
| | - Marco Di Eusanio
- Department of Cardiac Surgery, University of Bologna, Bologna, Italy
| | - Massimo Napodano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Francesco Maisano
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Alessandro Sticchi
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Marzocchi
- Cardiovascular Department, Institute of Cardiology, University of Bologna, Policlinico S, Orsola-Malpighi, Bologna, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Saia
- Cardiovascular Department, Institute of Cardiology, University of Bologna, Policlinico S, Orsola-Malpighi, Bologna, Italy
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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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18
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Toutouzas K, Synetos A, Latsios G, Mastrokostopoulos A, Stathogiannis K, Drakopoulou M, Trantalis G, Tsiamis E, Tousoulis D. The requirement of extracorporeal circulation system for transluminal aortic valve replacement: Do we really need it in the catheterization laboratory? Catheter Cardiovasc Interv 2015; 91:E43-E48. [DOI: 10.1002/ccd.25988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 04/06/2015] [Indexed: 11/06/2022]
Affiliation(s)
| | - Andreas Synetos
- First Department of CardiologyHippokration Hospital, Athens Medical SchoolAthens Greece
| | - George Latsios
- First Department of CardiologyHippokration Hospital, Athens Medical SchoolAthens Greece
| | | | | | - Maria Drakopoulou
- First Department of CardiologyHippokration Hospital, Athens Medical SchoolAthens Greece
| | - George Trantalis
- First Department of CardiologyHippokration Hospital, Athens Medical SchoolAthens Greece
| | - Eleftherios Tsiamis
- First Department of CardiologyHippokration Hospital, Athens Medical SchoolAthens Greece
| | - Dimitrios Tousoulis
- First Department of CardiologyHippokration Hospital, Athens Medical SchoolAthens Greece
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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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20
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Varela-Lema L, Queiro-Verdes T, Baz-Alonso JA, Cuenca-Castillo JJ, Durán-Muñoz D, Gónzalez-Juanatey JR, Herrera Noreña JM, Iñiguez-Romo A, López-Otero D, Pradas-Montilla G, Rubio-Álvarez J, Salgado-Fernández J, Trillo Nouche R, Vázquez-González N, López-García M. Post-introduction observation of transcatheter aortic valve implantation in Galicia (Spain). J Eval Clin Pract 2015; 21:34-42. [PMID: 25040767 DOI: 10.1111/jep.12225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2014] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Transcatheter aortic valve implantation constitutes an example of a technology introduced into the Galician Health Care System basket and subjected to a post-introduction observational study after coverage. This paper aims to describe the process and results of this experience, illustrating the main challenges and opportunities in using these studies for supporting decision making. METHODS The study protocol was developed by a multidisciplinary team consisting of experts from the Galician HTA Agency (avalia-t), interventional cardiologists and cardiac surgeons. Together they agreed on the information that was relevant and feasible for collection, and planned the study design, data collection and analysis of results. RESULTS During the 1-year recruitment period, 94 patients underwent percutaneous aortic valve replacement in the three authorized centres. Implantation rate and prosthesis models differed substantially across the centres. Overall, procedural success rate was 96.8% and hospital mortality was 7.4%. Complications during post-surgical admission were recorded in 40.4% of patients. Moderate residual aortic regurgitation was observed in 10% of patients, and the procedure was associated with a stroke rate of 3.3% at 30 days and 5.3% at 1 year. CONCLUSIONS Post-introduction observation has made it feasible to determine the use of this procedure within the SERGAS context and has enabled the assessment of performance in real-life conditions. The proposed strategic actions and interventions have been drawn up based upon the collective judgement of a group of experienced professionals, and have served to establish recommendations on further research that would be required to optimize health benefits.
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Affiliation(s)
- Leonor Varela-Lema
- Galician Agency for Health Technology Assessment (Axencia de Avaliación de Tecnologías Sanitarias de Galicia/avalia-t), Galician Health Authority, Santiago de Compostela, Santiago de Compostela, Spain
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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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Xue YT, Tan QW, Li P, Mou SF, Liu SJ, Bao Y, Jiao HC, Su WG. Investigating the role of acute mental stress on endothelial dysfunction: a systematic review and meta-analysis. Clin Res Cardiol 2014; 104:310-9. [PMID: 25391292 DOI: 10.1007/s00392-014-0782-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/21/2014] [Indexed: 12/16/2022]
Abstract
Chronic stress is a known risk factor for both endothelial dysfunction and cardiovascular disease (CVD), but less is known of how acute mental stress affects the vasculature. In this systematic review and meta-analysis, we analyzed the impact of acute mental stress on flow-mediated dilation (FMD), an indicator of endothelial function. We searched the Medline, Cochrane, EMBASE, and ISI Web of Knowledge databases through May 2014, to identify publications in English-language journals. The primary outcome was the change in FMD from baseline to the time of measurement. We also assessed the risk of bias and the heterogeneity of included studies. Our search identified eight prospective studies, which displayed significant heterogeneity. Four studies measured FMD while the subject was performing the task; six measured FMD after the task had been completed. The total number of participants was 164. The pooled results indicate that FMD did not change significantly while the task was being performed (pooled difference in means: -0.853; 95 % confidence interval (CI), -3.926/2.220; P = 0.586); however, FMD measured after the task was completed was significantly less than baseline (pooled difference in means: -2.450; 95 %CI, -3.925/-0.975; P = 0.001). In conclusions, our findings provide evidence that an acute stressful experience has a delayed, negative impact on the function of the endothelium. Repeated exposure to short-term stress may lead to permanent injury of the vasculature. Therefore, assessment of patients' exposure to both repeated acute mental stress and chronic stress may be useful in determining their risk of developing CVD.
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Affiliation(s)
- Yi-Tao Xue
- Department of Cardiology, Shandong University School of Medicine Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 42 West Wenhua Road, Jinan, 250011, Shandong Province, China,
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Clinical impact of a new left bundle branch block following TAVI implantation: 1-year results of the TAVIK cohort. Clin Res Cardiol 2014; 104:351-62. [DOI: 10.1007/s00392-014-0791-2] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/06/2014] [Indexed: 12/15/2022]
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Schelp V, Freitag-Wolf S, Hinzmann D, Bramlage P, Frey N, Frank D. Large-scale experience with an anchorless vascular closure device in a real-life clinical setting. Clin Res Cardiol 2014; 104:145-53. [PMID: 25293675 DOI: 10.1007/s00392-014-0766-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/26/2014] [Indexed: 12/11/2022]
Abstract
AIMS This study was designed to evaluate safety and effectiveness of the vascular closure device Exoseal (Cordis) for hemostatic control following cardiac catheterization in a real-life clinical setting. METHODS AND RESULTS This prospective, single-center study enrolled n = 2,031 consecutive patients who underwent coronary angiography via the femoral artery ± PCI (n = 801). Patients were excluded if they had radial access, percutaneous repair of structural heart disease, or if they had severe peripheral artery disease. If clinical abnormalities were discovered at the access site, color Doppler ultrasound was performed. The composite primary endpoint was defined as bleeding/vascular complications and device failure, and it was experienced by 5.4 % (n = 110) of patients. The most frequent complications were pseudoaneurysm (2.9 %, n = 58) and access-site hematoma >6 cm (1.8 %, n = 37). The overall device failure rate was 0.7 % (n = 14). Multiple logistic regression analysis demonstrated that the strongest independent predictors of bleeding/vascular complications and/or device failure were procedure duration (OR 2.1, CI 1.4-3.2), PCI (OR 2.7, CI 1.7-4.2), GP IIb/IIIa inhibitors (OR 2.9, CI 1.5-5.7), and age (OR 2.2, CI 1.4-3.5). CONCLUSIONS These results indicate that Exoseal was safe in a broad collective of patients. However, lengthy procedures, PCIs, the use of GP IIb/IIIa inhibitors, and elderly patients require special attention.
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Affiliation(s)
- Verena Schelp
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel Schittenhelmstr. 12, 24105, Kiel, Germany
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Hotline update of clinical trials and registries presented at the American College of Cardiology Congress 2014. Clin Res Cardiol 2014; 103:591-7. [PMID: 24915955 DOI: 10.1007/s00392-014-0733-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 05/30/2014] [Indexed: 10/25/2022]
Abstract
This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions during the Late Breaking Clinical Trial Sessions at the 63rd annual meeting of the American College of Cardiology in Washington, USA, from 29th to 31st March 2014. This article gives an overview on a number of novel clinical trials in the field of cardiovascular medicine, which were presented. Comprehensive summaries have been generated from the oral presentation and the webcasts of the American College of Cardiology, similar to as previously reported and should provide the readers with the most comprehensive information of relevant publications. The discussed studies are US CoreValve, Choice, Symplcity-HTN-3, GRS, ZEUS, GIPS-III, HEAT-PPCI, COPR-2, MSC-HF, POISE-2, SIRS. The data were presented by leading experts in the field.
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