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Marin-Cuartas M, de Waha S, de la Cuesta M, Deo SV, Kaminski A, Fach A, Meyer AL, Popov AF, Hagl C, Joskowiak D, Kuhn EW, Ius F, Leuschner F, Awad G, Thiele H, Abdalla A, Garbade J, Ender J, Wehrmann K, Eghbalzadeh K, Vitanova K, Conradi L, Diab M, Franz M, Geyer M, Meineri M, Misfeld M, Abdel-Wahab M, Bhadra OD, Osteresch R, Sandoval Boburg R, Lange R, Leontyev S, Saha S, Desch S, Lehmann S, Noack T, Doenst T, Borger MA, Kiefer P. Incidence and Outcomes of Emergency Intraprocedural Surgical Conversion During Transcatheter Aortic Valve Implantation: A Multicentric Analysis. J Am Heart Assoc 2024; 13:e033964. [PMID: 38958140 DOI: 10.1161/jaha.123.033964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/08/2024] [Indexed: 07/04/2024]
Affiliation(s)
- Mateo Marin-Cuartas
- University Department of Cardiac Surgery Leipzig Heart Center Leipzig Germany
| | - Suzanne de Waha
- University Department of Cardiac Surgery Leipzig Heart Center Leipzig Germany
| | | | - Salil V Deo
- Department of Veterans Affairs Louis Stokes Cleveland VA Medical Center Cleveland OH USA
| | - Alexander Kaminski
- Klinikum Karlsburg, Klinik für Herz-, Thorax- und Gefäßchirurgie Karlsburg Germany
| | - Andreas Fach
- Bremen Institute for Heart and Circulation Research (BIHKF) Affiliated Institute of Lübeck University Bremen Germany
| | - Anna L Meyer
- Department of Cardiac Surgery University Hospital Heidelberg Heidelberg Germany
| | - Aron-Frederik Popov
- Department of Cardiothoracic, Transplantation and Vascular Surgery Hannover Medical School Hannover Germany
| | - Christian Hagl
- Department of Cardiac Surgery Ludwig Maximillian University Munich Munich Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Munich Heart Alliance Munich Germany
| | - Dominik Joskowiak
- Department of Cardiac Surgery Ludwig Maximillian University Munich Munich Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Munich Heart Alliance Munich Germany
| | - Elmar W Kuhn
- Department for Cardiothoracic Surgery Heart Center at University of Cologne Cologne Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery Hannover Medical School Hannover Germany
| | - Florian Leuschner
- Department of Cardiology University Hospital Heidelberg Heidelberg Germany
| | - George Awad
- Department of Cardiothoracic Surgery Otto-von-Guericke University Magdeburg Magdeburg Germany
| | - Holger Thiele
- Department of Cardiology Heart Center Leipzig at University of Leipzig Leipzig Germany
| | - Ali Abdalla
- Klinikum Links der Weser - Klinik für Herzchirurgie Bremen Germany
| | - Jens Garbade
- Klinikum Links der Weser - Klinik für Herzchirurgie Bremen Germany
| | - Joerg Ender
- Department of Anesthesiology Heart Center Leipzig at University of Leipzig Leipzig Germany
| | - Katharina Wehrmann
- Klinikum Karlsburg, Klinik für Herz-, Thorax- und Gefäßchirurgie Karlsburg Germany
| | - Kaveh Eghbalzadeh
- Department for Cardiothoracic Surgery Heart Center at University of Cologne Cologne Germany
| | - Keti Vitanova
- Department of Cardiovascular Surgery, German Heart Center Munich Technische Universität München Munich Germany
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München Insure (Institute of Translational Cardiac Surgery) Munich Germany
| | - Lenard Conradi
- Department for Cardiovascular Surgery University Heart and Vascular Center Hamburg Hamburg Germany
| | - Mahmoud Diab
- Herz-Kreislauf-Zentrum, Klinikum Hersfeld-Rotenburg Rontenburg an der Fulda Germany
| | - Marcus Franz
- Department of Internal Medicine I Jena University Hospital - Friedrich Schiller University of Jena Jena Germany
| | - Martin Geyer
- Department of Cardiology, Cardiology I University Medical Center Mainz of the Johannes Gutenberg-University Mainz Mainz Germany
| | - Massimiliano Meineri
- Department of Anesthesiology Heart Center Leipzig at University of Leipzig Leipzig Germany
| | - Martin Misfeld
- University Department of Cardiac Surgery Leipzig Heart Center Leipzig Germany
- Department of Cardiothoracic Surgery Royal Prince Alfred Hospital Sydney NSW Australia
- Institute of Academic Surgery, RPAH Sydney NSW Australia
- The Baird Institute of Applied Heart and Lung Surgical Research Sydney NSW Australia
- Sydney Medical School University of Sydney Sydney NSW Australia
| | - Mohamed Abdel-Wahab
- Department of Cardiology Heart Center Leipzig at University of Leipzig Leipzig Germany
| | - Oliver D Bhadra
- Department for Cardiovascular Surgery University Heart and Vascular Center Hamburg Hamburg Germany
| | - Rico Osteresch
- Bremen Institute for Heart and Circulation Research (BIHKF) Affiliated Institute of Lübeck University Bremen Germany
| | - Rodrigo Sandoval Boburg
- Department of Cardiothoracic, Transplantation and Vascular Surgery Hannover Medical School Hannover Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich Technische Universität München Munich Germany
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München Insure (Institute of Translational Cardiac Surgery) Munich Germany
| | - Sergey Leontyev
- University Department of Cardiac Surgery Leipzig Heart Center Leipzig Germany
| | - Shekhar Saha
- Department of Cardiac Surgery Ludwig Maximillian University Munich Munich Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Munich Heart Alliance Munich Germany
| | - Steffen Desch
- Department of Cardiology Heart Center Leipzig at University of Leipzig Leipzig Germany
| | - Sven Lehmann
- Klinikum Links der Weser - Klinik für Herzchirurgie Bremen Germany
| | - Thilo Noack
- University Department of Cardiac Surgery Leipzig Heart Center Leipzig Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery Jena University Hospital - Friedrich Schiller University of Jena Jena Germany
| | - Michael A Borger
- University Department of Cardiac Surgery Leipzig Heart Center Leipzig Germany
| | - Philipp Kiefer
- University Department of Cardiac Surgery Leipzig Heart Center Leipzig Germany
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Nagasaka T, Koren O, Patel V, Naami R, Naami E, Shechter A, Kohan S, Allison Z, Lerner A, Cheng DE, Chakravarty T, Cheng W, Jilaihawi H, Ishii H, Nakamura M, Makkar RR. Two-Year Outcomes of Valve-in-Valve Using New-Generation Transcatheter Devices Compared With Redo-SAVR. Am J Cardiol 2023; 207:380-389. [PMID: 37778227 DOI: 10.1016/j.amjcard.2023.08.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023]
Abstract
Few studies have compared the clinical outcomes between valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) with new-generation valves and re-operative surgical aortic valve replacement (Redo-SAVR). We compared the clinical outcomes of patients who underwent ViV-TAVR with those of patients who underwent Redo-SAVR at Cedars-Sinai Medical Center between 2015 and 2021. New-generation valves were used for ViV-TAVR. A propensity score-matched (PSM) analysis was performed to adjust for differences in baseline characteristics. The primary end point was all-cause mortality at 30 days and 2 years. In-hospital procedural and clinical outcomes were also compared between the groups. A total of 256 patients (140 who underwent ViV-TAVR and 116 who underwent Redo-SAVR) were eligible for PSM. In the unmatched cohort, patients in the ViV-TAVR group were older and had more co-morbidities than those in the Redo-SAVR group. After PSM, there were no significant differences in all-cause death between the ViV-TAVR and Redo-SAVR groups at 30 days (3.9% vs 2.6%, p = 0.65) or 2 years (6.5% vs 7.8%, p = 0.75). The incidences of stroke and heart failure rehospitalization were similar at 30 days and 2 years. The cumulative complication rates during hospitalization were significantly lower in the ViV-TAVR group than in the Redo-SAVR group (11.7% vs 28.6% p = 0.015). The long-term outcomes of ViV-TAVR using new-generation valves were similar to those of Redo-SAVR, although ViV-TAVR was associated with lower rates of in-hospital complications.
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Affiliation(s)
- Takashi Nagasaka
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Ofir Koren
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Technion Israel Institute of Technology, Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Vivek Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Robert Naami
- Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Edmund Naami
- School of Medicine, University of Illinois, Chicago, Illinois
| | - Alon Shechter
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Siamak Kohan
- Internal Medicine, Kaiser Permanente Medical Center, Los Angeles, California
| | - Zev Allison
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Addee Lerner
- David Geffen School of Medicine, University of California (UCLA), Los Angeles, California
| | | | - Tarun Chakravarty
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Wen Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Hasan Jilaihawi
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Mamoo Nakamura
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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Wang G, Qin M, Zhang B, Yan Y, Yang F, Chen Q, Liu Y, Qiao F, Ni Y. Decreased expression of RPL15 and RPL18 exacerbated the calcification of valve interstitial cells during aortic valve calcification. Cell Biol Int 2023; 47:1749-1759. [PMID: 37431269 DOI: 10.1002/cbin.12070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 06/19/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
Calcific aortic valve disease (CAVD) is the most common valvular heart disease, with an increasing prevalence due to an aging population. The pathobiology of CAVD is a multifaceted and actively regulated process, but the detailed mechanisms have not been elucidated. The present study aims to identify the differentially expressed genes (DEGs) in calcified aortic valve tissues, and to analyze the correlation between DEGs and clinical features in CAVD patients. The DEGs were screened by microarray in normal and CAVD groups (n = 2 for each group), and confirmed by quantitative real-time polymerase chain reaction in normal (n = 12) and calcified aortic valve tissues (n = 34). A total of 1048 DEGs were identified in calcified aortic valve tissues, including 227 upregulated mRNAs and 821 downregulated mRNAs. Based on multiple bioinformatic analyses, three 60S ribosomal subunit components (RPL15, RPL18, and RPL18A), and two 40S ribosomal subunit components (RPS15 and RPS21) were identified as the top 5 hub genes in the protein-protein interaction network of DEGs. The expression of RPL15 and RPL18 was also found significantly decreased in calcified aortic valve tissues (both p < .01), and negatively correlated with the osteogenic differentiation marker OPN in CAVD patients (both p < .01). Moreover, inhibition of RPL15 or RPL18 exacerbated the calcification of valve interstitial cells under osteogenic induction conditions. The present study proved that decreased expression of RPL15 and RPL18 was closely associated with aortic valve calcification, which provided valuable clues to find therapeutic targets for CAVD.
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Affiliation(s)
- Guokun Wang
- Department of Cardiovascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Ming Qin
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Boyao Zhang
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yan Yan
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
- Department of Cardiothoracic Surgery, No.903 Hospital of PLA, Hangzhou, Zhejiang, China
| | - Fan Yang
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Qian Chen
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yang Liu
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
- Department of Critical Care Medicine, Naval Medical Center of PLA, Shanghai, China
| | - Fan Qiao
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yiming Ni
- Department of Cardiovascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Doenst T, Schneider U, Caldonazo T, Toshmatov S, Diab M, Siemeni T, Färber G, Kirov H. Cardiac Surgery 2022 Reviewed. Thorac Cardiovasc Surg 2023; 71:356-365. [PMID: 37196662 DOI: 10.1055/s-0043-57228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
PubMed displayed almost 37,000 hits for the search term "cardiac surgery AND 2022." As before, we used the PRISMA approach and selected relevant publications for a results-oriented summary. We focused on coronary and conventional valve surgery, their overlap with interventional alternatives, and briefly assessed surgery for aorta or terminal heart failure. In the field of coronary artery disease (CAD), key manuscripts addressed prognostic implications of invasive treatment options, classically compared modern interventions (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass grafting [CABG]), and addressed technical aspects of CABG. The general direction in 2022 confirms the superiority of CABG over PCI in patients with anatomically complex chronic CAD and supports an infarct-preventative effect as underlying mechanism. In addition, the relevance of proper surgical technique to achieve durable graft patency and the need for optimal medical treatment in CABG patients was impressively illustrated. In structural heart disease, the comparisons of interventional and surgical techniques have been characterized by prognostic and mechanistic investigations underscoring the need for durable treatment effects and reductions of valve-related complications. Early surgery for most valve pathologies appears to provide significant survival advantages, and two publications on the Ross operation prototypically illustrate an inverse association between long-term survival and valve-related complications. For surgical treatment of heart failure, the first xenotransplantation was certainly dominant, and in the aortic surgery field, innovations in arch surgery prevailed. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Sultonbek Toshmatov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
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Muneretto C, Di Bacco L, Di Eusanio M, Folliguet T, Rosati F, D'Alonzo M, Cugola D, Curello S, Palacios CM, Baudo M, Pollari F, Fischlein T. Sutureless and Rapid Deployment vs. Transcatheter Valves for Aortic Stenosis in Low-Risk Patients: Mid-Term Results. J Clin Med 2023; 12:4045. [PMID: 37373738 DOI: 10.3390/jcm12124045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Recent trials showed that TAVI is neither inferior nor superior to surgical aortic valve replacement. The aim of this study was to evaluate the outcomes of Sutureless and Rapid Deployment Valves (SuRD-AVR) when compared to TAVI in low surgical risk patients with isolated aortic stenosis. METHODS Data from five European Centers were retrospectively collected. We included 1306 consecutive patients at low surgical risk (EUROSCORE II < 4) who underwent aortic valve replacement by means of SuRD-AVR (n = 636) or TAVI (n = 670) from 2014 to 2019. A 1:1 nearest-neighbor propensity-score was performed, and two balanced groups of 346 patients each were obtained. The primary endpoints of the study were: 30-day mortality and 5-year overall survival. The secondary endpoint was 5-year survival freedom from major adverse cardiovascular and cerebrovascular events (MACCEs). RESULTS Thirty-day mortality was similar between the two groups (SuRD-AVR:1.7%, TAVI:2.0%, p = 0.779), while the TAVI group showed a significantly lower 5-year overall survival and survival freedom from MACCEs (5-year matched overall survival: SuRD-AVR: 78.5%, TAVI: 62.9%, p = 0.039; 5-year matched freedom from MACCEs: SuRD-AVR: 64.6%, TAVI: 48.7%, p = 0.004). The incidence of postoperative permanent pacemaker implantation (PPI) and paravalvular leak grade ≥ 2 (PVL) were higher in the TAVI group. Multivariate Cox Regression analysis identified PPI as an independent predictor for mortality. CONCLUSIONS TAVI patients had a significantly lower five-year survival and survival freedom from MACCEs with a higher rate of PPI and PVL ≥ 2 when compared to SuRD-AVR.
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Affiliation(s)
- Claudio Muneretto
- Division of Cardiac Surgery, University of Brescia Medical School, 250123 Brescia, Italy
| | - Lorenzo Di Bacco
- Division of Cardiac Surgery, University of Brescia Medical School, 250123 Brescia, Italy
| | | | - Thierry Folliguet
- Service de Chirurgie Thoracique et Cardio-Vasculaire, Hôpital H. Mondor, 94010 Créteil, France
| | - Fabrizio Rosati
- Division of Cardiac Surgery, University of Brescia Medical School, 250123 Brescia, Italy
| | - Michele D'Alonzo
- Division of Cardiac Surgery, University of Brescia Medical School, 250123 Brescia, Italy
| | - Diego Cugola
- Cardiac Surgery Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Salvatore Curello
- Cardiac Catheterization Laboratory, Spedali Civili, 250123 Brescia, Italy
| | | | - Massimo Baudo
- Division of Cardiac Surgery, University of Brescia Medical School, 250123 Brescia, Italy
| | - Francesco Pollari
- Cardiac Surgery Department, Klinikum Nürnberg-Paracelsus Medical University, 90419 Nürnberg, Germany
| | - Theodor Fischlein
- Cardiac Surgery Department, Klinikum Nürnberg-Paracelsus Medical University, 90419 Nürnberg, Germany
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Eckel CE, Kim WK, Grothusen C, Tiyerili V, Elsässer A, Sötemann D, Schlüter J, Choi YH, Charitos EI, Renker M, Hamm CW, Dohmen G, Möllmann H, Blumenstein J. Comparison of the New-Generation Self-Expanding NAVITOR Transcatheter Heart Valve with Its Predecessor, the PORTICO, in Severe Native Aortic Valve Stenosis. J Clin Med 2023; 12:3999. [PMID: 37373693 DOI: 10.3390/jcm12123999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Third-generation transcatheter heart valves (THVs) are designed to improve outcomes. Data on the new intra-annular self-expanding NAVITOR are scarce. AIMS The aim of this analysis was to compare outcomes between the PORTICO and the NAVITOR systems. METHODS Data from 782 patients with severe native aortic stenosis treated with PORTICO (n = 645) or NAVITOR (n = 137) from 05/2012 to 09/2022 were evaluated. The clinical and hemodynamic outcomes of 276 patients (PORTICO, n = 139; NAVITOR, n = 137) were evaluated according to VARC-3 recommendations. RESULTS Rates of postprocedural more-than-mild paravalvular leakage (PVL) were significantly lower for NAVITOR than for PORTICO (7.2% vs. 1.5%, p = 0.041). In addition, severe bleeding rates (27.3% vs. 13.1%, p = 0.005) and major vascular complications (5.8% vs. 0.7%, p = 0.036) were lower in the NAVITOR group. The mean gradients (7 vs. 8 mmHg, p = 0.121) and calculated aortic valve areas (1.90 cm2 vs. 1.99 cm2, p = 0.235) were comparable. Rates of PPI were similarly high in both groups (15.3 vs. 21.6, p = 0.299). CONCLUSIONS The NAVITOR demonstrated favorable in-hospital procedural outcome data, with lower rates of relevant PVL, major vascular complications, and severe bleeding than its predecessor the PORTICO and preserved favorable hemodynamic outcomes.
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Affiliation(s)
- Clemens Enno Eckel
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiology, University of Oldenburg, 26129 Oldenburg, Germany
| | - Won-Keun Kim
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
| | - Christina Grothusen
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiac and Vascular Surgery, University of Kiel, 24098 Kiel, Germany
| | - Vedat Tiyerili
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Albrecht Elsässer
- Department of Cardiology, University of Oldenburg, 26129 Oldenburg, Germany
| | - Dagmar Sötemann
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Judith Schlüter
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiology, University of Oldenburg, 26129 Oldenburg, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
| | | | - Matthias Renker
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Bad Nauheim, Germany
| | - Christian W Hamm
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Bad Nauheim, Germany
- Department of Cardiology, University of Giessen, 35390 Giessen, Germany
| | - Guido Dohmen
- Department of Cardiac Surgery, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Johannes Blumenstein
- Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiology, University of Oldenburg, 26129 Oldenburg, Germany
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7
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Bestehorn K, Bestehorn M, Zahn R, Perings C, Stellbrink C, Schächinger V. Transfemoral aortic valve implantation: procedural hospital volume and mortality in Germany. Eur Heart J 2023; 44:856-867. [PMID: 36459131 DOI: 10.1093/eurheartj/ehac698] [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: 06/10/2022] [Revised: 10/17/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
AIMS Studies assessing transfemoral transcatheter aortic valve implantation (TF-TAVI) showed lower rates of in-hospital mortality at high-volume hospitals and minimum caseloads were recommended to assure quality standards. METHODS AND RESULTS All patients in the German mandatory quality assurance registry with elective or urgent TF-TAVI procedures in 2018 and 2019 at 81 and 82 hospitals, respectively, were analysed. Observed in-hospital mortality was adjusted to expected mortality by the German AKL-KATH score (O/E) as well as by the EuroScore II (O/E2). Hospital volume and O/E were correlated by regression analyses and volume quartiles. 18 763 patients (age: 81.1 ± 1.0 years, mean EuroSCORE II: 6.9 ± 1.8%) and 22 137 patients (mean age: 80.7 ± 3.5 years, mean EuroSCORE II: 6.5 ± 1.6%) were analysed in 2018 and 2019, respectively. The average observed in-hospital mortality was 2.57 ± 1.83% and 2.36 ± 1.60%, respectively. Unadjusted in-hospital mortality was significantly inversely related to hospital volume by linear regression in both years. After risk adjustment, the association between hospital volume and O/E was statistically significant in 2019 (R2 = 0.049; P = 0.046), but not in 2018 (R2 = 0.027; P = 0.14). The variance of O/E explained by the number of cases in 2019 was low (4.9%). Differences in O/E outcome between the first and the fourth quartile were not statistically significant in both years (1.10 ± 1.02 vs. 0.82 ± 0.46; P = 0.26 in 2018; 1.16 0 .97 vs. 0.74 ± 0.39; P = 0.084 in 2019). Any chosen volume cut-off could not precisely differentiate between hospitals with not acceptable quality (>95th percentile O/E of all hospitals) and those with acceptable (O/E ≤95th percentile) or above-average (O/E < 1) quality. For example, in 2019 a cut-off value of 150 would only exclude one of two hospitals with not acceptable quality, while 20 hospitals with acceptable or above-average quality (25% of all hospitals) would be excluded. CONCLUSION The association between hospital volume and in-hospital mortality in patients undergoing elective TF-TAVI in Germany in 2018 and 2019 was weak and not consistent throughout various analytical approaches, indicating no clinical relevance of hospital volume for the outcome. However, these data were derived from a healthcare system with restricted access to hospitals to perform TAVI and overall high TAVI volumes. Instead of the unprecise surrogate hospital volume, the quality of hospitals performing TF-TAVI should be directly assessed by real achieved risk-adjusted mortality.
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Affiliation(s)
- Kurt Bestehorn
- Institut für klinische Pharmakologie, Technical University Dresden, Blasewitzer Str. 86, 01307 Dresden, Germany
| | | | - Ralf Zahn
- Medizinische Klinik B, Klinikum Ludwigshafen, Bremserstr. 79, 67063 Ludwigshafen am Rhein, Germany
| | - Christian Perings
- Medizinische Klinik I, St.-Marien-Hospital, Altstadtstr. 23, 44534 Lünen, Germany
| | - Christoph Stellbrink
- Universitätsklinik für Kardiologie und Internistische Intensivmedizin, Klinikum Bielefeld, Teutoburger Str. 50, 33604 Bielefeld, Germany
| | - Volker Schächinger
- Medizinische Klinik I, Herz-Thorax Zentrum, Klinikum Fulda, Pacelliallee 4, 36043 Fulda, Germany
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