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Angioletti C, Moretti G, Manetti S, Pastormerlo L, Vainieri M, Passino C. The evolution of TAVI performance overtime: an overview of systematic reviews. BMC Cardiovasc Disord 2024; 24:314. [PMID: 38907344 PMCID: PMC11191264 DOI: 10.1186/s12872-024-03980-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 06/14/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is a well-established treatment for high and intermediate-risk patients with severe aortic stenosis (AS). Recent studies have demonstrated non-inferiority of TAVI compared to surgery in low-risk patients. In the past decade, numerous literature reviews (SLRs) have assessed the use of TAVI in different risk groups. This is the first attempt to provide an overview of SRs (OoSRs) focusing on secondary studies reporting clinical outcomes/process indicators. This research aims to summarize the findings of extant literature on the performance of TAVI over time. METHODS A literature search took place from inception to April 2024. We searched MEDLINE and the Cochrane Library for SLRs. SLRs reporting at least one review of clinical indicators were included. Subsequently, a two-step inclusion process was conducted: [1] screening based on title and abstracts and [2] screening based on full-text papers. Relevant data were extracted and the quality of the reviews was assessed. RESULTS We included 33 SLRs with different risks assessed via the Society of Thoracic Surgeons (STS) score. Mortality rates were comparable between TAVI and Surgical Aortic Valve Replacement (SAVR) groups. TAVI is associated with lower rates of major bleeding, acute kidney injury (AKI) incidence, and new-onset atrial fibrillation. Vascular complications, pacemaker implantation, and residual aortic regurgitation were more frequent in TAVI patients. CONCLUSION This study summarizes TAVI performance findings over a decade, revealing a shift to include both high and low-risk patients since 2020. Overall, TAVI continues to evolve, emphasizing improved outcomes, broader indications, and addressing challenges.
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Affiliation(s)
- Carmen Angioletti
- Management and Healthcare Laboratory, Institute of Management, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Giaele Moretti
- Management and Healthcare Laboratory, Institute of Management, Sant'Anna School of Advanced Studies, Pisa, Italy.
| | - Stefania Manetti
- Department of Management Engineering, Politecnico di Milano, Milano, Italy
| | | | - Milena Vainieri
- Management and Healthcare Laboratory, Institute of Management, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Claudio Passino
- Fondazione Toscana G. Monasterio, Pisa, Italy
- Health Science Interdisciplinary Center, Sant'Anna School of Advanced Studies, Pisa, Italy
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2
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Yamamoto H, Nakayama T, Ishii N, Nakamura Y. Minimally Invasive Surgical Versus Transcatheter Aortic Valve Replacement: A Retrospective Observational Single-Center Study in Japan. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:547-556. [PMID: 37933787 PMCID: PMC10714700 DOI: 10.1177/15569845231205587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVE This study aimed to compare the outcomes of minimally invasive aortic valve replacement (MICS-AVR) versus transfemoral transcatheter aortic valve replacement (TF-TAVR) in Asian patients. METHODS We conducted a retrospective, observational, single-center study in Japan, including cases of MICS-AVR (n = 202) and TF-TAVR (n = 248) between 2014 and 2021. In a total of 450 cases, propensity score matching was performed at a ratio of 1:1, resulting in 96 pairs. Furthermore, we performed competing-risk regression and mediation analyses to determine the treatment effect on outcomes of interests, considering death as a competing risk, and to evaluate the mediation effect of paravalvular leak (PVL) severity. RESULTS There were similar incidences of all-cause death, cardiac death, stroke and cerebral hemorrhage, and aortic valve reintervention between the 2 groups. However, the TF-TAVR cohort had a longer hospital length of stay and higher rates of significant PVL compared with the MICS-AVR cohort. Multivariable-adjusted Cox regression analyses revealed that heart failure hospitalization (hazard ratio [HR] = 0.129, 95% confidence interval [CI]: 0.038 to 0.445, p = 0.001) and permanent pacemaker implantation (HR = 0.050, 95% CI: 0.006 to 0.409, p = 0.005) favored MICS-AVR. Competing-risk regression analyses confirmed similar findings. All outcomes were unrelated to PVL severity. CONCLUSIONS To our knowledge, this is the first comparative study of clinical outcomes in Asian patients undergoing MICS-AVR versus TF-TAVR, revealing that MICS-AVR could be a feasible and efficient alternative to TF-TAVR. Future larger-scale randomized controlled trials are needed to validate the present results.
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Affiliation(s)
- Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Japan
| | - Taisuke Nakayama
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Japan
| | - Naoki Ishii
- Department of Gastroenterology, Tokyo Shinagawa Hospital, Japan
| | - Yoshitsugu Nakamura
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Japan
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3
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Hedgire SS, Saboo SS, Galizia MS, Aghayev A, Bolen MA, Rajiah P, Ferencik M, Johnson TV, Kandathil A, Krieger EV, Maddu K, Maniar H, Renapurkar RD, Shen J, Tannenbaum A, Koweek LM, Steigner ML. ACR Appropriateness Criteria® Preprocedural Planning for Transcatheter Aortic Valve Replacement: 2023 Update. J Am Coll Radiol 2023; 20:S501-S512. [PMID: 38040467 DOI: 10.1016/j.jacr.2023.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
This document discusses preprocedural planning for transcatheter aortic valve replacement, evaluating the imaging modalities used in initial imaging for preprocedure planning under two variants 1) Preintervention planning for transcatheter aortic valve replacement: assessment of aortic root; and 2) Preintervention planning for transcatheter aortic valve replacement: assessment of supravalvular aorta and vascular access. US echocardiography transesophageal, MRI heart function and morphology without and with IV contrast, MRI heart function and morphology without IV contrast and CT heart function and morphology with IV contrast are usually appropriate for assessment of aortic root. CTA chest with IV contrast, CTA abdomen and pelvis with IV contrast, CTA chest abdomen pelvis with IV contrast are usually appropriate for assessment of supravalvular aorta and vascular access. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Sandeep S Hedgire
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Sachin S Saboo
- Research Author, South Texas Radiology Group, PA, San Antonio, Texas
| | | | - Ayaz Aghayev
- Panel Chair, Brigham & Women's Hospital, Boston, Massachusetts
| | | | | | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; Society of Cardiovascular Computed Tomography
| | - Thomas V Johnson
- Sanger Heart and Vascular Institute, Charlotte, North Carolina; American Society of Echocardiography
| | - Asha Kandathil
- University of Texas Southwestern Medical Center, Dallas, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | - Eric V Krieger
- University of Washington School of Medicine, Seattle, Washington; Society for Cardiovascular Magnetic Resonance
| | - Kiran Maddu
- Emory University, Atlanta, Georgia; Committee on Emergency Radiology-GSER
| | - Hersh Maniar
- Washington University School of Medicine, Saint Louis, Missouri; American Association for Thoracic Surgery
| | | | - Jody Shen
- Stanford University, Stanford, California
| | | | - Lynne M Koweek
- Specialty Chair, Duke University Medical Center, Durham, North Carolina
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4
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Coelho B, Ng M, Naoum C, Banoub M, Saad I, Salama A. Iatrogenic Aorto-Right Ventricular Fistula: A Rare Complication of Transcatheter Valve Implantation. CASE (PHILADELPHIA, PA.) 2023; 7:197-204. [PMID: 37325458 PMCID: PMC10264201 DOI: 10.1016/j.case.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Bianca Coelho
- MQ Health Cardiology, Macquarie University Hospital, Macquarie Park, New South Wales, Australia
| | - Martin Ng
- MQ Health Cardiology, Macquarie University Hospital, Macquarie Park, New South Wales, Australia
| | - Chris Naoum
- MQ Health Cardiology, Macquarie University Hospital, Macquarie Park, New South Wales, Australia
| | - Mina Banoub
- MQ Health Cardiology, Macquarie University Hospital, Macquarie Park, New South Wales, Australia
| | - Isabelle Saad
- MQ Health Cardiology, Macquarie University Hospital, Macquarie Park, New South Wales, Australia
| | - Amanda Salama
- MQ Health Cardiology, Macquarie University Hospital, Macquarie Park, New South Wales, Australia
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Camuglia AC, Cole CMW, Boyne N, Hayman SM, Cox SV, Moore PT, Lau JK, Delacroix S, Williamson AE, Duong M, Schwarz N, Montarello JK, Worthley SG. 30-Day Outcomes With the Portico Transcatheter Heart Valve: Insights From a Multi-Centre Australian Observational Study. Heart Lung Circ 2023; 32:224-231. [PMID: 36344392 DOI: 10.1016/j.hlc.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/10/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is an established therapy for the treatment of aortic valve disease in appropriately selected patients. Previous studies using the self-expanding Portico transcatheter heart valve (THV), (Abbott Structural Heart, St Paul, MN, USA) have demonstrated the technical feasibility of this system albeit in the hands of relatively inexperienced Portico users. The objective of this study was to assess the real-world safety and efficacy of the Portico THV (with and without the FlexNav delivery system, Abbott Structural Heart) at the 30-day timepoint in an Australian cohort. METHODS AND RESULTS This study was a retrospective real-world cohort analysis of 269 consecutive patients with severe aortic valve disease who underwent TAVI at multiple centres within Australia between February 2015 and April 2021. Of the 269 patients, 51.7% were female, mean Society of Thoracic Surgeons (STS) score was 5.2 (±6.8) and 98.5% had successful implantations. Thirty (30)-day post-implantation all-cause mortality was observed in one (0.4%) patient, major vascular complications in two (0.7%) patients, more-than-mild paravalvular leak in six (2.2%) patients and requirement for new permanent pacemaker implantation in 27 (10.2%) patients. Haemodynamic parameters at 30 days included mean effective orifice area (EOA) of 2.3 (±0.9) cm2 and mean aortic valve gradient (AVG) of 9.6 (±6.2) mmHg. CONCLUSION This analysis of the Portico THV in a real-world setting suggested that the system is associated with satisfactory safety and efficacy parameters. Previously published datasets may not have found similar findings owing to lower operator experience with the Portico THV system.
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Affiliation(s)
- Anthony C Camuglia
- The Wesley Hospital, Brisbane, Qld, Australia; Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia.
| | - Christopher M W Cole
- The Wesley Hospital, Brisbane, Qld, Australia; Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
| | - Nicholas Boyne
- The Wesley Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
| | - Sam M Hayman
- The Wesley Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
| | - Stephen V Cox
- The Wesley Hospital, Brisbane, Qld, Australia; Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
| | - Peter T Moore
- The Wesley Hospital, Brisbane, Qld, Australia; Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
| | - Jerrett K Lau
- Royal Adelaide Hospital, Adelaide, SA, Australia; St. Andrew's Hospital, Adelaide, SA, Australia
| | - Sinny Delacroix
- GenesisCare, Adelaide, SA, Australia; Abbott Laboratories, Sylmar, CA, USA
| | | | | | | | - Joseph K Montarello
- Royal Adelaide Hospital, Adelaide, SA, Australia; St. Andrew's Hospital, Adelaide, SA, Australia
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Institutional re-evolution of mitral valve procedures. J Geriatr Cardiol 2022; 19:551-554. [PMID: 35975014 PMCID: PMC9361158 DOI: 10.11909/j.issn.1671-5411.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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7
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Coti I, Werner P, Kaider A, Mach M, Kocher A, Laufer G, Andreas M. Rapid-deployment aortic valve replacement for patients with bicuspid aortic valve: a single-centre experience. Eur J Cardiothorac Surg 2022; 62:6514631. [DOI: 10.1093/ejcts/ezac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/18/2021] [Accepted: 01/07/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
The benefit of rapid-deployment aortic valve replacement (RD-AVR) in patients with a bicuspid aortic valve (BAV) is controversial due to aortic root asymmetry and potential increased risk for valve dislocation and paravalvular leak. This study aimed to analyse the outcomes of surgical aortic valve replacement with a rapid-deployment bioprosthesis in patients with a BAV.
METHODS
Between May 2010 and December 2020, all consecutive patients who underwent RD-AVR at the Medical University of Vienna were included in our institutional database. Assessment of preoperative characteristics, operative outcomes, long-term survival and clinical events was performed. The outcomes of patients presenting with a native BAV were compared with a control group of patients with native tricuspid valve (TAV); reoperative aortic valve replacements were excluded.
RESULTS
Out of 816 patients, who underwent RD-AVR at our institution, 107 patients with a BAV, mean age 68 (standard deviation: 8) years, were compared with a control group of 690 patients with a TAV, mean age 74 (standard deviation: 7) years; patients presenting with a BAV were significantly younger than patients with a TAV (P < 0.001). Concomitant procedures were performed in 44 (41.1%) patients in the BAV group and in 339 (49.1%) patients in the TAV group (P = 0.123); surgery of the ascending aorta was necessary in 24 (22.4%) in the BAV group, compared with 29 (4.2%) in the control group (P < 0.001). The 5-year cumulative incidence of moderate-to-severe paravalvular regurgitation in the BAV group was 10.7% [95% confidence interval (CI): 4.2–20.7%] and 3.9% (95% CI: 2.4–6.1%) in the TAV group (P = 0.057). Reoperation with valve explantation due to non-structural valve dysfunction at 5 years was 2.8% (95% CI: 0.5–8.8%) in the BAV group, compared to 1.9% (95% CI: 1.0–3.2%) in the TAV cohort (P = 0.89). The overall long-term survival rate in the BAV group was 92% (95% CI: 81–97%) at 5 years and 88% (95% CI: 73–95%), at 10 years, significantly better compared to the TAV group (log-rank test P = 0.002).
CONCLUSIONS
RD-AVR can be performed in patients with a BAV with convincingly medical outcomes. However, a trend to increased frequency of moderate–severe paravalvular regurgitation was observed at long-term follow-up. Consequently, a different surgical approach, compared to tricuspid valves, with distinctly specific technical- and anatomical considerations and requirements, is recommended.
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Affiliation(s)
- Iuliana Coti
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Paul Werner
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kaider
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Markus Mach
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Alfred Kocher
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Guenther Laufer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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8
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Chiariello GA, Romagnoli E, Biondi-Zoccai G, Frati G. Transcatheter versus surgical aortic valve replacement for severe aortic stenosis: Pat Garrett versus Billy the Kid? Eur J Cardiothorac Surg 2021; 61:988-989. [PMID: 34918064 DOI: 10.1093/ejcts/ezab528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 02/05/2023] Open
Affiliation(s)
- Giovanni A Chiariello
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCSS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Enrico Romagnoli
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCSS, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Napoli, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,IRCCS NEUROMED, Pozzilli, Italy
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Barili F, Freemantle N, Musumeci F, Martin B, Anselmi A, Rinaldi M, Kaul S, Rodriguez-Roda J, Di Mauro M, Folliguet T, Verhoye JP, Sousa-Uva M, Parolari A. Five-year outcomes in trials comparing transcatheter aortic valve implantation versus surgical aortic valve replacement: a pooled meta-analysis of reconstructed time-to-event data. Eur J Cardiothorac Surg 2021; 61:977-987. [PMID: 34918068 DOI: 10.1093/ejcts/ezab516] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES The incidence of outcomes in trials comparing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) is expected to be different in the short and long term. We planned a meta-analysis of reconstructed time-to-event data from trials comparing TAVI and SAVR to evaluate their time-varying effects on outcomes. METHODS We performed a systematic review of the literature from January 2007 through September 2021 on Medline, Embase, the Cochrane Central Register of Controlled Trials and specialistic websites, including randomized trials with allocation to TAVI or SAVR that reported at least 1-year follow-up and that graphed Kaplan-Meier curves of end points. The comparisons were done with grouped frailty Cox models in a landmark framework and fully parametric models. RESULTS Seven trials were included (7770 participants). TAVI showed a lower incidence of the composite of death or stroke in the first 6 months [risk-stratified hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.56-0.77, P-value <0.001], with an HR reversal after 24 months favouring SAVR (risk-stratified HR 1.25; 95% CI 1.08-1.46; P-value 0.003). These outcomes were confirmed for all-cause death (risk-stratified HR after 24 months 1.18; 95% CI 1.03-1.35; P-value 0.01). TAVI was also associated with an increased incidence of rehospitalization after 6 months (risk-stratified HR 1.42; 95% CI 1.06-1.91; P-value 0.018) that got worse after 24 months (risk-stratified HR 1.67; 95% CI 1.24-2.24; P-value <0.001). CONCLUSIONS Although it could appear that there is no difference between TAVI and SAVR in the 5-year cumulative results, TAVI shows a strong protective effect in the short term that runs out after 1 year. TAVI becomes a risk factor for all-cause mortality and the composite end point after 24 months and for rehospitalization after 6 months.
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Affiliation(s)
- Fabio Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nicholas Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Francesco Musumeci
- Department of Heart and Vessels, Cardiac Surgery Unit and Heart Transplantation Center, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Barbara Martin
- Department of Research and Third Mission Area, University of Turin, Turin, Italy
| | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Mauro Rinaldi
- Department of Cardiac Surgery, AOU "Città della Salute e della Scienza di Torino", University of Turin, Turin, Italy
| | - Sanjay Kaul
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Michele Di Mauro
- Cardiothoracic and Vascular Department, Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Jean-Philippe Verhoye
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Miguel Sousa-Uva
- Department of Cardiothoracic Surgery, Hospital de Santa Crux, Carnaxide, Portugal
| | - Alessandro Parolari
- Universitary Cardiac Surgery Unit, IRCCS Policlinico S. Donato, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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10
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Barili F, Freemantle N, Pilozzi Casado A, Rinaldi M, Folliguet T, Musumeci F, Gerosa G, Parolari A. Mortality in trials on transcatheter aortic valve implantation versus surgical aortic valve replacement: a pooled meta-analysis of Kaplan-Meier-derived individual patient data. Eur J Cardiothorac Surg 2021; 58:221-229. [PMID: 32236543 DOI: 10.1093/ejcts/ezaa087] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES This meta-analysis of Kaplan-Meier-estimated individual patient data was designed to evaluate the effects of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) on the long-term all-cause mortality rate, to examine the potential time-varying effect and to model their hazard ratios (HRs) over time. Moreover, we sought to compare traditional meta-analytic tools and estimated individual patient data meta-analyses. METHODS Trials comparing TAVI versus SAVR were identified through Medline, Embase, Cochrane databases and specialist websites. The primary outcome was death from any cause at follow-up. Enhanced secondary analyses of survival curves were performed estimating individual patient time-to-event data from published Kaplan-Meier curves. Treatments were compared with the random effect Cox model in a landmark framework and fully parametric models. RESULTS We identified 6 eligible trials that included 6367 participants, randomly assigned to undergo TAVI (3252) or SAVR (3115). According to the landmark analysis, the incidence of death in the first year after implantation was significantly lower in the TAVI group [risk-profile stratified HR 0.85, 95% confidence interval (CI) 0.73-0.99; P = 0.04], whereas there was a reversal of the HR after 40 months (risk-profile stratified HR 1.31, 95% CI 1.01-1.68; P = 0.04) favouring SAVR over TAVI. This time-varying trend of HRs was also confirmed by a fully parametric time-to-event model. Traditional meta-analytic tools were shown to be biased because they did not intercept heterogeneity and the time-varying effect. CONCLUSIONS The mortality rates in trials of TAVI versus SAVR are affected by treatments with a time-varying effect. TAVI is related to better survival in the first months after implantation whereas, after 40 months, it is a risk factor for all-cause mortality.
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Affiliation(s)
- Fabio Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
| | - Nicholas Freemantle
- Department of Primary Care and Population Health, University College London, London, UK
| | | | - Mauro Rinaldi
- Department of Cardiac Surgery, AOU "Città della Salute e della Scienza di Torino", University of Turin, Turin, Italy
| | | | - Francesco Musumeci
- Department of Heart and Vessels, Cardiac Surgery Unit and Heart Transplantation Center, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Gino Gerosa
- Department of Cardiac Surgery, University of Padua, Padua, Italy
| | - Alessandro Parolari
- Unit of Cardiac Surgery and Translational Research, IRCCS Policlinico S. Donato, University of Milan, Milan, Italy
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11
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Yashima F, Briasoulis A, Kuno T, Noguchi M, Ahmad H, Zaid S, Goldberg JB, Malik AH, Tang GHL. Cerebral embolic protection during transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:9-13. [PMID: 34024747 DOI: 10.1016/j.carrev.2021.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is controversial that cerebral embolic protection devices (CEPDs) reduce clinical stroke during transcatheter aortic valve replacement (TAVR). Herein, we investigated the impact of CEPDs on in-hospital clinical stroke using a nationally representative sample. METHODS AND RESULTS Using the National Inpatient Sample (NIS) database, 109,240 patients who underwent TAVR between 2017 and 2018 were included. They were categorized into 2 groups according to usage of CEPDs; the CEPD and non-CEPD groups. After propensity score matching, 3805 pairs were acquired. Our main outcome was in-hospital clinical stroke. Other outcomes were in-hospital mortality, acute kidney injury (AKI), AKI leading to hemodialysis, bleeding requiring transfusion, overall bleeding complications, infectious complications, length of stay, and total cost. In-hospital clinical stroke did not significantly differ between the 2 groups (0.7% versus 1.1%, p = 0.449). The CEPD group was associated with a significantly lower in-hospital mortality (0.5% versus 1.4%, p = 0.029) and reduced total cost ($49,047 ± 19,666 versus $50,051 ± 23,190, p < 0.001), compared with the non-CEPD group, whereas there were no significant differences in the other outcomes. CONCLUSIONS By using the NIS database with a large number of cases, TAVR with CEPDs was not associated with a lower incidence of in-hospital clinical stroke compared with no use of CEPDs after matching.
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Affiliation(s)
- Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, IA, USA.
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - Masahiko Noguchi
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Hasan Ahmad
- Department of Cardiology, Westchester Medical Center & New York Medical College, NY, USA
| | - Syed Zaid
- Department of Cardiology, Westchester Medical Center & New York Medical College, NY, USA
| | - Joshua B Goldberg
- Department of Cardiology, Westchester Medical Center & New York Medical College, NY, USA
| | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center & New York Medical College, NY, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, NY, New York, USA
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12
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Kuno T, Yokoyama Y, Briasoulis A, Mori M, Iwagami M, Ando T, Takagi H, Bangalore S. Duration of Antiplatelet Therapy Following Transcatheter Aortic Valve Replacement: Systematic Review and Network Meta-Analysis. J Am Heart Assoc 2021; 10:e019490. [PMID: 33870703 PMCID: PMC8200731 DOI: 10.1161/jaha.120.019490] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Although current guidelines recommend dual antiplatelet therapy (DAPT) for 3 to 6 months following transcatheter aortic valve replacement (TAVR), there are no studies directly comparing outcomes of different durations of DAPT following TAVR. Methods and Results PubMed, EMBASE, and Cochrane Database were searched through November 2020 to identify clinical studies that investigated single antiplatelet therapy versus DAPT use following TAVR. Studies using oral anticoagulants and antiplatelet therapy concomitantly were excluded. The DAPT group was subdivided by the duration of DAPT. We extracted the risk ratios (RRs) of major or life‐threatening bleeding, stroke, and all‐cause mortality. Four randomized controlled trials, 2 propensity‐score matched studies, and 1 observational study were identified, yielding a total of 2498 patients who underwent TAVR assigned to the single antiplatelet therapy group (n=1249), 3‐month DAPT group (n=485), or 6‐month DAPT group (n=764). Pooled analyses demonstrated that when compared with the single antiplatelet therapy group, the rates of major or life‐threatening bleeding were significantly higher in the 3‐ and 6‐month DAPT groups (RR [95% CI]=2.13 [1.33–3.40], P=0.016; RR [95% CI]=2.54 [1.49–4.33], P=0.007, respectively) with no difference between the 3‐month DAPT versus 6‐month DAPT groups. The rates of stroke and all‐cause mortality were similar among the 3 groups. Conclusions In this network meta‐analysis of antiplatelet therapy following TAVR, single antiplatelet therapy with aspirin had lower bleeding without increasing stroke or death when compared with either 3‐ or 6‐month DAPT.
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Affiliation(s)
- Toshiki Kuno
- Department of Medicine Icahn School of Medicine at Mount SinaiMount Sinai Beth Israel New York NY
| | - Yujiro Yokoyama
- Department of Surgery St. Luke's University Health Network Bethlehem PA
| | - Alexandros Briasoulis
- Division of Cardiology, Heart Failure and Transplantation University of Iowa Iowa City IA
| | - Makoto Mori
- Division of Cardiac Surgery Yale School of Medicine New Haven CT
| | - Masao Iwagami
- Department of Health Services Research University of Tsukuba Japan
| | - Tomo Ando
- Department of Cardiology Kawasaki Saiwai Hospital Kawasaki Japan
| | - Hisato Takagi
- Department of Cardiovascular Surgery Shizuoka Medical Center Shizuoka Japan
| | - Sripal Bangalore
- Division of Cardiovascular Medicine New York University School of Medicine New York NY
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13
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Saad M, Seoudy H, Frank D. Challenging Anatomies for TAVR-Bicuspid and Beyond. Front Cardiovasc Med 2021; 8:654554. [PMID: 33928138 PMCID: PMC8076502 DOI: 10.3389/fcvm.2021.654554] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/15/2021] [Indexed: 12/23/2022] Open
Abstract
Transcatheter aortic valve replacement has emerged as the standard treatment for the majority of patients with symptomatic aortic stenosis. As transcatheter aortic valve replacement expands to patients across all risk groups, optimal patient selection strategies and device implantation techniques become increasingly important. A significant number of patients referred for transcatheter aortic valve replacement present with challenging anatomies and clinical indications that had been historically considered a contraindication for transcatheter aortic valve replacement. This article aims to highlight and discuss some of the potential obstacles that are encountered in clinical practice with a particular emphasis on bicuspid aortic valve disease.
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Affiliation(s)
- Mohammed Saad
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Hatim Seoudy
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
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14
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Tarantini G, Baumgartner H, Frank D, Husser O, Bleiziffer S, Rudolph T, Jeger R, Fraccaro C, Hovorka T, Wendler O. Four-year mortality in women and men after transfemoral transcatheter aortic valve implantation using the SAPIEN 3. Catheter Cardiovasc Interv 2021; 97:876-884. [PMID: 32886851 DOI: 10.1002/ccd.29257] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/07/2020] [Accepted: 08/02/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To investigate 4-year, post-transcatheter aortic valve implantation (TAVI) survival and predictors of survival by sex, in a real-world cohort that underwent transfemoral TAVI with SAPIEN 3 transcatheter heart valve. BACKGROUND Previous TAVI investigations of first-generation devices demonstrated an early- to mid-term survival advantage in women compared with men. METHODS SOURCE 3 (SAPIEN 3 Aortic Bioprosthesis European Outcome) is a post-approval, multicentre, observational registry. Patients (N = 1,694, 49.2% women, age 81.7 ± 6.7 years) with severe aortic stenosis and high surgical risk (logistic EuroSCORE 17.8%) underwent TAVI between 2014 and 2015. Kaplan-Meier event estimates were used to determine mortality by sex. Predictors of overall mortality were identified using a cox multivariate proportional hazard model. RESULTS At 4 years, women had lower all-cause mortality than men (36.0 vs 39.7%; p = .0911; HR: 0.87 [95% CI: 0.75-1.02]). No difference was observed for cardiac mortality between women 24.2% and men 24.7% (p = .76; HR: 0.97 [95% CI: 0.79-1.19]). When adjusted for baseline characteristics (age, height, weight, NYHA functional class, renal insufficiency, EuroScore, and tricuspid regurgitation), sex had no impact on mortality. CONCLUSIONS In this large, real-world cohort, all-cause mortality trended lower in women than men at 4 years post TAVI; however, several baseline factors, but not sex, were predictors of mortality. No difference between sexes was observed for cardiovascular mortality.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, University of Padova, Padova, Italy
| | - Helmut Baumgartner
- Department of Cardiology III, University-Hospital Münster, Münster, Germany
| | - Derk Frank
- University Hospital Schleswig-Holstein, Kiel, Germany and DZHK (German Centre for Cardiovascular Research), Kiel, Germany
| | - Oliver Husser
- Department of Cardiology, Klinik für Innere Medizin, St.-Johannes-Hospital, Dortmund, Germany
| | - Sabine Bleiziffer
- Klinik für Thorax- und Kardiovaskularchirurgie, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Tanja Rudolph
- Klinik für Thorax- und Kardiovaskularchirurgie, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Raban Jeger
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Science, University of Padova, Padova, Italy
| | - Tomas Hovorka
- Statistics Department, Edwards Lifesciences, Prague, Czech Republic
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
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15
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Kylies D, Freitag-Wolf S, Fulisch F, Seoudy H, Kuhn C, Kihm LP, Pühler T, Lutter G, Dempfle A, Frey N, Feldkamp T, Frank D. Improvement of renal function after transcatheter aortic valve replacement and its impact on survival. BMC Nephrol 2021; 22:77. [PMID: 33653283 PMCID: PMC7923662 DOI: 10.1186/s12882-021-02274-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/18/2021] [Indexed: 11/26/2022] Open
Abstract
Background Chronic kidney disease as well as acute kidney injury are associated with adverse outcomes after transcatheter aortic valve replacement (TAVR). However, little is known about the prognostic implications of an improvement in renal function after TAVR. Methods Renal improvement (RI) was defined as a decrease in postprocedural creatinine in μmol/l of ≥1% compared to its preprocedural baseline value. A propensity score representing the likelihood of RI was calculated to define patient groups which were comparable regarding potential confounders (age, sex, BMI, NYHA classification, STS score, log. EuroSCORE, history of atrial fibrillation/atrial flutter, pulmonary disease, previous stroke, CRP, creatinine, hsTNT and NT-proBNP). The cohort was stratified into 5 quintiles according to this propensity score and the survival time after TAVR was compared within each subgroup. Results Patients in quintile 5 (n = 93) had the highest likelihood for RI. They were characterized by higher creatinine, lower eGFR, higher NYHA class, higher NT-proBNP, being mostly female and having shorter overall survival time. Within quintile 5, patients without RI had significantly shorter survival compared to patients with RI (p = 0.002, HR = 0.32, 95% CI = [0.15–0.69]). There was no survival time difference between patients with and without RI in the whole cohort (p = 0.12) and in quintiles 1 to 4 (all p > 0.16). Analyses of specific subgroups showed that among patients with NYHA class IV, those with RI also had a significant survival time benefit (p < 0.001, HR = 0.15; 95%-CI = [0.05–0.44]) compared to patients without RI. Conclusions We here describe a propensity score-derived specific subgroup of patients in which RI after TAVR correlated with a significant survival benefit. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02274-5.
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Affiliation(s)
- Dominik Kylies
- Department of Internal Medicine IV, Nephrology and Hypertensiology, University Hospital Schleswig-Holstein, Kiel, Germany.,Present Address: Department of Internal Medicine III, Nephrology, Rheumatology and Endocrinology, University Hospital Hamburg (UKE), Hamburg, Germany
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Florian Fulisch
- Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Hatim Seoudy
- Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
| | - Christian Kuhn
- Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Lars Philipp Kihm
- Department of Internal Medicine I, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Pühler
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Georg Lutter
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany
| | - Thorsten Feldkamp
- Department of Internal Medicine IV, Nephrology and Hypertensiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology, Angiology and Critical Care, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/ Kiel/ Lübeck, Kiel, Germany.
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16
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Rullo CA. Transcatheter aortic valve replacement: An alternative for severe aortic stenosis. JAAPA 2021; 34:39-44. [PMID: 33600109 DOI: 10.1097/01.jaa.0000733244.57997.fe] [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: 11/25/2022]
Abstract
ABSTRACT Transcatheter aortic valve replacement (TAVR) is considered a lower-risk procedure for patients with severe aortic valve stenosis. Several FDA-approved trials performed in the United States support TAVR to be beneficial over surgical aortic valve replacement in certain patient populations. An optimal TAVR program consists of a multidisciplinary team that selects candidates for the procedure based on shared decision-making and the patient's anatomy and risk factors, and follows the patients through the Transcatheter Valve Therapy National Registry.
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Affiliation(s)
- Christine A Rullo
- Christine A. Rullo practices in cardiothoracic surgery at Beacon Medical Group in South Bend, Ind. The author has disclosed no potential conflicts of interest, financial or otherwise
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17
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Sá MPBO, Simonato M, Van den Eynde J, Cavalcanti LRP, Alsagheir A, Tzani A, Fovino LN, Kampaktsis PN, Gallo M, Laforgia PL, Ruhparwar A, Weymann A, Hirji SA, Kaneko T, H L Tang G. Balloon versus self-expandable transcatheter aortic valve implantation for bicuspid aortic valve stenosis: A meta-analysis of observational studies. Catheter Cardiovasc Interv 2021; 98:E746-E757. [PMID: 33555107 DOI: 10.1002/ccd.29538] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/15/2020] [Accepted: 01/17/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is a rising trend for transcatheter aortic valve implantation (TAVI) in bicuspid aortic stenosis patients. Data on the use of self-expandable (SEV) vs. balloon-expandable (BEV) valves in these patients are scarce. Therefore, we systematically compared clinical outcomes in bicuspid aortic stenosis patients treated with SEV and BEV. METHODS Data were extracted from PubMed/MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, Google Scholar and reference lists of relevant articles. Eight studies published from 2013 to 2020 including a total of 1,080 patients (BEV: n = 620; SEV: n = 460) were selected. Primary endpoints were procedural, 30-day and 1-year mortality. Secondary endpoints were new pacemaker implantation, annular rupture, coronary obstruction, moderate-to-severe paravalvular leak, need of second valve, stroke and acute kidney injury. RESULTS We found no statistically significant difference in mortality between patients treated with BEV vs. SEV during index procedure, at 30 days and at 1 year. BEVs showed a statistically significant higher risk of annulus rupture (2.5%) in comparison with SEV (0%) (OR 5.81 [95% CI, 3.78-8.92], p < .001). New generation BEVs were also associated with significantly less paravalvular leak when compared to new generation SEVs (OR 0.08 [95% CI, 0.02-0.35], p = .001). CONCLUSIONS This meta-analysis of observational studies of TAVI for bicuspid valves, showed no difference in short- and mid-term TAVI mortality with BEVs and SEVs. BEVs presented a higher risk of annular rupture in comparison with SEV.
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Affiliation(s)
- Michel Pompeu B O Sá
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco-PROCAPE, University of Pernambuco, Recife, Pernambuco, Brazil
| | - Matheus Simonato
- Division of Cardiac Surgery, Escola Paulista de Medicina-UNIFESP, São Paulo, São Paulo, Brazil
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Luiz Rafael P Cavalcanti
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco-PROCAPE, University of Pernambuco, Recife, Pernambuco, Brazil
| | - Ali Alsagheir
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.,Division of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Aspasia Tzani
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Michele Gallo
- Department of Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | - Pietro L Laforgia
- I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Sameer A Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, New York, USA
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18
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Kadoya Y, Zen K, Tamaki N, Yashige M, Takamatsu K, Ito N, Kuwabara K, Yamano M, Yamano T, Nakamura T, Yaku H, Matoba S. Prognostic value of cardiac 123 I-metaiodobenzylguanidine imaging for predicting cardiac events after transcatheter aortic valve replacement. ESC Heart Fail 2021; 8:1106-1116. [PMID: 33400391 PMCID: PMC8006649 DOI: 10.1002/ehf2.13123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/16/2020] [Accepted: 11/07/2020] [Indexed: 01/02/2023] Open
Abstract
Aims In patients with aortic valve stenosis (AS), cardiac sympathetic nervous (CSN) dysfunction and its improvement after transcatheter aortic valve replacement (TAVR) have been reported. The prognostic impact of CSN function remains unclear. This study investigated the prognostic value of cardiac 123I‐metaiodobenzylguanidine (MIBG) imaging for predicting cardiac events after TAVR. Methods and results This single‐centre prospective observational study enrolled patients with AS between July 2017 and May 2019. MIBG scintigraphy was performed before and soon after TAVR to evaluate the late heart–mediastinum ratio (L‐H/M). Patients were classified into three pairs of groups based on the baseline and post‐TAVR L‐H/M (≥2.0 or <2.0) and on the presence of TAVR‐related improvement in L‐H/M. The study endpoint was the occurrence of major adverse cardiac events (MACE), defined as a composite of all‐cause death, non‐fatal myocardial infarction, and hospitalization due to heart failure. Among the 187 consecutive patients who underwent TAVR, 107 (27 men; median age: 86 years) were evaluated. Over a median follow‐up of 366 days, 15 (14.0%) patients had MACE. The incidence of MACE was significantly low in patients with L‐H/M improvement and/or high post‐TAVR L‐H/M (≥2.0). Baseline L‐H/M and frailty were associated with poor response of L‐H/M to TAVR treatment. TAVR‐related improvement in L‐H/M had significant effects on MACE, with an adjusted hazard ratio of 0.233 (95% confidence interval, 0.064–0.856; P = 0.028). Conclusions TAVR‐related improvement in L‐H/M was an independent predictor of cardiac events, 1 year after TAVR. Cardiac MIBG imaging is useful for predicting cardiac events after TAVR.
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Affiliation(s)
- Yoshito Kadoya
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Masaki Yashige
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuaki Takamatsu
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Nobuyasu Ito
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kensuke Kuwabara
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tetsuhiro Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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19
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Nai Fovino L, Cipriani A, Fabris T, Massussi M, Scotti A, Lorenzoni G, Guerra MC, Cardaioli F, Rodinò G, Matsuda Y, Masiero G, Leoni L, Zorzi A, Fraccaro C, Tarantini G. Anatomical Predictors of Pacemaker Dependency After Transcatheter Aortic Valve Replacement. Circ Arrhythm Electrophysiol 2020; 14:e009028. [PMID: 33306415 DOI: 10.1161/circep.120.009028] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Conduction disturbances after transcatheter aortic valve replacement (TAVR) are often transient. Limited data exist on anatomic factors predisposing to pacemaker dependency after TAVR. We sought to assess the rate and the possible predictors of pacemaker dependency after TAVR. METHODS Consecutive patients undergoing pacemaker implantation up to 30 days after TAVR between May 2014 and September 2019 were included. Baseline electrocardiographic, computed tomography, and procedural characteristics were collected, including valve implantation depth and membranous septum length, an anatomic surrogate of the distance between the aortic annulus and the His bundle. Pacemaker dependency at 30 days and 1 year and all-cause mortality during follow-up were evaluated. RESULTS Of 728 TAVR patients, 112 (53.5% men; median age, 81 years) underwent pacemaker implantation after TAVR. Of these, 44.6% (50 of 112) were pacemaker dependent at 30 days and 46.7% (36 of 77) at 1 year. By multivariate analysis, independent predictors of 30-day pacemaker dependency included left ventricular outflow tract calcifications under the left coronary cusp (odds ratio, 5.69 [95% CI, 1.45-22.31]; P=0.013) and a difference between membranous septum length and implantation depth (ΔMSID) ≥3 mm (odds ratio, 7.58 [95% CI, 2.07-27.78]; P=0.002). Conversely, membranous septum length and implantation depth alone were not associated with pacemaker dependency (odds ratio, 0.79 [95% CI, 0.60-1.05]; P=0.11 and odds ratio, 1.11 [95% CI, 0.99-1.24]; P=0.08). At a median follow-up of 28.1 (11.7-48.6) months, pacemaker-dependent patients did not show a worse survival (P=0.26). CONCLUSIONS Less than half of the patients undergoing pacemaker implantation after TAVR are pacemaker-dependent at midterm follow-up. ΔMSID ≥3 mm and the presence of left ventricular outflow tract calcifications under the left coronary cusp, but not membranous septum length nor implantation depth alone, are predictive of long-term pacemaker dependency after TAVR, thus influencing device selection and programming.
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Affiliation(s)
- Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Tommaso Fabris
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Mauro Massussi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Andrea Scotti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Giulia Lorenzoni
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Maria Chiara Guerra
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Giulio Rodinò
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Yuji Matsuda
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Loira Leoni
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
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20
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Yashima F, Yokoyama Y, Takagi H, Briasoulis A, Kuno T. Clinical outcomes of transcatheter aortic valve implantation in failed bioprosthetic surgical valves vs. native aortic stenosis: insights from a meta-analysis. Cardiovasc Interv Ther 2020; 37:182-190. [PMID: 33206349 DOI: 10.1007/s12928-020-00732-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
There is no meta-analysis comparing clinical outcomes between valve-in-valve transcatheter aortic valve implantation for failed surgical bioprosthetic valves (ViV-TAVI) and native valve TAVI for aortic stenosis (NV-TAVI). We aimed to investigate clinical outcomes between ViV-TAVI and NV-TAVI using a meta-analysis. EMBASE and MEDLINE were searched through April 2020 to investigate the comparative outcomes between ViV-TAVI and NV-TAVI. The main outcomes were short-term (30-day/in-hospital) mortality, pacemaker implantation (PMI), life threatening and/or major bleeding, stroke, and coronary obstruction, and long-term (1-year) mortality and stroke. Our search identified 5 observational studies enrolling a total of 8428 patients (1442 patients with ViV-TAVI and 6986 with NV-TAVI). ViV-TAVI was associated with significantly lower rates of short-term mortality, PMI, and life threatening and/or major bleeding, compared with NV-TAVI (relative risk [RR] [95% CI] 0.54 [0.34-0.84], P = 0.007; 0.25 [0.19-0.35], P < 0.0001; 0.64 [0.46-0.89], P = 0.008, respectively). There were no significant differences in rates of short-term stroke and coronary obstruction between ViV-TAVI and NV-TAVI (RR [95% CI] 0.59 [0.35-1.01], P = 0.06; 1.86 [0.78-4.41], P = 0.16, respectively). ViV-TAVI was also associated with a significantly lower rate of 1-year mortality compared with NV-TAVI (RR [95% CI] 0.64 [0.51-0.81], P = 0.0002), whereas there was no significant difference in long-term stroke (RR [95% CI] 0.71 [0.45-1.12], P = 0.51). ViV-TAVI was associated with significantly lower rates of short-term mortality, PMI, and life threatening and/or major bleeding, and long-term mortality, without increased risks of stroke and coronary obstruction, compared with NV-TAVI.
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Affiliation(s)
- Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Yujiro Yokoyama
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, Iowa, USA
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue, 16th street, New York, NY, 10003, USA.
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Lorenzoni G, Azzolina D, Fraccaro C, Di Liberti A, D'Onofrio A, Cavalli C, Fabris T, D'Amico G, Cibin G, Nai Fovino L, Ocagli H, Gerosa G, Tarantini G, Gregori D. Using Wearable Devices to Monitor Physical Activity in Patients Undergoing Aortic Valve Replacement: Protocol for a Prospective Observational Study. JMIR Res Protoc 2020; 9:e20072. [PMID: 33180023 PMCID: PMC7691084 DOI: 10.2196/20072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 12/25/2022] Open
Abstract
Background In last few decades, several tools have been developed to measure physical function objectively; however, their use has not been well established in clinical practice. Objective This study aims to describe the preoperative physical function and to assess and compare 6-month postoperative changes in the physical function of patients undergoing treatment for aortic stenosis with either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). The study also aims to evaluate the feasibility of wearable devices in assessing physical function in such patients. Methods This is a prospective observational study. The enrollment will be conducted 1 month before patients’ SAVR/TAVR. Patients will be provided with the wearable device at baseline (activity tracker device, Garmin vívoactive 3). They will be trained in the use of the device, and they will be requested to wear it on the wrist of their preferred hand until 12 months after SAVR/TAVR. After baseline assessment, they will undergo 4 follow-up assessments at 1, 3, 6, and 12 months after SAVR/TAVR. At baseline and each follow-up, they will undergo a set of standard and validated tests to assess physical function, health-related quality of life, and sleep quality. Results The ethics committee of Vicenza in Veneto Region in Italy approved the study (Protocol No. 943; January 4, 2019). As of October 2020, the enrollment of participants is ongoing. Conclusions The use of the wearable devices for real-time monitoring of physical activity of patients undergoing aortic valve replacement is a promising opportunity for improving the clinical management and consequently, the health outcomes of such patients. Trial Registration Clinicaltrials.gov NCT03843320; https://tinyurl.com/yyareu5y International Registered Report Identifier (IRRID) DERR1-10.2196/20072
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Affiliation(s)
- Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Chiara Fraccaro
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessandro Di Liberti
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Augusto D'Onofrio
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Chiara Cavalli
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Tommaso Fabris
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gianpiero D'Amico
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giorgia Cibin
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Luca Nai Fovino
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Honoria Ocagli
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giuseppe Tarantini
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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22
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Kuno T, Takagi H, Ando T, Ueyama H, Fujisaki T, Kodaira M, Numasawa Y, Briasoulis A, Hayashida K. Short- and Long-term Outcomes in Dialysis Patients Undergoing Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis. Can J Cardiol 2020; 36:1754-1763. [DOI: 10.1016/j.cjca.2020.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 12/30/2022] Open
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Fraccaro C, Campante Teles R, Tchétché D, Saia F, Bedogni F, Montorfano M, Fiorina C, Meucci F, De Benedictis M, Leonzi O, Barbierato M, Dumonteil N, Stolcova M, Maffeo D, Compagnone M, Brito J, Chieffo A, Tarantini G. Transcatheter aortic valve implantation (TAVI) in cardiogenic shock: TAVI-shock registry results. Catheter Cardiovasc Interv 2020; 96:1128-1135. [PMID: 32627924 DOI: 10.1002/ccd.29112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/18/2020] [Accepted: 06/05/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Aim of this study is to evaluate safety, feasibility, and mid-term outcome of transcatheter aortic valve implantation (TAVI) in cardiogenic shock (CS). BACKGROUND Balloon aortic valvuloplasty in patients with severe aortic valve stenosis (SAS) complicated by CS is indicated but associated with a grim prognosis. TAVI might be a more reasonable treatment option in this setting but data are scant. METHODS From March 2008 to February 2019, 51 patients with severe aortic valvulopathy (native SAS or degenerated aortic bioprosthesis) and CS treated by TAVI in 11 European centers were included in this multicenter registry. Demographic, clinical, and procedural data were collected, as well as clinical and echocardiographic follow-up. RESULTS The mean age of our study population was 75.8 ± 13, 49% were women, and mean Society of Thoracic Surgeons (STS) score was 19 ± 15%. Device success was achieved in 94.1%, with a 5% incidence of moderate/severe paravalvular leak. The 30-day events were mortality 11.8%, stroke 2.0%, vascular complications 5.9%, and acute kidney injury 34%. Valve Academic Research Consortium-2 early safety endpoint was reached in 35.3% of cases. At 1-year of follow-up, the mortality rate was 25.7% and the readmission for congestive heart failure was 8.6%. CONCLUSIONS TAVI seems to be a therapeutic option for patients with CS and SAS or degenerated aortic bioprosthesis in terms of both safety and efficacy at early and long-term follow-up.
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Affiliation(s)
- Chiara Fraccaro
- Interventional Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Rui Campante Teles
- Serviço de Cardiologia, Hospital de Santa Cruz CHLO, Carnaxide, Portugal.,CEDOC, Nova Medical School, Lisbon, Portugal
| | - Didier Tchétché
- Groupe Cardiovasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Francesco Saia
- Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | | | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Claudia Fiorina
- Cardiac Catheterization Laboratory, Cardiothoracic Department Spedali Civili, Brescia, Italy
| | - Francesco Meucci
- Cardio-Toraco-Vascular Department, Careggi University Hospital, Florence, Italy
| | | | - Ornella Leonzi
- Department of Cardiology, Fondazione Poliambulanza, Brescia, Italy
| | - Marco Barbierato
- Dipartimento Cardio-Toraco-Vascolare, Emodinamica Aziendale AULSS 3 Serenissima, Mestre, Italy
| | - Nicolas Dumonteil
- Groupe Cardiovasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Miroslava Stolcova
- Cardio-Toraco-Vascular Department, Careggi University Hospital, Florence, Italy
| | - Diego Maffeo
- Department of Cardiology, Fondazione Poliambulanza, Brescia, Italy
| | - Miriam Compagnone
- Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - João Brito
- Serviço de Cardiologia, Hospital de Santa Cruz CHLO, Carnaxide, Portugal
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Tarantini
- Interventional Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
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24
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Tarantini G, Nai Fovino L, Le Prince P, Darremont O, Urena M, Bartorelli AL, Vincent F, Hovorka T, Alcalá Navarro Y, Dumonteil N, Ohlmann P, Wendler O. Coronary Access and Percutaneous Coronary Intervention Up to 3 Years After Transcatheter Aortic Valve Implantation With a Balloon-Expandable Valve. Circ Cardiovasc Interv 2020; 13:e008972. [PMID: 32580586 PMCID: PMC7373469 DOI: 10.1161/circinterventions.120.008972] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Coronary artery disease and aortic stenosis often coexist. Transcatheter aortic valve implantation (TAVI) has emerged as a valid therapeutic option for younger, lower-risk patients who may eventually require coronary artery disease treatment. Thus, post-TAVI coronary access (CA) and percutaneous coronary intervention are expected to increase. The purpose of this study was to retrospectively evaluate patients who were enrolled in the SOURCE 3 (SAPIEN 3 Aortic Bioprosthesis European Outcome) European registry for treatment with the balloon-expandable SAPIEN 3 transcatheter heart valve and underwent CA with or without percutaneous coronary intervention after TAVI. Methods: Baseline characteristics and clinical outcomes of patients with or without CA up to 3 years after TAVI were compared. A Kaplan-Meier estimate with a univariate model determined the impact of CA on cardiac mortality. Results: Of 1936 TAVI patients (mean age 81.6 years, 52% male), 68 (3.5%) had CA within 3 years (mean 441±332 days) after TAVI. At baseline, the logistic EuroSCORE was similar (20.2% versus 18.3%, P=0.2, CA and non-CA groups, respectively). Higher rates of coronary artery disease (76.5% versus 50.6%, P<0.001), myocardial infarction (20.6% versus 11.5%, P=0.03) and previous coronary artery bypass graft (22.1% versus 11.0%, P=0.01) were present in the CA group. In 100% of patients, CA was successfully achieved. The clinical success of percutaneous coronary intervention was 97.9%. Cardiovascular mortality was numerically higher in patients with CA than in those without CA. Conclusions: In the large SOURCE 3 European registry, CA was needed at 3-year follow-up after TAVI with a balloon-expandable valve in 3.5% of patients and was successful in all patients. The clinical success of percutaneous coronary intervention was 97.9%. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02698956.
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Affiliation(s)
- Giuseppe Tarantini
- Cardiology Clinic, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health Padova, University of Padua, Italy (G.T., L.N.F.)
| | - Luca Nai Fovino
- Cardiology Clinic, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health Padova, University of Padua, Italy (G.T., L.N.F.)
| | | | | | | | | | | | - Tomas Hovorka
- Edwards Lifesciences, Prague, Czech Republic (T.H., Y.A.N.)
| | | | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel (GCVI), Clinique Pasteur, Toulouse, France (N.D.)
| | - Patrick Ohlmann
- Department of Interventional Cardiology, University Hospital of Strasbourg, France (P.O.)
| | - Olaf Wendler
- King's College Hospital, London, United Kingdom (O.W.)
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25
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Matsuda Y, Nai Fovino L, Giacoppo D, Scotti A, Massussi M, Ueshima D, Sasano T, Fabris T, Tarantini G. Association between surgical risk and 30‐day stroke after transcatheter versus surgical aortic valve replacement: a systematic review and meta‐analysis. Catheter Cardiovasc Interv 2020; 97:E536-E543. [DOI: 10.1002/ccd.29105] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/07/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Yuji Matsuda
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
- Department of Cardiovascular Medicine Graduate School of General Medical and Dental Science, Tokyo Medical and Dental University Tokyo Japan
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Daniele Giacoppo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Andrea Scotti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Mauro Massussi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Daisuke Ueshima
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine Graduate School of General Medical and Dental Science, Tokyo Medical and Dental University Tokyo Japan
| | - Tommaso Fabris
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
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Nai Fovino L, Scotti A, Massussi M, Cardaioli F, Rodinò G, Matsuda Y, Pavei A, Masiero G, Napodano M, Fraccaro C, Fabris T, Tarantini G. Coronary Angiography After Transcatheter Aortic Valve Replacement (TAVR) to Evaluate the Risk of Coronary Access Impairment After TAVR-in-TAVR. J Am Heart Assoc 2020; 9:e016446. [PMID: 32578484 PMCID: PMC7670517 DOI: 10.1161/jaha.120.016446] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Transcatheter aortic valve replacement (TAVR)‐in‐TAVR is a possible treatment for transcatheter heart valve (THV) degeneration. However, the displaced leaflets of the first THV will create a risk plane (RP) under which the passage of a coronary catheter will be impossible. The aim of our study was to evaluate the potential risk of impaired coronary access (CA) after TAVR‐in‐TAVR. Methods and Results We prospectively performed coronary angiography after TAVR with different THVs in 137 consecutive patients, looking where the catheter crossed the valve frame. If coronary cannulation was achieved from below the RP, the distance between valve frame and aortic wall was measured by aortic angiography. CA after TAVR‐in‐TAVR was defined as feasible if the catheter passed above the RP, as theoretically feasible if passed under the RP with valve‐to‐aorta distance >2 mm, and as unfeasible if passed under the RP with valve‐to‐aorta distance ≤2 mm. Seventy‐two patients (53%) received a Sapien 3 THV, 26 (19%) received an Evolut Pro/R THV, and 39 (28%) received an Acurate Neo THV. CA after TAVR‐in‐TAVR was considered feasible in 40.9% (68.1%, 19.2%, and 5.1%, respectively; P<0.001), theoretically feasible in 27.7% (8.3%, 42.3%, and 53.8%, respectively; P<0.001), and unfeasible in 31.4% (23.6%, 38.5%, and 41.1%, respectively; P=0.116). Independent predictors of impaired CA after TAVR‐in‐TAVR were female sex (odds ratio [OR], 3.99; 95% CI, 1.07–14.86; P=0.040), sinotubular junction diameter (OR, 0.62; 95% CI, 0.48–0.80; P<0.001), and implantation of a supra‐annular THV (OR, 6.61; 95% CI, 1.98–22.03; P=0.002). Conclusions CA after TAVR‐in‐TAVR might be unfeasible in >30% of patients currently treated with TAVR. Patients with a small sinotubular junction and those who received a supra‐annular THV are at highest risk of potential CA impairment with TAVR‐in‐TAVR.
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Affiliation(s)
- Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Andrea Scotti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Mauro Massussi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Giulio Rodinò
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Yuji Matsuda
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Andrea Pavei
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Massimo Napodano
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Tommaso Fabris
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
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27
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Bechtel AJ, Huffmyer JL. Gender Differences in Postoperative Outcomes After Cardiac Surgery. Anesthesiol Clin 2020; 38:403-415. [PMID: 32336392 DOI: 10.1016/j.anclin.2020.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Women presenting for cardiac surgery tend to be older and have hypertension, diabetes, and overweight or underweight body mass index than men. Despite improvements in surgical techniques and medications, women have increased risk for morbidity and mortality after multiple types of cardiac surgery. Women presenting for transcatheter aortic valve replacement are older and frailer than men, and have increased risk of intraoperative complications, but lower mortality at mid- and long-term ranges compared with men. Adherence to recovery and rehabilitation from cardiac surgery is challenging for women. Solutions should focus on increased family support, and use of group exercise and activities.
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Affiliation(s)
- Allison J Bechtel
- Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA 22908-0710, USA
| | - Julie L Huffmyer
- Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA 22908-0710, USA.
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Takagi H, Hari Y, Nakashima K, Kuno T, Ando T. Mortality after transcatheter versus surgical aortic valve replacement: an updated meta-analysis of randomised trials. Neth Heart J 2020; 28:320-333. [PMID: 32166571 PMCID: PMC7270388 DOI: 10.1007/s12471-020-01378-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background To determine whether transcatheter aortic valve implantation (TAVI) improves early (30-day) and midterm (1-year) mortality compared with surgical aortic valve replacement (SAVR), we performed an updated meta-analysis of all the currently available randomised controlled trials (RCTs). Methods To identify all RCTs providing both 30-day and 1‑year mortality after TAVI versus SAVR, PubMed and ClinicalTrials.gov were searched up to and including July 2019. A risk difference (RD) and its 95% confidence interval were generated using data of prespecified outcomes in both the TAVI and SAVR groups. Study-specific estimates were pooled using inverse variance-weighted averages of RDs in the random-effects model. Results We identified seven eligible high-quality RCTs including a total of 7631 as-treated patients. Pooled analyses demonstrated significantly lower 30-day (RD −0.60%; p = 0.046) and 1‑year all-cause mortality (RD −1.12%; p = 0.03) after TAVI than after SAVR. No funnel plot asymmetry was detected for 30-day and 1‑year mortality. Meta-regression analyses indicated that RDs of 30-day and 1‑year mortality between TAVI and SAVR were not modulated by mean Society of Thoracic Surgeons Predicted Risk of Mortality score. Bleeding complications at 30 days and 1 year and stage 2/3 acute kidney injury at 30 days were significantly less frequent after TAVI than after SAVR, whereas major vascular complications and new permanent pacemaker implantation at 30 days and 1 year were significantly more frequent after TAVI than after SAVR. Conclusion The best evidence from the present meta-analysis of all the currently available RCTs suggests that TAVI may reduce 30-day and 1‑year all-cause mortality compared with SAVR. Electronic supplementary material The online version of this article (10.1007/s12471-020-01378-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- H Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
| | - Y Hari
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - K Nakashima
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - T Kuno
- Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - T Ando
- Division of Interventional Cardiology, Department of Cardiology, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
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Ozaki Procedure. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 27:451-453. [PMID: 32082906 DOI: 10.5606/tgkdc.dergisi.2019.01903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 11/21/2022]
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Purita PAM, Tahoces LS, Fraccaro C, Nai Fovino L, Kim WK, Espada-Guerreiro C, De Backer O, Seiffert M, Nombela-Franco L, Gomez RM, Mangieri A, Franzone A, Bedogni F, Castriota F, Attisano T, Søndergaard L, Antolin RH, Tarantini G. Transcatheter treatment of native aortic valve regurgitation: Results from an international registry using the transfemoral ACURATE neo valve. IJC HEART & VASCULATURE 2020; 27:100480. [PMID: 32083165 PMCID: PMC7016455 DOI: 10.1016/j.ijcha.2020.100480] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/24/2019] [Accepted: 01/31/2020] [Indexed: 12/26/2022]
Abstract
Native aortic valve regurgitation (NAVR) presents technical challenges for TAVR. This is the largest study on NAVR patients treated with the ACURATE neo valve. Intraprocedural mortality was 0%, device success 87.5% and moderate PVL rate 8.3%. Device success tended to be higher with perimeter-based >10% oversizing.
Background Transcatheter aortic valve replacement (TAVR) has been validated for the treatment of severe symptomatic aortic stenosis in patients at high and intermediate surgical risk. Recently, TAVR has been proposed as an alternative to medical therapy in inoperable patients with severe native aortic valve regurgitation (NAVR). This multicenter international registry sought to evaluate safety and efficacy of TAVR with the self-expandable ACURATE neo valve in a cohort of patients with NAVR. Methods A total of 24 patients with severe NAVR treated by TAVR between September 2016 and October 2018 in 13 European centers were included. Clinical, procedural and follow up data were inserted in a dedicated database. Outcomes were codified according to Valve Academic Research Consortium-2 criteria. Results Mean age was 79.4 years, 58.4% were female. Mean EuroSCORE II and STS score were 5% and 3.9%, respectively. Device success was 87.5%. Moderate paravalvular leak (PVL) was found in two (8.3%) of patients, both with a perimeter oversizing index <10%. Implantation of a second device was necessary in three cases (12.5%), one for severe PVL and two for device displacement. New pacemaker implantation rate was 21.1%. At 30 days, stroke and all-cause mortality rates were 0% and 4.1%, respectively. Conclusions This multicenter study suggests good feasibility and early safety of transfemoral TAVR with the self-expandable ACURATE neo device in patients with severe NAVR refused for surgery. Rates of moderate PVL, new pacemaker implantation and need for a second valve were higher than those reported for TAVR in aortic stenosis.
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Affiliation(s)
| | | | - Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | | | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Morritz Seiffert
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Luis Nombela-Franco
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Anna Franzone
- Department of Advanced Biomedical Sciences, University Federico II University, Naples, Italy
| | - Francesco Bedogni
- IRCCS Policlinico San Donato, Piazza E.Malan, San Donato Milanese, Italy
| | | | - Tiziana Attisano
- Dipartiment of Cardiac, Thoracic and Vascular SciencesHospital S. Giovanni Di Dio e Ruggi D'aragona, Salerno, Italy
| | | | | | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
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Nai Fovino L, Scotti A, Massussi M, Fabris T, Cardaioli F, Rodinò G, Matsuda Y, Frigo F, Fraccaro C, Tarantini G. Incidence and feasibility of coronary access after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 96:E535-E541. [DOI: 10.1002/ccd.28720] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 12/31/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Andrea Scotti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Mauro Massussi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Tommaso Fabris
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Giulio Rodinò
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Yuji Matsuda
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Francesca Frigo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
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Ueshima D, Nai Fovino L, Brener SJ, Fabris T, Scotti A, Barioli A, Giacoppo D, Pavei A, Fraccaro C, Napodano M, Tarantini G. Transcatheter aortic valve replacement for bicuspid aortic valve stenosis with first- and new-generation bioprostheses: A systematic review and meta-analysis. Int J Cardiol 2020; 298:76-82. [DOI: 10.1016/j.ijcard.2019.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 01/10/2023]
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Ferlini M, Fortuni F, Di Giacomo C, Cornara S, Somaschini A, Oltrona Visconti L, Ferrario M. Transcatheter aortic valve replacement versus surgery in low-risk patients: a meta-analysis of randomized studies. J Cardiovasc Med (Hagerstown) 2019; 21:168-170. [PMID: 31568091 DOI: 10.2459/jcm.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Tarantini G, Nai Fovino L, D'Errigo P, Rosato S, Barbanti M, Tamburino C, Ranucci M, Santoro G, Badoni G, Seccareccia F. Factors influencing the choice between transcatheter and surgical treatment of severe aortic stenosis in patients younger than 80 years: Results from the OBSERVANT study. Catheter Cardiovasc Interv 2019; 95:E186-E195. [PMID: 31423704 DOI: 10.1002/ccd.28447] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/01/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We aimed to analyze the baseline features and clinical outcomes of patients younger than 80 years undergoing transfemoral transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) enrolled in the OBservational Study of Effectiveness of SAVR-TAVR procedures for severe Aortic steNosis Treatment (OBSERVANT) real-world study, focusing on variables guiding Heart Team decision toward TAVI. BACKGROUND Patients treated with TAVI, independently of surgical risk score, are mostly older than 80 years. METHODS OBSERVANT is a multicenter, observational, prospective cohort study that enrolled patients with symptomatic severe aortic stenosis (AS) who underwent SAVR or TAVI from December 2010 to June 2012 in 93 Italian participating hospitals. For this analysis, baseline characteristics, therapeutic approach and outcomes up to 5 years of follow-up of 4,801 patients under 80 years of age were collected. Patients were stratified by age classes (<65, 65-74, and 75-79 years). RESULTS Patients <80 years of age with severe symptomatic AS undergoing TAVI (n = 483) had significantly higher Logistic EuroSCORE (10.84% vs. 5.22%, p < .001) and prevalence of comorbidities compared to subjects undergoing SAVR (n = 4,318). The decision to perform TAVI over SAVR was driven by anatomical factors, mainly previous cardiac surgery (odds ratio [OR] 24.73, confidence interval [CI] 12.71-48.10, p < .001) and the presence of porcelain aorta (OR 17.44, CI 6.67-45.55, p < .001), and clinical factors, mainly moderate-severe frailty score (OR 5.49, CI 3.33-9.07, p < .001), oxygen dependency (OR 7.42, CI 2.75-20.04, p < .001) and need for dialytic treatment (OR 5.24, CI 1.54-17.80, p < .008). Among patients undergoing TAVI, those under 65 years had the highest baseline risk profile (despite a low Logistic EuroSCORE) and the highest 5-year mortality compared to those 65-74 and 75-79-year-old (65.22% vs. 48.54% vs. 55.24%, log-rank p = .061). CONCLUSION Among patients under 80 years of age with symptomatic severe AS, only 10% underwent TAVI. These patients were at higher baseline risk compared to those undergoing SAVR. The decision to perform TAVI was driven by the presence of both anatomical and clinical factors beyond surgical risk scores. Patients under 65 years of age, despite the low Logistic EuroSCORE, had the highest preoperative risk profile and carried the worse outcome.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | | | | | - Marco Barbanti
- Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Marco Ranucci
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy
| | - Gennaro Santoro
- Fondazione "G.Monasterio" CNR/Regione Toscana per la Ricerca Medica e la Sanità Pubblica, Florence, Italy
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Tabata N, Tsujita K. Newer Specific Risk Scores for Outcome After Transcatheter Aortic Valve Replacement. Circ J 2019; 83:1630-1632. [PMID: 31243188 DOI: 10.1253/circj.cj-19-0498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Noriaki Tabata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
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36
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
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Ielasi A, Latib A, Tespili M, Donatelli F. Current results and remaining challenges of trans-catheter aortic valve replacement expansion in intermediate and low risk patients. IJC HEART & VASCULATURE 2019; 23:100375. [PMID: 31193348 PMCID: PMC6525308 DOI: 10.1016/j.ijcha.2019.100375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 05/01/2019] [Accepted: 05/04/2019] [Indexed: 01/15/2023]
Abstract
TAVR has become the standard treatment in patients at increased surgical risk (STS or EuroSCORE II ≥4% or logistic EuroSCORE I ≥ 10% or other risk factors not included in these scores such as frailty, porcelain aorta, sequelae of chest radiation) and it is increasingly being performed in patients at intermediate to low (STS or EuroSCORE II <4% or logistic EuroSCORE I < 10%) surgical risk. Although non-inferiority has been demonstrated in intermediate and low-risk patients, several challenges need to be addressed before expansion to younger patients. Current trends, trials results, and remaining challenges are summarized and discussed in this review.
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Affiliation(s)
- Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
| | - Azeem Latib
- Clinical and Interventional Cardiology Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
- Department of Cardiology, Montefiore Medical Center, New York, NY, United States
| | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
| | - Francesco Donatelli
- Cardiac Surgery Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
- Chair of Cardiac Surgery, University of Milan, Milan, Italy
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TAVR-present, future, and challenges in developing countries. Indian J Thorac Cardiovasc Surg 2019; 35:473-484. [PMID: 33061033 DOI: 10.1007/s12055-018-00786-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/10/2018] [Accepted: 12/19/2018] [Indexed: 12/25/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has become a well-established therapy for inoperable and high-risk patients of Aortic Stenosis in most of the part of the world. The technological advancements in the hemodynamic performance and design of valve prosthesis and also the data provided by various trials regarding the safety and efficacy of TAVR have widened the scope of TAVR in intermediate and low-risk groups also. The main focus of this review is to discuss the feasibility of TAVR in developing countries. Along with this review, it also gives a detailed outlook of the pros and cons of TAVR along with insight into the future of TAVR and its adoption into the low-risk group.
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