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Takei Y, Saito S, Shibasaki I, Kuwata T, Yamada Y, Fukuda H. Simulation to determine the approach of transcatheter aortic valve implantation in patients undergoing hemodialysis. Surg Today 2024; 54:428-435. [PMID: 37668736 PMCID: PMC11026236 DOI: 10.1007/s00595-023-02743-4] [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: 04/19/2023] [Accepted: 08/13/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE The present study investigated potential access vessels in patients receiving hemodialysis who underwent surgical aortic valve replacement and determined which approaches were most suitable for performing transcatheter aortic valve implantation. METHODS Consecutive patients undergoing hemodialysis with aortic valve stenosis who underwent surgical aortic valve replacement were included. Preoperative computed tomography data were analyzed to assess the vessel diameter and calcification. Simulations were conducted to determine the feasibility of inserting the 14-F eSheath of Sapien 3 via transfemoral, trans-cervical, trans-subclavian, and direct aorta approaches. RESULTS A total of 72 patients were included in this study. The access route was characterized by severe calcification of the common iliac artery. The transfemoral approach was feasible in 77.8% of the cases, but the rate decreased to 33% when the calculations were based on the maximum sheath extension diameter. The trans-cervical, trans-subclavian, and direct aortic approaches were suitable for many patients. Lower extremity artery disease was identified as a risk factor for the unsuitability of the transfemoral approach. CONCLUSIONS Common iliac artery calcification in patients undergoing hemodialysis restricts the use of the transfemoral approach. Therefore, some patients require alternative approaches.
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Affiliation(s)
- Yusuke Takei
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-Machi, Shimotuga-gun, Tochigi, 321-0293, Japan.
| | - Shunsuke Saito
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-Machi, Shimotuga-gun, Tochigi, 321-0293, Japan
| | - Ikuko Shibasaki
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-Machi, Shimotuga-gun, Tochigi, 321-0293, Japan
| | - Toshiyuki Kuwata
- Division of Cardiovascular Surgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan
| | - Yasuyuki Yamada
- Division of Cardiovascular Surgery, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Hirotsugu Fukuda
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-Machi, Shimotuga-gun, Tochigi, 321-0293, Japan
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2
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Iida M. Aortic Valve Replacement in Patients With ESRD and Heart Failure With Reduced Ejection Fraction: The Worst Scenario, but There Remains a Hope. Am J Cardiol 2023; 206:360-361. [PMID: 37735060 DOI: 10.1016/j.amjcard.2023.08.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Masato Iida
- Department of Cardiology, Aichi Sannomaru Clinic, Nagoya, Japan.
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3
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Kipourou K, O’Driscoll JM, Sharma R. Valvular Heart Disease in Patients with Chronic Kidney Disease. Eur Cardiol 2022; 17:e02. [PMID: 35154392 PMCID: PMC8819604 DOI: 10.15420/ecr.2021.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/19/2021] [Indexed: 11/06/2022] Open
Abstract
Valvular heart disease (VHD) is highly prevalent in patients with chronic kidney disease (CKD) from the early stages to end-stage renal disease (ESRD). Aortic and mitral valves are the most frequently affected, leading to aortic valve and/or mitral annular calcification, which, in turn, causes either valve stenosis or regurgitation at an accelerated rate compared with the general population. Tricuspid regurgitation is also prevalent in CKD and ESRD, and haemodialysis patients are at an increasingly high risk of infective endocarditis. As for pathophysiology, several mechanisms causing VHD in CKD have been proposed, highlighting the complexity of the process. Echocardiography constitutes the gold standard for the assessment of VHD in CKD/ESRD patients, despite the progress of other imaging modalities. With regard to treatment, the existing 2017 European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines on the management of VHD addressing patients with normal kidney function are also applied to patients with CKD/ESRD.
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Affiliation(s)
- Konstantina Kipourou
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Jamie M O’Driscoll
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK; School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - Rajan Sharma
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK; School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
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4
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Geisler D, Rudziński PN, Hasan W, Andreas M, Hasimbegovic E, Adlbrecht C, Winkler B, Weiss G, Strouhal A, Delle-Karth G, Grabenwöger M, Mach M. Identifying Patients without a Survival Benefit following Transfemoral and Transapical Transcatheter Aortic Valve Replacement. J Clin Med 2021; 10:4911. [PMID: 34768430 PMCID: PMC8584860 DOI: 10.3390/jcm10214911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/21/2021] [Accepted: 10/18/2021] [Indexed: 01/01/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) offers a novel treatment option for patients with severe symptomatic aortic valve stenosis, particularly for patients who are unsuitable candidates for surgical intervention. However, high therapeutical costs, socio-economic considerations, and numerous comorbidities make it necessary to target and allocate available resources efficiently. In the present study, we aimed to identify risk factors associated with futile treatment following transfemoral (TF) and transapical (TA) TAVR. Five hundred and thirty-two consecutive patients (82 ± 9 years, female 63%) who underwent TAVR between June 2009 and December 2016 at the Vienna Heart Center Hietzing were retrospectively analyzed to identify predictors of futility, defined as all-cause mortality at one year following the procedure for the overall patient cohort, as well as the TF and TA cohort. Out of 532 patients, 91 (17%) did not survive the first year after TAVR. A multivariate logistic model identified cerebrovascular disease, home oxygen dependency, wheelchair dependency, periinterventional myocardial infarction, and postinterventional renal replacement therapy as the factors independently associated with an increased one-year mortality. Our findings underscore the significance of a precise preinterventional evaluation, as well as illustrating the subtle differences in baseline characteristics in the TF and TA cohort and their impact on one-year mortality.
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Affiliation(s)
- Daniela Geisler
- Department of Cardio-Vascular Surgery, Klinik Floridsdorf and Karl Landsteiner Institute for Cardio-Vascular Research, 1210 Vienna, Austria; (D.G.); (B.W.); (M.G.)
| | - Piotr Nikodem Rudziński
- Department of Coronary and Structural Heart Diseases, The Cardinal Stefan Wyszyński Institute of Cardiology, 04-628 Warsaw, Poland;
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (M.A.); (E.H.)
| | | | - Martin Andreas
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (M.A.); (E.H.)
| | - Ena Hasimbegovic
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (M.A.); (E.H.)
- Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital, 1090 Vienna, Austria
| | - Christopher Adlbrecht
- Imed19-Privat, Private Clinical Research Center, Chimanistrasse 1, 1190 Vienna, Austria;
| | - Bernhard Winkler
- Department of Cardio-Vascular Surgery, Klinik Floridsdorf and Karl Landsteiner Institute for Cardio-Vascular Research, 1210 Vienna, Austria; (D.G.); (B.W.); (M.G.)
| | - Gabriel Weiss
- Department of Vascular Surgery, Klinik Ottakring, 1160 Vienna, Austria;
- Medical Faculty, Sigmund Freud University, 1020 Vienna, Austria
| | - Andreas Strouhal
- Department of Cardiology, Klinik Floridsdorf and the Karl Landsteiner Institute for Cardiovascular & Intensive Care Research Vienna, 1210 Vienna, Austria; (A.S.); (G.D.-K.)
| | - Georg Delle-Karth
- Department of Cardiology, Klinik Floridsdorf and the Karl Landsteiner Institute for Cardiovascular & Intensive Care Research Vienna, 1210 Vienna, Austria; (A.S.); (G.D.-K.)
| | - Martin Grabenwöger
- Department of Cardio-Vascular Surgery, Klinik Floridsdorf and Karl Landsteiner Institute for Cardio-Vascular Research, 1210 Vienna, Austria; (D.G.); (B.W.); (M.G.)
- Medical Faculty, Sigmund Freud University, 1020 Vienna, Austria
| | - Markus Mach
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (M.A.); (E.H.)
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5
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Garcia S, Cubeddu RJ, Hahn RT, Ternacle J, Kapadia SR, Kodali SK, Thourani VH, Jaber WA, Asher CR, Elmariah S, Makkar R, Webb JG, Herrmann HC, Lu M, Devireddy CM, Malaisrie SC, Smith CR, Mack MJ, Sorajja P, Cavalcante JL, Goessl M, Shroff GR, Leon MB, Pibarot P. 5-Year Outcomes Comparing Surgical Versus Transcatheter Aortic Valve Replacement in Patients With Chronic Kidney Disease. JACC Cardiovasc Interv 2021; 14:1995-2005. [PMID: 34556273 DOI: 10.1016/j.jcin.2021.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/14/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to compare 5-year cardiovascular, renal, and bioprosthetic valve durability outcomes in patients with severe aortic stenosis (AS) and chronic kidney disease (CKD) undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). BACKGROUND Patients with severe AS and CKD undergoing TAVR or SAVR are a challenging, understudied clinical subset. METHODS Intermediate-risk patients with moderate to severe CKD (estimated glomerular filtration rate <60 mL/min/m2) from the PARTNER (Placement of Aortic Transcatheter Valve) 2A trial (patients randomly assigned to SAPIEN XT TAVR or SAVR) and SAPIEN 3 Intermediate Risk Registry were pooled. The composite primary outcome of death, stroke, rehospitalization, and new hemodialysis was evaluated using Cox regression analysis. Patients with and without perioperative acute kidney injury (AKI) were followed through 5 years. A core laboratory-adjudicated analysis of structural valve deterioration and bioprosthetic valve failure was also performed. RESULTS The study population included 1,045 TAVR patients (512 SAPIEN XT, 533 SAPIEN 3) and 479 SAVR patients. At 5 years, SAVR was better than SAPIEN XT TAVR (52.8% vs 68.0%; P = 0.04) but similar to SAPIEN 3 TAVR (52.8% vs 58.7%; P = 0.89). Perioperative AKI was more common after SAVR than TAVR (26.3% vs 10.3%; P < 0.001) and was independently associated with long-term outcomes. Compared with SAVR, bioprosthetic valve failure and stage 2 or 3 structural valve deterioration were significantly greater for SAPIEN XT TAVR (P < 0.05) but not for SAPIEN 3 TAVR. CONCLUSIONS In intermediate-risk patients with AS and CKD, SAPIEN 3 TAVR and SAVR were associated with a similar risk for the primary endpoint at 5 years. AKI was more common after SAVR than TAVR, and SAPIEN 3 valve durability was comparable with that of surgical bioprostheses.
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Affiliation(s)
- Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
| | | | - Rebecca T Hahn
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Julien Ternacle
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, Québec, Québec, Canada
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Susheel K Kodali
- Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart and Vascular Institute, Atlanta, Georgia, USA
| | - Wael A Jaber
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Craig R Asher
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Weston, Weston, Florida, USA
| | - Sammy Elmariah
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Raj Makkar
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Howard C Herrmann
- Department of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Lu
- Edwards Lifesciences, Irvine, California, USA
| | - Chandan M Devireddy
- Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - S Chris Malaisrie
- Department of Cardiac Surgery, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Craig R Smith
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor Scott & White Health, Plano, Texas, USA
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - João L Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Mario Goessl
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Gautam R Shroff
- Hennepin Healthcare and University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Martin B Leon
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, Québec, Québec, Canada
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Terrosu P, Boccanelli A, Sabino G, Alboni P, Baldasseroni S, Bo M, Desideri G, Marchionni N, Palazzo G, Rozzini R, Ungar A, Vetta F, Zito G. Severe aortic stenosis and transcatheter aortic valve replacement in elderly patients: utility vs futility. Minerva Med 2021; 113:640-646. [PMID: 34542953 DOI: 10.23736/s0026-4806.21.07777-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Recently, transcatheter aortic valve replacement (TAVR) has emerged as established standard treatment for symptomatic severe aortic stenosis, providing an effective, less-invasive alternative to open cardiac surgery for inoperable or high-risk older patients. EVIDENCE ACQUISITION In order to assess the anticipated benefit of aortic replacement, considerable interest now lies in better identifying factors likely to predict outcome. In the elderly population frailty and medical comorbidities have been shown to significantly predict mortality, functional recovery and quality of life after transcatheter aortic valve replacement. Scientific literature focused on the three items will be discussed. EVIDENCE SYNTHESIS High likelihood of futility is described in patients with severe chronic lung, kidney, liver disease and/or frailty. The addition of frailty components to conventional risk prediction has been shown to result in improved discrimination for death and disability following the procedure and identifies those individuals least likely to derive benefit. Several dedicated risk score have been proposed to provide new insights into predicted "futile" outcome. However, assessment of frailty according to a limited number of variables is not sufficient, while a multi-dimensional geriatric assessment significantly improves risk prediction. CONCLUSIONS A multidisciplinary heart team that includes geriatricians can allow the customization of therapeutic interventions in elderly patients to optimise care and avoid futility.
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Affiliation(s)
| | | | - Giuseppe Sabino
- UOC di Cardiologia, AOU-Ospedale SS. Annunziata, Sassari, Italy
| | - Paolo Alboni
- SICGe - Società Italiana di Cardiologia Geriatrica, Firenze, Italy
| | | | - Mario Bo
- SICGe - Società Italiana di Cardiologia Geriatrica, Firenze, Italy
| | | | | | - Giuseppe Palazzo
- SICGe - Società Italiana di Cardiologia Geriatrica, Firenze, Italy
| | - Renzo Rozzini
- SICGe - Società Italiana di Cardiologia Geriatrica, Firenze, Italy
| | - Andrea Ungar
- SICGe - Società Italiana di Cardiologia Geriatrica, Firenze, Italy
| | - Francesco Vetta
- SICGe - Società Italiana di Cardiologia Geriatrica, Firenze, Italy
| | - Giovanni Zito
- SICGe - Società Italiana di Cardiologia Geriatrica, Firenze, Italy
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Lemes da Silva MV, Nunes Filho ACB, Rosa VEE, Caixeta A, Lemos Neto PA, Ribeiro HB, Almeida BO, Mariani J, Campos CM, Abizaid AAC, Mangione JA, Sampaio RO, Caramori P, Sarmento-Leite R, Tarasoutchi F, Franken M, de Brito FS. Improvement of renal function after transcatheter aortic valve replacement in patients with chronic kidney disease. PLoS One 2021; 16:e0251066. [PMID: 33984005 PMCID: PMC8118303 DOI: 10.1371/journal.pone.0251066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/19/2021] [Indexed: 12/29/2022] Open
Abstract
Background Chronic kidney disease is commonly found in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) and has marked impact in their prognosis. It has been shown however that TAVR may improve renal function by alleviating the hemodynamic barrier imposed by AS. Nevertheless, the predictors of and clinical consequences of renal function improvement are not well established. Our aim was to assess the predictors of improvement of renal function after TAVR. Methods The present work is an analysis of the Brazilian Registry of TAVR, a national non-randomized prospective study with 22 Brazilian centers. Patients with baseline renal dysfunction (estimated glomerular filtration rate [eGFR] < 60mL/min/1.73m2) were stratified according to renal function after TAVR: increase >10% in eGFR were classified as TAVR induced renal function improvement (TIRFI); decrease > 10% in eGFR were classified as acute kidney injury (AKI) and stable renal function (neither criteria). Results A total of 819 consecutive patients with symptomatic severe AS were included. Of these, baseline renal dysfunction (estimated glomerular filtration rate [eGFR] < 60mL/min/1.73m2) was present in 577 (70%) patients. Considering variance in renal function between baseline and at discharge after TAVR procedure, TIRFI was seen in 197 (34.1%) patients, AKI in 203 (35.2%), and stable renal function in 177 (30.7%). The independent predictors of TIRFI were: absence of coronary artery disease (OR: 0.69; 95% CI 0.48–0.98; P = 0.039) and lower baseline eGFR (OR: 0.98; 95% CI 0.97–1.00; P = 0.039). There was no significant difference in 30-day and 1-year all-cause mortality between patients with stable renal function or TIRFI. Nonetheless, individuals that had AKI after TAVR presented higher mortality compared with TIRFI and stable renal function groups (29.3% vs. 15.4% vs. 9.5%, respectively; p < 0.001). Conclusions TIRFI was frequently found among baseline impaired renal function individuals but was not associated with improved 1-year outcomes.
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Affiliation(s)
- Michel V. Lemes da Silva
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Antonio C. B. Nunes Filho
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
- * E-mail:
| | - Vitor E. E. Rosa
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Adriano Caixeta
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
| | - Pedro A. Lemos Neto
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
| | - Henrique B. Ribeiro
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Breno O. Almeida
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
| | - José Mariani
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Carlos M. Campos
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- Department of Cardiology, Instituto Prevent Senior, Sao Paulo, Brazil
| | - Alexandre A. C. Abizaid
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - José A. Mangione
- Department of Interventional Cardiology, Hospital Beneficiência Portuguesa, Sao Paulo, Brazil
| | - Roney O. Sampaio
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo Caramori
- Department of Interventional Cardiology, Hospital São Lucas – PUCRS, Porto Alegre, Brazil
| | - Rogério Sarmento-Leite
- Department of Interventional Cardiology, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | - Flávio Tarasoutchi
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Marcelo Franken
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
| | - Fábio S. de Brito
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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8
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Shroff GR, Bangalore S, Bhave NM, Chang TI, Garcia S, Mathew RO, Rangaswami J, Ternacle J, Thourani VH, Pibarot P. Evaluation and Management of Aortic Stenosis in Chronic Kidney Disease: A Scientific Statement From the American Heart Association. Circulation 2021; 143:e1088-e1114. [PMID: 33980041 DOI: 10.1161/cir.0000000000000979] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aortic stenosis with concomitant chronic kidney disease (CKD) represents a clinical challenge. Aortic stenosis is more prevalent and progresses more rapidly and unpredictably in CKD, and the presence of CKD is associated with worse short-term and long-term outcomes after aortic valve replacement. Because patients with advanced CKD and end-stage kidney disease have been excluded from randomized trials, clinicians need to make complex management decisions in this population that are based on retrospective and observational evidence. This statement summarizes the epidemiological and pathophysiological characteristics of aortic stenosis in the context of CKD, evaluates the nuances and prognostic information provided by noninvasive cardiovascular imaging with echocardiography and advanced imaging techniques, and outlines the special risks in this population. Furthermore, this statement provides a critical review of the existing literature pertaining to clinical outcomes of surgical versus transcatheter aortic valve replacement in this high-risk population to help guide clinical decision making in the choice of aortic valve replacement and specific prosthesis. Finally, this statement provides an approach to the perioperative management of these patients, with special attention to a multidisciplinary heart-kidney collaborative team-based approach.
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Bocchino PP, Angelini F, Alushi B, Conrotto F, Cioffi GM, Tersalvi G, Senatore G, Pedrazzini G, De Ferrari GM, Biasco L. Transcatheter Aortic Valve Replacement in Young Low-Risk Patients With Severe Aortic Stenosis: A Review. Front Cardiovasc Med 2021; 7:608158. [PMID: 33381528 PMCID: PMC7767870 DOI: 10.3389/fcvm.2020.608158] [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: 09/19/2020] [Accepted: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
In the last decades, transcatheter aortic valve replacement (TAVR) revolutionized the treatment of symptomatic severe aortic stenosis. The efficacy and safety of TAVR were first proven in inoperable and high-risk patients. Then, subsequent randomized clinical trials showed non-inferiority of TAVR as compared to surgical aortic valve replacement also in intermediate- and low-risk populations. As TAVR was progressively studied and clinically used in lower-risk patients, issues were raised questioning its opportunity in a younger population with a longer life-expectancy. As long-term follow-up data mainly derive from old studies with early generation devices on high or intermediate surgical risk patients, results can hardly be extended to most of currently treated patients who often show a low surgical risk and are treated with newer generation prostheses. Thus, in this low-risk younger population, decision making is difficult due to the lack of supporting data. The aim of the present review is to revise current literature regarding TAVR in younger patients.
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Affiliation(s)
- Pier Paolo Bocchino
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Filippo Angelini
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Brunilda Alushi
- Department of General and Interventional Cardiology, Helios Klinikum Erfurt, Erfurt, Germany.,Department of Cardiology, Campus Benjamin Franklin, Charite' Medical University Berlin, Berlin, Germany
| | - Federico Conrotto
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Giacomo Maria Cioffi
- Department of Cardiology, Kantonsspital Luzern, Lucerne, Switzerland.,Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Gregorio Tersalvi
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.,Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Gaetano Senatore
- Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, Ciriè, Italy
| | - Giovanni Pedrazzini
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.,Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Luigi Biasco
- Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, Ciriè, Italy.,Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
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Axelsson Raja A, Warming PE, Nielsen TL, Plesner LL, Ersbøll M, Dalsgaard M, Schou M, Rydahl C, Brandi L, Iversen K. Left-sided heart disease and risk of death in patients with end-stage kidney disease receiving haemodialysis: an observational study. BMC Nephrol 2020; 21:413. [PMID: 32977752 PMCID: PMC7519512 DOI: 10.1186/s12882-020-02074-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular disease is the most common cause of death in patients with end-stage kidney disease on haemodialysis. The potential clinical consequence of systematic echocardiographic assessment is however not clear. In an unselected, contemporary population of patients on maintenance haemodialysis we aimed to assess: the prevalence of structural and functional heart disease, the potential therapeutic consequences of echocardiographic screening and whether left-sided heart disease is associated with prognosis. METHODS Adult chronic haemodialysis patients in two large dialysis centres had transthoracic echocardiography performed prior to dialysis and were followed prospectively. Significant left-sided heart disease was defined as moderate or severe left-sided valve disease or left ventricular ejection fraction (LVEF) ≤40%. RESULTS Among the 247 included patients (mean 66 years of age [95%CI 64-67], 68% male), 54 (22%) had significant left-sided heart disease. An LVEF ≤40% was observed in 31 patients (13%) and severe or moderate valve disease in 27 (11%) patients. The findings were not previously recognized in more than half of the patients (56%) prior to the study. Diagnosis had a potential impact on management in 31 (13%) patients including for 18 (7%) who would benefit from initiation of evidence-based heart failure therapy. After 2.8 years of follow-up, all-cause mortality among patients with and without left-sided heart disease was 52 and 32% respectively (hazard ratio [HR] 1.95 (95%CI 1.25-3.06). A multivariable adjusted Cox proportional hazard analysis showed that left-sided heart disease was an independent predictor of mortality with a HR of 1.60 (95%CI 1.01-2.55) along with age (HR per year 1.05 [95%CI 1.03-1.07]). CONCLUSION Left ventricular systolic dysfunction and moderate to severe valve disease are common and often unrecognized in patients with end-stage kidney failure on haemodialysis and are associated with a higher risk of death. For more than 10% of the included patients, systematic echocardiographic assessment had a potential clinical consequence.
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Affiliation(s)
- Anna Axelsson Raja
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
- Department of Cardiology, Copenhagen University Hospital Rigshopitalet, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark.
| | - Peder E Warming
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- Department of Cardiology, Endocrinology and Nephrology, Copenhagen University Hospital Nordsjaellands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark
| | - Ture L Nielsen
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- Department of Cardiology, Endocrinology and Nephrology, Copenhagen University Hospital Nordsjaellands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark
| | - Louis L Plesner
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- Department of Cardiology, Endocrinology and Nephrology, Copenhagen University Hospital Nordsjaellands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark
| | - Mads Ersbøll
- Department of Cardiology, Copenhagen University Hospital Rigshopitalet, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark
| | - Morten Dalsgaard
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Casper Rydahl
- Department of Nephrology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Lisbet Brandi
- Department of Cardiology, Endocrinology and Nephrology, Copenhagen University Hospital Nordsjaellands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital Herlev, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
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11
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Kaur P, Ajibawo T, Yomi T, Patel N, Baksh M, Okotcha E, Kataria S, Patel RS. Aortic Stenosis Patients With Transcatheter Aortic Valve Replacement: Caution Recommended With Renal Failure During Hospitalization. Cureus 2020; 12:e9384. [PMID: 32850251 PMCID: PMC7445110 DOI: 10.7759/cureus.9384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective Our study aimed to assess the risk of in-patient mortality due to renal failure and other comorbidities in aortic stenosis (AS) patients undergoing transcatheter aortic valve replacement (TAVR). Methods We conducted a cross-sectional study using a Nationwide Inpatient Sample (NIS, January 2010 to December 2014) from the United States and included 33,325 patients with a primary diagnosis of AS. Logistic regression was used to evaluate the odds ratio (OR) for in-hospital mortality in AS by comorbidities including renal failure. Results The prevalence of renal failure in AS patients is 29.2%, and a higher proportion were males (60.1%) and non-white (14.1%). Major loss of function (96.6%) and in-hospital mortality (5.1%) were also proportionally higher in prevalence. Female patients (OR 1.35, 95% CI 1.20-1.51) had higher odds of in-patient mortality in AS patients. Race was a non-significant predictor for mortality risk. Patients with comorbid coagulopathy (OR 2.02, 95% CI 1.79-2.27) and heart failure (OR 1.62, 95% CI 1.39-1.89) have increased mortality in AS inpatients. After controlling confounders, renal failure was significantly associated with increased in-hospital mortality (OR 1.43, 95% CI 1.28-1.61) in AS patients. Conclusion Renal failure was prevalent in AS patients and was an independent factor that increases the risk of in-hospital mortality by 43%. Due to worse outcomes, more studies are required to evaluate risk-benefit ratio and strategies to improve health-related quality of life in post-TAVR patients with renal failure, and optimally decrease inpatient mortality.
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Affiliation(s)
- Pawandeep Kaur
- Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| | - Temitope Ajibawo
- Internal Medicine, Brookdale University Hospital Medical Center, New York City, USA
| | - Timiiye Yomi
- Medicine, University of Benin School of Medicine, Benin City, NGA
| | - Neev Patel
- Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
| | - Mizba Baksh
- Internal Medicine, Dr. Nandamuri Taraka Rama Rao University of Health Sciences, Vijayawada, IND
| | - Edmond Okotcha
- Medicine, Vinnytsia Pirogov National Medical University, Vinnytsia Oblast, UKR
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12
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Candellier A, Hénaut L, Morelle J, Choukroun G, Jadoul M, Brazier M, Goffin É. Aortic stenosis in patients with kidney failure: Is there an advantage for a PD-first policy? Perit Dial Int 2020; 41:158-167. [DOI: 10.1177/0896860820941371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Aortic stenosis (AS) is the most common valvular disease. It is twice as prevalent in patients with kidney failure as compared to the general population. In addition, AS progresses at a faster rate and is associated with a higher risk of death and poorer quality of life in patients on dialysis. Chronic kidney disease–mineral and bone disorder (CKD-MBD), inflammation, and hemodynamic disturbances contribute to the pathophysiology and progression of AS. Whether the type of dialysis modality, that is, hemodialysis (HD) versus peritoneal dialysis (PD), has a differential impact on the development and progression of AS in patients with kidney failure remains debated. Recent data indicate that the prevalence of valvular calcifications might be lower and the development of AS delayed in PD patients, as compared to those treated with HD. This could be accounted for by several mechanisms including reduced valvular shear stress, better preservation of residual kidney function (with better removal of protein-bound uremic toxins and CKD-MBD profile), and lower levels of systemic inflammation. Given the high morbidity and mortality rates related to interventional procedures in the population with kidney failure, surgical and transcatheter aortic valve replacement should be considered in selected patients with severe AS. Strategies slowing down the progression of aortic valve remodeling should remain the cornerstone in the management of individuals with kidney failure and mild to moderate AS. This review explores the potential benefits of PD in patients with kidney failure and AS and provides some clues to help clinicians in the decision-making process when options for kidney replacement therapy are considered in patients with AS.
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Affiliation(s)
- Alexandre Candellier
- Division of Nephrology, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
- UR UPJV 7517, MP3CV, CURS, Amiens, France
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | | | - Johann Morelle
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - Gabriel Choukroun
- Division of Nephrology, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
- UR UPJV 7517, MP3CV, CURS, Amiens, France
| | - Michel Jadoul
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | | | - Éric Goffin
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
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13
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Bruno AG, Santona L, Palmerini T, Taglieri N, Marrozzini C, Ghetti G, Orzalkiewicz M, Galiè N, Saia F. Predicting and improving outcomes of transcatheter aortic valve replacement in older adults and the elderly. Expert Rev Cardiovasc Ther 2020; 18:663-680. [DOI: 10.1080/14779072.2020.1778465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Antonio Giulio Bruno
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Laura Santona
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Tullio Palmerini
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Nevio Taglieri
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Cinzia Marrozzini
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Gabriele Ghetti
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Mateusz Orzalkiewicz
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Nazzareno Galiè
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Francesco Saia
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
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14
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Asgar AW, Ouzounian M, Adams C, Afilalo J, Fremes S, Lauck S, Leipsic J, Piazza N, Rodes-Cabau J, Welsh R, Wijeysundera HC, Webb JG. 2019 Canadian Cardiovascular Society Position Statement for Transcatheter Aortic Valve Implantation. Can J Cardiol 2020; 35:1437-1448. [PMID: 31679616 DOI: 10.1016/j.cjca.2019.08.011] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/29/2019] [Accepted: 08/02/2019] [Indexed: 01/12/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) or replacement has rapidly changed the treatment of patients with severe symptomatic aortic stenosis. It is now the standard of care for patients believed to be inoperable or at high surgical risk, and a reasonable alternative to surgical aortic valve replacement for those at intermediate surgical risk. Recent clinical trial data have shown the benefits of this technology in patients at low surgical risk as well. This update of the 2012 Canadian Cardiovascular Society TAVI position statement incorporates clinical evidence to provide a practical framework for patient selection that does not rely on surgical risk scores but rather on individual patient evaluation of risk and benefit from either TAVI or surgical aortic valve replacement. In addition, this statement features new wait time categories and treatment time goals for patients accepted for TAVI. Institutional requirements and recommendations for operator training and maintenance of competency have also been revised to reflect current standards. Procedural considerations such as decision-making for concomitant coronary intervention, antiplatelet therapy after intervention, and follow-up guidelines are also discussed. Finally, we suggest that all patients with aortic stenosis might benefit from evaluation by the heart team to determine the optimal individualized treatment decision.
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Affiliation(s)
- Anita W Asgar
- Institut de Cardiologie de Montreal, Universite de Montreal, Montreal, Quebec, Canada.
| | - Maral Ouzounian
- Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Corey Adams
- Health Sciences Centre, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Jonathan Afilalo
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Stephen Fremes
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sandra Lauck
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Leipsic
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Josep Rodes-Cabau
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Universite de Laval, Quebec, Quebec, Canada
| | - Robert Welsh
- Mazankowski Alberta Heart Institute and University of Alberta, Edmonton, Alberta, Canada
| | | | - John G Webb
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Rattanawong P, Kanitsoraphan C, Kewcharoen J, Riangwiwat T, Chongyangyuenvong P, Vutthikraivit W, Mannem SR, Chung EH. Chronic kidney disease is associated with increased mortality and procedural complications in transcatheter aortic valve replacement: a systematic review and meta‐analysis. Catheter Cardiovasc Interv 2019; 94:E116-E127. [DOI: 10.1002/ccd.28102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/28/2018] [Accepted: 01/02/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Pattara Rattanawong
- Department of Internal Medicine, University of Hawaii Internal Medicine Residency Program Honolulu Hawaii
- Department of Internal Medicine, Faculty of Medicine, Ramathibodi HospitalMahidol University Bangkok Thailand
| | - Chanavuth Kanitsoraphan
- Department of Internal Medicine, University of Hawaii Internal Medicine Residency Program Honolulu Hawaii
| | - Jakrin Kewcharoen
- Department of Internal Medicine, University of Hawaii Internal Medicine Residency Program Honolulu Hawaii
| | | | | | - Wasawat Vutthikraivit
- Department of Internal MedicineTexas Tech University Health Sciences Center Lubbock Texas
| | | | - Eugene H. Chung
- Department of Internal Medicine, Michigan MedicineUniversity of Michigan Ann Arbor Michigan
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16
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Aubry P, Demian H. [Management of renal failure in old patients undergoing percutaneous cardiac interventions]. Ann Cardiol Angeiol (Paris) 2018; 67:466-473. [PMID: 30384963 DOI: 10.1016/j.ancard.2018.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The elderly benefit from the advances of the interventional cardiology, especially for coronary artery disease and aortic valve stenosis. The prevalence of comorbidities is high in old population, but the benefit-risk balance remains often positive. Chronic kidney disease is frequent and amplifies the risks of contrast-induced nephropathy and acute kidney injury with an impact on clinical course and outcomes, and additional costs. Preventive strategies recognized as efficient to limit renal adverse events must be applied. Future approach may involve research in vulnerable old patients undergoing cardiac interventions.
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Affiliation(s)
- P Aubry
- Département de cardiologie, groupe hospitalier Bichat-Claude-Bernard, Assistance publique des hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France; Service de cardiologie, centre hospitalier de Gonesse, 95500 Gonesse, France.
| | - H Demian
- Service de cardiologie, centre hospitalier de Gonesse, 95500 Gonesse, France
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17
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Pineda AM, Kevin Harrison J, Kleiman NS, Reardon MJ, Conte JV, O'Hair DP, Chetcuti SJ, Huang J, Yakubov SJ, Popma JJ, Beohar N. Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement. Catheter Cardiovasc Interv 2018; 93:740-748. [DOI: 10.1002/ccd.27928] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 09/24/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Andres M. Pineda
- Division of CardiologyUniversity of Florida College of Medicine‐Jacksonville Jacksonville Florida
| | - J. Kevin Harrison
- Department of MedicineDuke University Medical Center Durham North Carolina
| | - Neal S. Kleiman
- Department of CardiologyHouston Methodist DeBakey Heart and Vascular Center Houston Texas
| | - Michael J. Reardon
- Department of Cardiothoracic SurgeryHouston Methodist DeBakey Heart and Vascular Center Houston Texas
| | - John V. Conte
- Division of Cardiac SurgeryJohns Hopkins University Baltimore Maryland
| | - Daniel P. O'Hair
- Department of Cardiothoracic SurgeryAurora Healthcare Milwaukee Wisconsin
| | - Stanley J. Chetcuti
- Department of Internal Medicine, Division of CardiologyUniversity of Michigan Ann Arbor Michigan
| | - Jian Huang
- Coronary and Structural Heart Clinical Department Mounds View Minnesota
| | | | - Jeffrey J. Popma
- Department of Internal Medicine, Cardiovascular DivisionBeth Israel Deaconess Medical Center Boston Massachusetts
| | - Nirat Beohar
- Division of Cardiology at Mount Sinai Medical Center, Columbia University Miami Beach Florida
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18
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Amione-Guerra J, Mattathil S, Prasad A. A Meta-Analysis of Clinical Outcomes of Transcatheter Aortic Valve Replacement in Patients with End-Stage Renal Disease. STRUCTURAL HEART 2018. [DOI: 10.1080/24748706.2018.1522460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Javier Amione-Guerra
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio , San Antonio, Texas, USA
| | - Stephanie Mattathil
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio , San Antonio, Texas, USA
| | - Anand Prasad
- Department of Medicine, Division of Cardiology, University of Texas Health Science Center at San Antonio , San Antonio, Texas, USA
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19
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van Mourik MS, Vendrik J, Abdelghani M, van Kesteren F, Henriques JPS, Driessen AHG, Wykrzykowska JJ, de Winter RJ, Piek JJ, Tijssen JG, Koch KT, Baan J, Vis MM. Guideline-defined futility or patient-reported outcomes to assess treatment success after TAVI: what to use? Results from a prospective cohort study with long-term follow-up. Open Heart 2018; 5:e000879. [PMID: 30275957 PMCID: PMC6157566 DOI: 10.1136/openhrt-2018-000879] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/27/2018] [Accepted: 08/14/2018] [Indexed: 01/04/2023] Open
Abstract
Objective Transcatheter aortic valve implantation (TAVI) provides a significant symptom relief and mortality reduction in most patients; however, a substantial group of patients does not experience the same beneficial results according to physician-determined outcomes. Methods Single-centre prospective design; the population comprises all consecutive patients undergoing TAVI in 2012-2017. TAVI futility was defined as the combined endpoint of either no symptomatic improvement or mortality at 1 year. We actively gathered telephone follow-up using a predefined questionnaire. Results Guideline defined TAVI futility was present in 212/741 patients. Multivariate regression showed lower albumin and non-transfemoral approach to be predictive for futility. In addition to these, chronic obstructive pulmonary disease, lower estimated glomerular filtration rate, atrial fibrillation, low-flow-low-gradient aortic stenosis and lower Body Mass Index were predictive for 1-year mortality. Patients who showed symptomatic benefit estimated the percentage in which their symptoms were remedied higher than patients who did not (80% vs 60%, p<0.001). Guideline-defined TAVI futility occurs frequently, contrasting with patient-reported outcome measures (PROMs). The vast majority in both groups would again choose for TAVI treatment. Conclusion Lower albumin and non-transfemoral access route were predictors for guideline-defined TAVI futility, defined as mortality within 1 year or no objective symptomatic improvement in New York Heart Association class. Futility according to this definition occurred frequently in this study, contrasting with much more positive PROMs. The majority of patients would undergo a TAVI again, underlining the patients' experienced value of TAVI and putting the definition of TAVI futility further on debate. In the near future, less-strict criteria for TAVI futility, that is, using a shorter warranted life expectancy and incorporating patients' perceived outcomes, should be used.
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Affiliation(s)
- Martijn Stefan van Mourik
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeroen Vendrik
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mohammad Abdelghani
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Floortje van Kesteren
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jose P S Henriques
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Antoine H G Driessen
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joanna J Wykrzykowska
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Robbert J de Winter
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan J Piek
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan G Tijssen
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Karel T Koch
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Baan
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M Marije Vis
- Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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20
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Nijenhuis VJ, Peper J, Vorselaars VMM, Swaans MJ, De Kroon T, Van der Heyden JAS, Rensing BJWM, Heijmen R, Bos WJW, Ten Berg JM. Prognostic Value of Improved Kidney Function After Transcatheter Aortic Valve Implantation for Aortic Stenosis. Am J Cardiol 2018. [PMID: 29525062 DOI: 10.1016/j.amjcard.2018.01.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is associated with acute kidney injury (AKI), but can also improve the kidney function (IKF). We assessed the effects of kidney function changes in relation to baseline kidney function on 2-year clinical outcomes after TAVI. In total, 639 consecutive patients with aortic stenosis who underwent TAVI were stratified into 3 groups according to the ratio of serum creatinine post- to pre-TAVI: IKF (≤0.80; n = 95 [15%]), stable kidney function (0.80 to 1.5; n = 477 [75%]), and AKI (≥1.5; n = 67 [10%]). Different AKI risk scores were compared using receiving-operator characteristics. Median follow-up was 24 (8 to 44) months. At 3 months, the increase in estimated glomerular filtration rate in the IKF group remained, and the decreased estimated glomerular filtration rate in the AKI group recovered. Compared with a stable kidney function, AKI showed a higher 2-year mortality rate (adjusted hazard ratio [HR] 3.69, 95% confidence interval [CI] 2.43 to 5.62) and IKF a lower mortality rate (adjusted hazard ratio 0.53, 95% CI 0.30 to 0.93). AKI also predicted major and life-threatening bleeding (adjusted odds ratio 2.94, 95% CI 1.27 to 6.78). Independent predictors of AKI were chronic kidney disease and pulmonary hypertension. Independent predictors of IKF were female gender, a preserved kidney function, absence of atrial fibrillation, and hemoglobin level. Established AKI risk scores performed moderately and did not differentiate between AKI and IKF. In conclusion, AKI is transient and is independently associated with a higher mortality rate, whereas IKF is sustained and is associated with a lower mortality rate. These effects are independent of baseline kidney function. Further studies are warranted to investigate the role of IKF and generate a dedicated prediction model.
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Affiliation(s)
| | - Joyce Peper
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Thom De Kroon
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Benno J W M Rensing
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Robin Heijmen
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Willem-Jan W Bos
- Department of Internal Medicine and Nephrology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jurrien M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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21
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Castriota F, Nerla R, Micari A, Squeri A, Cremonesi A. Contrast-Zero Transcatheter Aortic Valve Replacement for Patients With Severe Renal Dysfunction. JACC Cardiovasc Interv 2018; 11:820-822. [DOI: 10.1016/j.jcin.2018.01.280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/15/2018] [Accepted: 01/23/2018] [Indexed: 11/28/2022]
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22
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Ali N, Patel PA, Lindsay SJ. Recent developments and controversies in transcatheter aortic valve implantation. Eur J Heart Fail 2018; 20:642-650. [PMID: 29368369 DOI: 10.1002/ejhf.1141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/03/2017] [Accepted: 12/26/2017] [Indexed: 12/19/2022] Open
Abstract
Interventional cardiology has been revolutionised by transcatheter aortic valve implantation (TAVI), which has become established as the benchmark treatment for severe aortic stenosis in patients at high risk for surgical aortic valve replacement (AVR). Increased procedural familiarity and progression in device technology has enabled improvements to be made in complication rates, which have led to a commensurate expansion in the use of TAVI; it is now a viable alternative to AVR in patients at intermediate surgical risk, and has been used in cohorts such as those with bicuspid aortic valves or pure, severe aortic regurgitation. Given the rapid expansion in the use of TAVI, including cohorts of younger patients with fewer co-morbidities, attention must be paid to further reducing remaining complications, such as cardiac tamponade or stroke. To this end, novel techniques and devices have been devised and trialled, with varying levels of success. Furthermore, significant work has gone into refining the technique with exploration of alternative imaging modalities, as well as alternative access routes to provide greater options for patients with challenging vascular anatomy. Whilst significant progress has been made with TAVI, areas of uncertainty remain such as the management of concomitant coronary artery disease and the optimum post-procedure antiplatelet regimen. As such, research in this field continues apace, and is likely to continue as use of TAVI becomes more widespread. This review provides a summary of the existing evidence, as well as an overview of recent developments and contentious issues in the field of TAVI.
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Affiliation(s)
- Noman Ali
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Peysh A Patel
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Steven J Lindsay
- Department of Cardiology, Bradford Royal Infirmary, Bradford, UK
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Al-Rashid F, Bienholz A, Hildebrandt HA, Patsalis PC, Totzeck M, Kribben A, Wendt D, Jakob H, Lind A, Jánosi RA, Rassaf T, Kahlert P. Transfemoral transcatheter aortic valve implantation in patients with end-stage renal disease and kidney transplant recipients. Sci Rep 2017; 7:14397. [PMID: 29089579 PMCID: PMC5663698 DOI: 10.1038/s41598-017-14486-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 10/11/2017] [Indexed: 11/09/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has evolved to a treatment of choice in high-risk patients and is therefore ideal for patients with advanced chronic kidney disease, as patients with end-stage renal disease and kidney transplant recipients. Especially, outcome of this special patient group is very important. 22 patients with chronic kidney disease stage 5 undergoing intermittent hemodialysis treatment (CKD 5D) and 8 kidney transplant recipients (KT) with severe aortic valve stenosis underwent transfemoral TAVI. TAVI was successfully performed in all patients. Postinterventional acute kidney injury (AKI) occurred in four kidney transplant recipients (KDIGO grade 1: n = 3, grade 3: n = 1) but creatinine/eGFR returned to baseline values in all patients. Short-term (30-day) mortality was 3% (1 patient in CKD 5D group). KT had a higher 2-year mortality than CKD5D patients (31% vs. 53%; p = 0.309), and cause of death was non-cardiac because of sepsis in all cases. The amount of contrast medium during TAVI was not associated with the development of acute kidney injury. TAVI is feasible in patients with CKD5D and in KT. Postinterventional AKI in these patients is often mild and does not impact renal function at day 30, while infection/ sepsis is the leading cause of mid-term mortality.
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Affiliation(s)
- Fadi Al-Rashid
- The Department of Cardiology and Vascular Medicine of the West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany.
| | - Anja Bienholz
- The Department of Nephrology, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Heike Annelie Hildebrandt
- The Department of Cardiology and Vascular Medicine of the West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Polycarpos-Christos Patsalis
- The Department of Cardiology and Vascular Medicine of the West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Matthias Totzeck
- The Department of Cardiology and Vascular Medicine of the West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Andreas Kribben
- The Department of Nephrology, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Daniel Wendt
- The Department of Cardiovascular Surgery of the West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Heinz Jakob
- The Department of Cardiovascular Surgery of the West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Alexander Lind
- The Department of Cardiology and Vascular Medicine of the West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Rolf Alexander Jánosi
- The Department of Cardiology and Vascular Medicine of the West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Tienush Rassaf
- The Department of Cardiology and Vascular Medicine of the West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Philipp Kahlert
- The Department of Cardiology and Vascular Medicine of the West-German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany
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Manolis AS, Manolis AA. Transcatheter aortic valve implantation in nonagenarians: selectively feasible or extravagantly futile? Ann Cardiothorac Surg 2017; 6:524-531. [PMID: 29062749 DOI: 10.21037/acs.2017.07.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A growing number of nonagenarians is recorded as life expectancy increases. Unfortunately, this extreme-aged group is plagued by increased prevalence of aortic stenosis amidst a higher occurrence of comorbidities that pose dilemmas to cardiologists and cardiac surgeons when having to choose a conservative or interventional treatment modality, and a surgical or transcatheter aortic valve implantation (TAVI) approach. TAVI is an expensive procedure, which also confers a higher mortality and morbidity risk in nonagenarians, compared to younger patients. Considering the physiologic rather the chronologic age alone, and adopting a shared-decision making approach (participatory medicine), it may be more realistic to determine a patient's candidacy for this non-surgical therapeutic modality. Thus, it comes down to the patient selection process by having the heart team review each nonagenarian case individually and getting the patient and the family involved, always aiming to prolong and improve patient's quality of life (QoL), but also taking into consideration patient preferences and values, sharing and respecting goals, realistic expectations, and end-of-life views and ideas. One should keep in mind that there is always the possibility that TAVI may be clinically futile for patients who have a multitude of comorbidities and extreme frailty, for whom a transition to palliative care might be prudent. Selecting nonagenarian patients with low comorbidity index and with no extreme frailty, adopting a minimalistic approach and paying attention to vascular access hemostasis may provide the elements that may lead to a successful, desirable and hopefully cost-effective outcome.
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Affiliation(s)
- Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
| | - Antonis A Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
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