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Lausberg HF, Schäfers HJ. Recent innovations in aortic valve surgery: True progress? TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:155-160. [PMID: 37484648 PMCID: PMC10357859 DOI: 10.5606/tgkdc.dergisi.2023.98551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Henning F. Lausberg
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
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2
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Magro PL, Sousa-Uva M. In low-risk patients aged >70-75 with severe aortic stenosis, is transcatheter superior to surgical aortic valve replacement in terms of reported cardiovascular composite outcomes and survival? Interact Cardiovasc Thorac Surg 2022; 34:40-44. [PMID: 34999806 PMCID: PMC8923392 DOI: 10.1093/icvts/ivab218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/16/2021] [Accepted: 07/02/2021] [Indexed: 11/14/2022] Open
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: In low-risk patients aged >70-75 with severe aortic stenosis, is transcatheter superior to surgical aortic valve replacement in terms of reported composite outcomes and survival? More than 73 papers were found using the reported search, of which 8 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. The only low-risk randomized control trial to date [Nordic Aortic Valve Intervention (NOTION)] regarding an elderly population did not show a statistically significant difference between the 2 approaches regarding the composite endpoint of death, stroke or myocardial infarction. A subgroup analysis of elderly patients in the 2 main low-risk randomized control trials did not yield statistically different results from those of the overall population; the results indicated the superiority of transcatheter aortic valve implantation regarding the composite of death, stroke or rehospitalization at 1 year [The Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis (PARTNER 3)] and non-inferiority regarding a composite of death or stroke at 2 years [Medtronic Evolut Transcatheter Aortic Valve Replacement in Low-Risk Patients (Evolut LR)]. The results from lower evidence studies are largely consistent with these findings. Overall, there is no compelling evidence indicating that older age should be an isolated criterion for the choice between transcatheter aortic valve replacement and surgical aortic valve replacement in otherwise low-risk patients. The superiority of either technique regarding the aforementioned composite short-term outcomes in this particular subgroup of patients is unclear.
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Affiliation(s)
- Pedro Lamares Magro
- Department of Cardiothoracic Surgery, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Miguel Sousa-Uva
- Department of Cardiothoracic Surgery, Hospital de Santa Cruz, Carnaxide, Portugal
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3
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Acute Kidney Injury Following Aortic Valve Replacement in Patients Without Chronic Kidney Disease. Can J Cardiol 2021; 37:37-46. [DOI: 10.1016/j.cjca.2020.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/25/2020] [Accepted: 03/14/2020] [Indexed: 01/17/2023] Open
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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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5
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Tzamalis P, Alataki S, Bramlage P, Schmitt C, Schymik G. Comparison of Valve Durability and Outcomes of Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients With Severe Symptomatic Aortic Stenosis and Less-Than-High-Risk for Surgery. Am J Cardiol 2020; 125:1202-1208. [PMID: 32085868 DOI: 10.1016/j.amjcard.2020.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 12/31/2022]
Abstract
This study aimed to investigate the rate of severe structural valve deterioration (SVD) and long-term outcomes of patients with severe symptomatic aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). Propensity score matched analysis of patients who underwent TAVI (n = 216) and SAVR (n = 216) between 2008 and 2012. Long-term echocardiographic parameters and clinical outcomes were assessed after more than 6 years after TAVI/SAVR. Rate of severe SVD was 10.5% versus 4.5% in the TAVI and SAVR groups, respectively, but the difference was not statistically significant (hazard ratio [HR] 2.5; 95% confidence interval [CI] 0.7 to 8.3; p = 0.159). This was largely driven by higher rates of mean transprosthetic gradient ≥40 mm Hg (7.0 vs 3.4%; p = 0.327) and aortic regurgitation (4.7% vs 0%; p = 0.058). TAVI patients had lower survival rates at 6 years than SAVR patients (40.7% vs 59.6%, respectively, p <0.001, HR 2.15; 95% CI 1.45 to 3.20). Rate of cardiovascular events (14.4% TAVI vs 18.2% SAVR, HR 0.8; 95% CI 0.4 to 1.3; p = 0.347) and permanent pacemaker implantation (PPI; 16.0% TAVI vs 9.2% SAVR, p = 0.234) was similar between the 2 groups. In conclusion, incidence of moderate and severe SVD was not statistically different between TAVI and SAVR. Rate of moderate or severe aortic regurgitation was significantly higher in the TAVI group with predominant use of first-generation valves. Reintervention rate was low in both groups. Survival rate was lower after TAVI, probably because of higher frailty index, but incidence of cardiovascular events, PPI, and SVD was similar in both groups.
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Affiliation(s)
- Panagiotis Tzamalis
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany.
| | - Sofia Alataki
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Claus Schmitt
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Gerhard Schymik
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
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6
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Vipparthy SC, Ravi V, Avula S, Kambhatla S, Mahmood M, Kabour A, Ali SS, Barzallo M, Mungee S. Meta-Analysis of Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients With Low Surgical Risk. Am J Cardiol 2020; 125:459-468. [PMID: 31784051 DOI: 10.1016/j.amjcard.2019.10.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 11/29/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is the current standard of care for patients with severe aortic stenosis who are at high risk for surgery. However, several recent studies have demonstrated the comparable safety and efficacy of TAVI in low-risk patients as well. We sought to pool the existing data to further assert its comparability. MEDLINE, Cochrane, and Embase databases were evaluated for relevant articles published from January 2005 to June 2019. Studies comparing outcomes of TAVI versus surgical aortic valve replacement in patients who are at low risk for surgery were included. Twelve studies (5 randomized controlled trials and 7 observational studies) totaling 27,956 patients were included. Follow-up ranged from 3 months to 5 years. Short-term all-cause mortality, short-term, and 1-year cardiac mortality were significantly lower in the TAVI group. One-year all-cause mortality, short-term, and 1-year stroke and myocardial infarction were similar in both groups. Rate of acute kidney injury and new-onset atrial fibrillation were lower in the TAVI group, whereas permanent pacemaker implantation and major vascular complications were higher in the TAVI group. Subgroup analysis of randomized controlled trials showed significantly lower 1-year all-cause mortality in the TAVI group. In conclusion, in severe aortic stenosis patients at low surgical risk, TAVI when compared with surgical aortic valve replacement, demonstrated a lower rate of short-term all-cause mortality, short-term, and 1-year cardiac mortality and similar in terms of 1-year all-cause mortality. TAVI is emerging as a safe and efficacious alternative for low surgical risk patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Marco Barzallo
- OSF St. Francis Medical Center, UICOMP, Peoria, Illinois
| | - Sudhir Mungee
- OSF St. Francis Medical Center, UICOMP, Peoria, Illinois
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7
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Kushiyama A, Taniguchi T, Morimoto T, Shiomi H, Ando K, Kanamori N, Murata K, Kitai T, Kawase Y, Izumi C, Miyake M, Mitsuoka H, Kato M, Hirano Y, Matsuda S, Inada T, Nagao K, Mabuchi H, Takeuchi Y, Yamane K, Toyofuku M, Ishii M, Minamino-Muta E, Kato T, Inoko M, Ikeda T, Komasa A, Ishii K, Hotta K, Higashitani N, Kato Y, Inuzuka Y, Jinnai T, Morikami Y, Saito N, Minatoya K, Kimura T. Age-Related Differences in the Effects of Initial Aortic Valve Replacement vs. Conservative Strategy on Long-Term Outcomes in Asymptomatic Patients With Severe Aortic Stenosis. Circ J 2020; 84:252-261. [DOI: 10.1253/circj.cj-19-0431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | | | | | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Yuichi Kawase
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Hirokazu Mitsuoka
- Division of Cardiology, Nara Hospital, Kindai University Faculty of Medicine
| | - Masashi Kato
- Department of Cardiovascular Medicine, Mitsubishikyoto Hospital
| | - Yutaka Hirano
- Department of Cardiology, Kindai University Hospital
| | | | - Tsukasa Inada
- Department of Cardiovascular Center, Osaka Red Cross Hospital
| | - Kazuya Nagao
- Department of Cardiovascular Center, Osaka Red Cross Hospital
| | | | | | | | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center
| | - Mitsuru Ishii
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | | | - Takao Kato
- Kyoto University Graduate School of Medicine
| | - Moriaki Inoko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital
| | | | - Akihiro Komasa
- Department of Cardiology, Kansai Electric Power Hospital
| | | | - Kozo Hotta
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | | | | | | | | | | | | | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine
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Sangaraju S, Cox I, Dalrymple-Hay M, Lloyd C, Suresh V, Riches T, Melhuish S, Asopa S, Newcombe S, Deutsch C, Bramlage P. Effect of procedural refinement of transfemoral transcatheter aortic valve implantation on outcomes and costs: a single-centre retrospective study. Open Heart 2019; 6:e001064. [PMID: 31673385 PMCID: PMC6802979 DOI: 10.1136/openhrt-2019-001064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/16/2019] [Accepted: 09/12/2019] [Indexed: 11/28/2022] Open
Abstract
Objectives To determine the effect of introducing several procedural refinements of transfemoral transcatheter aortic valve implantation (TAVI) on clinical outcomes and costs. Design Retrospective analysis comparing two consecutive 1-year periods, before and after the introduction of procedural refinements. Setting Tertiary hospital aortic valve programme. Participants Consecutive patients undergoing transfemoral TAVI treated between April 2014 and August 2015 using the initial setup (n=70; control group) or between September 2015 and August 2016 after the introduction of procedural refinements (n=89). Interventions Introduction of conscious sedation, percutaneous access and closure, omission of transoesophageal echocardiography during the procedure, and an early discharge procedure. Outcome measures Procedural characteristics, complications and outcomes; length of stay in intensive care unit (ICU) and hospital; hospital-related direct costs associated with TAVI. Results There were no statistically significant differences in the incidence of complications or mortality between the two groups. The mean length of stay in the ICU was significantly shorter in the procedural-refinement group compared with the control group (5.1 vs 57.2 hours, p<0.001), as was the mean length of hospital stay (4.7 vs 6.6 days, p<0.001). The total cost per TAVI procedure was significantly lower, by £3580, in the procedural-refinement group (p<0.001). This was largely driven by lower ICU costs. Conclusions Among patients undergoing transfemoral TAVI, procedural refinement facilitated a shorter stay in ICU and earlier discharge from hospital and was cost saving compared with the previous setup.
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Affiliation(s)
| | - Ian Cox
- Cardiology, University Hospitals Plymouth NHS, Plymouth, Devon, UK
| | | | - Clinton Lloyd
- Cardiology, University Hospitals Plymouth NHS, Plymouth, Devon, UK
| | | | - Tania Riches
- Cardiology, University Hospitals Plymouth NHS, Plymouth, Devon, UK
| | | | - Sanjay Asopa
- Cardiology, University Hospitals Plymouth NHS, Plymouth, Devon, UK
| | | | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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Howard C, Jullian L, Joshi M, Noshirwani A, Bashir M, Harky A. TAVI and the future of aortic valve replacement. J Card Surg 2019; 34:1577-1590. [PMID: 31600005 DOI: 10.1111/jocs.14226] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aortic valve stenosis (AS) is the most common valvular pathology and has traditionally been managed using surgical aortic valve replacement (SAVR). A large proportion of affected patient demographics, however, are unfit to undergo major surgery given underlying comorbidities. Since its introduction in 2002, transcatheter aortic valve implantation (TAVI) has gained popularity and transformed the care available to different-risk group patients with severe symptomatic AS. Specific qualifying criteria and refinement of TAVI techniques are fundamental in determining successful outcomes for intervention. Given the successful applicability in high-risk patients, TAVI has been further developed and trialed in intermediate and low-risk patients. Within intermediate-risk patient groups, TAVI was shown to be noninferior to SAVR evaluating 30-d mortality and secondary endpoints such as the risk of bleeding, development of acute kidney injury, and length of admission. The feasibility of expanding TAVI procedures into low-risk patients is still a controversial topic in the literature. A number of trials have recently been published which demonstrate TAVI as noninferior and even superior over SAVR for primary study endpoints.
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Affiliation(s)
- Callum Howard
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Lucas Jullian
- Department of Cardiothoracic Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - Mihika Joshi
- Department of Cardiology, Countess of Chester Hospital, Chester, UK
| | - Arish Noshirwani
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mohamad Bashir
- Department of Aortovascular Surgery, Manchester Royal Infirmary, Manchester, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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Peri-procedural hemostasis disorders in surgical and transcatheter aortic valve implantation. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2019; 15:176-186. [PMID: 31497050 PMCID: PMC6727236 DOI: 10.5114/aic.2019.83649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/13/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Despite their high effectiveness, surgical aortic valve replacement (AVR) and transcatheter aortic valve implantation (TAVI) are associated with substantial risk of bleeding. Although procedure-related hemostasis disorders might be crucial for safety of both procedures, the amount of data on the peri-procedural status of hemostasis in patients with aortic valve stenosis (AS) subjected to AVR and TAVI is negligible. Aim To investigate the profile of peri-procedural hemostasis in elderly patients with AS, subjected to aortic valve prosthesis implantation. Material and methods We performed a prospective analysis of global hemostasis using ROTEM thromboelastometry and platelet reactivity assessment using impedance aggregometry in 30 consecutive patients ≥ 70 years old subjected to AVR and TAVI. All tests were performed within 24 h before, directly and 24 h after the procedures. Results Surgical aortic valve replacement was characterized by transient hypofibrinogenemia and von Willebrand factor (vWF) depletion, which quickly recovered within 24 h after AVR. Transcatheter aortic valve implantation was characterized by substantial alteration of platelet function and vWF depletion with significant platelet reactivity impairment and increase in platelet sensitivity to antiplatelet agent, early after the procedure. TAVI-related hemostasis alterations were not recovered at 24 h after the procedure. Conclusions Surgical and transcatheter aortic valve replacement procedures are associated with substantial and diverse peri-procedural hemostasis disorders. Since hemostasis disorders related to TAVI are mainly characterized by impaired platelet function, early dual antiplatelet prophylaxis after TAVI requires careful consideration.
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Virtanen MPO, Eskola M, Jalava MP, Husso A, Laakso T, Niemelä M, Ahvenvaara T, Tauriainen T, Maaranen P, Kinnunen EM, Dahlbacka S, Jaakkola J, Vasankari T, Airaksinen J, Anttila V, Rosato S, D’Errigo P, Savontaus M, Juvonen T, Laine M, Mäkikallio T, Valtola A, Raivio P, Biancari F. Comparison of Outcomes After Transcatheter Aortic Valve Replacement vs Surgical Aortic Valve Replacement Among Patients With Aortic Stenosis at Low Operative Risk. JAMA Netw Open 2019; 2:e195742. [PMID: 31199448 PMCID: PMC6575142 DOI: 10.1001/jamanetworkopen.2019.5742] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
IMPORTANCE Transcatheter aortic valve replacement (TAVR) has been shown to be a valid alternative to surgical aortic valve replacement (SAVR) in patients at high operative risk with severe aortic stenosis (AS). However, the evidence of the benefits and harms of TAVR in patients at low operative risk is still scarce. OBJECTIVE To compare the short-term and midterm outcomes after TAVR and SAVR in low-risk patients with AS. DESIGN, SETTING, AND PARTICIPANTS This retrospective comparative effectiveness cohort study used data from the Nationwide Finnish Registry of Transcatheter and Surgical Aortic Valve Replacement for Aortic Valve Stenosis of patients at low operative risk who underwent TAVR or SAVR with a bioprosthesis for severe AS from January 1, 2008, to November 30, 2017. Low operative risk was defined as a Society of Thoracic Surgeons Predicted Risk of Mortality score less than 3% without other comorbidities of clinical relevance. One-to-one propensity score matching was performed to adjust for baseline covariates between the TAVR and SAVR cohorts. EXPOSURES Primary TAVR or SAVR with a bioprosthesis for AS with or without associated coronary revascularization. MAIN OUTCOMES AND MEASURES The primary outcomes were 30-day and 3-year survival. RESULTS Overall, 2841 patients (mean [SD] age, 74.0 [6.2] years; 1560 [54.9%] men) fulfilled the inclusion criteria and were included in the analysis; TAVR was performed in 325 patients and SAVR in 2516 patients. Propensity score matching produced 304 pairs with similar baseline characteristics. Third-generation devices were used in 263 patients (86.5%) who underwent TAVR. Among these matched pairs, 30-day mortality was 1.3% after TAVR and 3.6% after SAVR (P = .12). Three-year survival was similar in the study cohorts (TAVR, 85.7%; SAVR, 87.7%; P = .45). Interaction tests found no differences in terms of 3-year survival between the study cohorts in patients younger than vs older than 80 years or in patients who received recent aortic valve prostheses vs those who did not. CONCLUSIONS AND RELEVANCE Transcatheter aortic valve replacement using mostly third-generation devices achieved similar short- and mid-term survival compared with SAVR in low-risk patients. Further studies are needed to assess the long-term durability of TAVR prostheses before extending their use to low-risk patients.
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Affiliation(s)
- Marko P. O. Virtanen
- Heart Hospital, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Markku Eskola
- Heart Hospital, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere, Finland
| | | | | | - Teemu Laakso
- Heart Center, Helsinki University Hospital, Helsinki, Finland
| | - Matti Niemelä
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Tuomas Ahvenvaara
- Department of Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Tuomas Tauriainen
- Department of Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Pasi Maaranen
- Heart Hospital, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere, Finland
| | | | | | | | | | | | - Vesa Anttila
- Heart Center, Turku University Hospital, Turku, Finland
| | - Stefano Rosato
- National Centre of Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Paola D’Errigo
- National Centre of Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Tatu Juvonen
- Heart Center, Helsinki University Hospital, Helsinki, Finland
| | - Mika Laine
- Heart Center, Helsinki University Hospital, Helsinki, Finland
| | - Timo Mäkikallio
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Antti Valtola
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Peter Raivio
- Heart Center, Helsinki University Hospital, Helsinki, Finland
| | - Fausto Biancari
- Heart Center, Turku University Hospital, Turku, Finland
- Department of Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Surgery, University of Turku, Turku, Finland
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12
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Tzamalis P, Herzberger V, Bergmann J, Wuerth A, Bramlage P, Schroefel H, Schmitt C, Schymik G. The association of diabetes mellitus treated with oral antidiabetic drugs and insulin with mortality after transcatheter valve implantation: a 3-year follow-up of the TAVIK registry. Cardiovasc Diabetol 2019; 18:63. [PMID: 31138207 PMCID: PMC6540569 DOI: 10.1186/s12933-019-0873-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/22/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) on insulin is a patient-related factor in the assessment of surgical risk based on the EuroSCORE II and, as such, it confers additional risk on outcomes after transcatheter aortic valve implantation (TAVI). The aim of this study was to investigate the effect of diabetes mellitus treated with insulin and oral antidiabetic drugs on clinical outcomes after TAVI. METHODS This study is an analysis of 2000 patients who underwent TAVI between 2008 and 2015. Patients were stratified post hoc into the following categories: without diabetes (n = 1337), with diabetes treated with oral antidiabetic drugs (OAD; n = 387) and with diabetes treated using insulin (n = 276). RESULTS There was no significant difference in device success (89.5% vs 89.4% vs 88.8%, adjusted odds ratio (adjOR) 1.10 [95% confidence interval (CI) 0.64-1.91]) and VARC-2-defined major complications among the three groups of patients (without DM, OAD, and insulin, respectively). Minor but not major or disabling strokes (adjOR 2.19; 95% CI 1.11-4.3) and overall renal complications (but not stage 2/3 alone) (adjOR 1.46; 95% CI 1.18-1.81) were more common in patients with diabetes than in those without diabetes. Insulin-treated patients had a significantly lower survival rate than that of patients with orally treated diabetes and of those without diabetes at 1 year (75.7% vs. 84.5% vs 84.7%, pairwise p < 0.01) and 3 years (56.9% vs. 65.9% vs. 67.9%, adj. p < 0.05) after TAVI. However, insulin-treated diabetes was not identified as an independent risk factor for higher mortality in the first (HR 1.29; 95% CI 0.97-1.72, p = 0.084) and 3rd years (HR 1.21; 95% CI 0.98-1.49; p = 0.079) after multivariable adjustment. CONCLUSIONS Although insulin-dependent DM is an established component of surgical risk assessment, it was not identified as an independent factor associated with reduced survival in TAVI. DM treated with oral antidiabetic drugs or insulin may have less role in decision making of treatment in TAVI candidates.
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Affiliation(s)
- Panagiotis Tzamalis
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestr. 90, 76133, Karlsruhe, Germany.
| | - Valentin Herzberger
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestr. 90, 76133, Karlsruhe, Germany
| | - Jens Bergmann
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestr. 90, 76133, Karlsruhe, Germany
| | - Alexander Wuerth
- Medical Clinic III-Department of Cardiology, Vincentius Hospital Karlsruhe, Karlsruhe, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Holger Schroefel
- Department Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Claus Schmitt
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestr. 90, 76133, Karlsruhe, Germany
| | - Gerhard Schymik
- Medical Clinic IV-Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestr. 90, 76133, Karlsruhe, Germany
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Tang L, Lesser JR, Schneider LM, Burns MR, Gössl M, Garberich R, Niikura H, Witt D, Sorajja P. Prospective Evaluation for Hypoattenuated Leaflet Thickening Following Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 123:658-666. [PMID: 30528421 DOI: 10.1016/j.amjcard.2018.11.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 12/31/2022]
Abstract
Prospective investigations for the frequency of hypoattenuated leaflet thickening (HALT) and its clinical implications in transcatheter aortic valve implantation (TAVI) patients are limited. We initiated a prospective screening program of TAVI patients for HALT beginning in July 2015. Eligible patients were evaluated with gated, contrast-enhanced multidetector computed tomography within 30 days of TAVI, and examined for HALT and clinical outcomes. During the study period, 287 patients (81 ± 8 years; 53% men) who underwent TAVI with commercially approved devices were examined. Overall, 26 patients (9.1%) had occurrence of HALT, and only one of these patients had detectable hemodynamic changes on echocardiography at diagnosis. Notably, 9 of 26 HALT patients had been receiving warfarin, however, the HALT patients more often had subtherapeutic international normalized ratio whereas using warfarin than patients without HALT on index multidetector computed tomography imaging (p = 0.01). Patients who developed HALT had lower baseline aortic gradient, valvuloarterial impedance, and peak aortic velocity, and more commonly had been treated with balloon-expandable valves (73% of all HALT cases) with a higher incidence among those who received larger prostheses. All patients with HALT were placed on anticoagulation at diagnosis, and valvular function remained unchanged at follow-up. Two patients with HALT (7.7%) experienced ischemic stroke. A statistical trend for more major adverse clinical events was present in HALT patients. In conclusion, HALT was detected in 9% of TAVI cases in this prospective observational cohort, with a greater frequency in patients with large, balloon-expandable prostheses. Prospective screening may be considered as early HALT is reversible by timely therapeutic anticoagulation.
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