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Chen BY, Huang TF, Jiang XD, Ding XY, Zhou XF. Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve implantation. BMC Cardiovasc Disord 2024; 24:448. [PMID: 39182065 PMCID: PMC11344446 DOI: 10.1186/s12872-024-04101-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 08/07/2024] [Indexed: 08/27/2024] Open
Abstract
OBJECTIVE This study aimed to identify the incidence, risk factors, and outcomes of permanent pacemaker (PPM) implantation after transcatheter aortic valve implantation (TAVI) procedures. METHODS A retrospective analysis was conducted on 70 patients who underwent TAVI at the Department of Cardiology, Fujian Provincial Hospital, from January 2018 to March 2022. Based on whether a new PPM was implanted after TAVI, all patients were divided into two groups: NEW PPM and NO PPM. Baseline characteristics and clinical data were compared between the two groups. Univariate analysis was used to analyze different variables between the two groups. A binary logistic regression analysis was used to evaluate independent correlates for PPM implantation after TAVI. RESULTS The mean age of the 70 patients was 73.1 ± 8.8 years. The incidence of PPM implantation was 17.1%. Patients with diabetes and chronic kidney disease were more likely to require PPM (50% vs. 20.7%, p = 0.042, 25% vs. 5.2%, p = 0.042). Our study did not identify any significant differences in the incidence of electrocardiographic conduction disturbances except for the previous right bundle branch block (RBBB) (NO PPM 6.9% vs. NEW PPM 33.3%, p < 0.05). We found that prosthesis size, implantation depth, procedural duration, and length of hospital and intensive care unit (ICU) stays were comparable between the two groups. The leading independent predictors of PPM implantation were previous RBBB (odds ratio 10.129, p = 0.034). CONCLUSION The previous RBBB was the leading independent predictor of PPM implantation. New PPM was not associated with significantly new-onset left BBB, extended post-procedure hospitalization, ICU stay, or procedural duration.
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Affiliation(s)
- Bing-Ying Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
- The Fourth Department of Intensive Care Unit, Fuzhou University Affiliated Provincial Hospital, Fuzhou, 350001, Fujian, China
- Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou, 350001, Fujian, People's Republic of China
| | - Ting-Feng Huang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
- The Fourth Department of Intensive Care Unit, Fuzhou University Affiliated Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Xin-Da Jiang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
- The Fourth Department of Intensive Care Unit, Fuzhou University Affiliated Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Xiao-Yan Ding
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
- The Fourth Department of Intensive Care Unit, Fuzhou University Affiliated Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Xiao-Fen Zhou
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China.
- The Fourth Department of Intensive Care Unit, Fuzhou University Affiliated Provincial Hospital, Fuzhou, 350001, Fujian, China.
- Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou, 350001, Fujian, People's Republic of China.
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, 350001, Fujian, People's Republic of China.
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2
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Primessnig U, Wiedenhofer JM, Trippel TD, Loddenkemper CM, Schrader H, Brand A, Spethmann S, Stangl K, Haghikia A, Landmesser U, Boldt LH, Blaschke F, Hindricks G, Sündermann SH, Grubitzsch H, Falk V, Dreger H, Sherif M. Early clinical outcomes of Portico and Edwards Sapien 3 valve prosthesis in transcatheter aortic valve replacement: propensity-matched analysis. Front Cardiovasc Med 2024; 11:1400626. [PMID: 39077114 PMCID: PMC11284094 DOI: 10.3389/fcvm.2024.1400626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/25/2024] [Indexed: 07/31/2024] Open
Abstract
Introduction There is a lack of real-world data directly comparing different valve prostheses for transaortic valve replacement (TAVR). We aimed to compare early clinical outcomes at 30-days between the self-expandable Portico valve (Abbott) with the balloon-expandable Edwards Sapien 3 valve (Edwards Lifesciences) (ES3). Methods Out of 1,901 patients undergoing TAVR between January 2018 and December 2021, all patients who received either Portico valve or ES3 valve via transfemoral TAVR were matched using nearest-neighbor (1:1) propensity scoring. Primary endpoints were single safety endpoints and early safety composite endpoints defined by Valve Academic Research Consortium-2 (VARC-2) criteria. The secondary endpoint was to analyze risk predictors for new permanent pacemaker (PPM) implantation in TAVR. Results Out of 661 complete cases, a total of 434 patients were successfully matched based on age, sex, Euro Score II and STS-score. In the matched cohort, 217 received either a Portico or valve and 217 received an ES3 valve. The VARC-2 early safety composite scores indicated a significantly greater overall 30-day safety risk in the Portico group at 9.2% (n = 20) compared to 3.7% (n = 8) in the ES3 group (p = 0.032). The requirement for new permanent pacemaker (PPM) implantation was also higher in the Portico group, at 21.2% (n = 46) vs. 13.4% (n = 29) in the ES3 group (p = 0.042). 30-day mortality was higher was 3.7% (n = 8) in Portico group compared to 0.9% in ES3 group (p = 0.11). Furthermore, implantation of the Portico valve was identified as a significant risk predictor for new PPM implantation, alongside higher age, preprocedural atrioventricular block (AVB) and longer total procedure duration. Conclusion This study shows significantly higher rates of early clinical complications for Portico valve prostheses compared to ES3. These findings should be especially taken into consideration when selecting valve prosthesis for high-risk patients.
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Affiliation(s)
- Uwe Primessnig
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Julia M. Wiedenhofer
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Tobias D. Trippel
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Carina M. Loddenkemper
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Helene Schrader
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Brand
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
| | - Sebastian Spethmann
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
| | - Karl Stangl
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
| | - Arash Haghikia
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany
| | - Ulf Landmesser
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany
| | - Leif-Hendrik Boldt
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Florian Blaschke
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Gerhard Hindricks
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
| | - Simon H. Sündermann
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Herko Grubitzsch
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Volkmar Falk
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Henryk Dreger
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Mohammad Sherif
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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3
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Seth A, Kumar V, Singh VP, Kumar D, Varma P, Rastogi V. Myval: A Novel Transcatheter Heart Valve for the Treatment of Severe Aortic Stenosis. Interv Cardiol 2023; 18:e12. [PMID: 37398875 PMCID: PMC10311401 DOI: 10.15420/icr.2020.32] [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: 10/26/2020] [Accepted: 05/04/2022] [Indexed: 07/04/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) performed using femoral arterial access is now a guideline recommended treatment for severe calcific aortic stenosis (AS) in elderly patients. Technological advancements and procedural refinements have focused on making TAVI simpler, safer, more effective and durable. Myval (Meril Lifesciences) is a new generation balloon-expandable transcatheter heart valve (THV) developed in India that possesses novel features to improve deliverability and aid precise deployment. Following the first-in-human study, Myval was approved in India for commercial implantation in October 2018 and was subsequently given a CE mark in April 2019. This article reviews the science, technology and up-to-date clinical evidence for the Myval THV.
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Affiliation(s)
- Ashok Seth
- Interventional Cardiology and Structural Therapies, Fortis Escorts Heart Institute New Delhi, India
| | - Vijay Kumar
- Interventional Cardiology and Structural Therapies, Fortis Escorts Heart Institute New Delhi, India
| | - Vivudh Pratap Singh
- Interventional Cardiology and Structural Therapies, Fortis Escorts Heart Institute New Delhi, India
| | - Dhananjay Kumar
- Interventional Cardiology and Structural Therapies, Fortis Escorts Heart Institute New Delhi, India
| | - Puneet Varma
- Interventional Cardiology and Structural Therapies, Fortis Escorts Heart Institute New Delhi, India
| | - Vishal Rastogi
- Interventional Cardiology and Structural Therapies, Fortis Escorts Heart Institute New Delhi, India
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Sattar Y, Prakash P, Almas T, Mir T, Titus A, Ahmad S, Khan MS, Aggarwal A, Ullah W, Alhharbi A, Kakouros N, Alraies MC, Qureshi WT. Cardiovascular Outcomes of Older versus Newer Generation Transcatheter Aortic Valve Replacement Recipients: A Systematic Review & Meta-analysis. Curr Probl Cardiol 2023; 48:101467. [PMID: 36272548 DOI: 10.1016/j.cpcardiol.2022.101467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 01/04/2023]
Abstract
Newer generation transcatheter heart valves (THV) are presumed to yield better clinical efficacy and postprocedural complication profile as compared to transcatheter aortic valve replacement (TAVR) using older generation THVs. The real impact of newer generation valves on TAVR outcomes is not well known. Studies comparing older and newer generation THVs were identified from online databases including PubMed, EMBASE, Cochrane, and ClinicalTrials.gov from inception until August 2020. The primary outcome of the study was to compare mortality. Secondary outcomes included cerebrovascular events, myocardial infarction, major vascular complications, major bleeding, acute kidney injury, paravalvular leak, and post-procedural pacemaker implantation. Statistical analysis was performed using the Mantel-Haenszel random effect model with an odds ratio (OR), 95% confidence interval (CI), and p-value significance ≤0.05. A total of 14 studies were included with a combined patient population of 5697 patients (older generation n=1996; newer generation n=3701). Newer generation valves showed statistically significant results favoring lower major vascular complications (OR=2.05; 95% CI, 1.33-3.18; P = 0.00), major bleeding (OR=1.99; 95% CI, 1.35-2.93; P = 0.00), acute kidney injury (OR=1.71; 95% CI, 1.13-2.59; P = 0.01), paravalvular leak (OR=2.41; 95% CI, 1.11-5.28; P = 0.03) and mortality (OR=1.50; 95% CI, 1.10-2.06; P = 0.01) as compared to older generation valves. Cerebrovascular events, myocardial infarction, and pacemaker placement rates were found to be similar between older and newer generation valves. TAVR outcomes using newer generation valves are superior to those of older generation valves in terms of major vascular complications, acute kidney injury, paravalvular leak, and mortality.
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Affiliation(s)
- Yasar Sattar
- Department of Cardiology, West Virginia University, Morgantown, WV
| | - Preeya Prakash
- Department of Internal Medicine, Detroit Medical center, Wayne State University, Detroit, MI
| | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tanveer Mir
- Department of Internal Medicine, Detroit Medical center, Wayne State University, Detroit, MI
| | - Anoop Titus
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | - Saad Ahmad
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai - Elmhurst Hospital, Queens, NY
| | | | - Ankita Aggarwal
- Department of Internal Medicine, Ascension providence Rochester
| | - Waqas Ullah
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA
| | - Anas Alhharbi
- Department of Cardiology, West Virginia University, Morgantown, WV
| | - Nikolaos Kakouros
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA
| | - M Chadi Alraies
- Department of Interventional Cardiology, Detroit Medical Center, DMC Heart Hospital, Detroit, MI
| | - Waqas T Qureshi
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA.
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Dogosh AA, Adawi A, El Nasasra A, Cafri C, Barrett O, Tsaban G, Barashi R, Koifman E. Comparison of Transcatheter Aortic Valve Implantation Devices in Aortic Stenosis: A Network Meta-Analysis of 42,105 Patients. J Clin Med 2022; 11:jcm11185299. [PMID: 36142947 PMCID: PMC9506011 DOI: 10.3390/jcm11185299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background: In recent years, trans-catheter aortic valve implantation (TAVI) has emerged as an excellent alternative to surgical aortic valve replacement (SAVR). Currently, there are several approved devices on the market, yet comparisons among them are scarce. We aimed to compare the various devices via a network meta-analysis. Methods: We performed a network meta-analysis including randomized controlled trials (RCTs) and propensity-matched studies that provide comparisons of either a single TAVI with SAVR or two different TAVI devices and report clinical outcomes. Results: We included 12 RCT and 13 propensity-matched studies comprising 42,105 patients, among whom 27,134 underwent TAVI using various valve systems (Sapien & Sapien XT, Sapien 3, Corvalve, Evolut & Evolut Pro, Acurate Neo, Portico). The mean follow-up time was 23.4 months. Sapien 3 was superior over SAVR in the reduction of all-cause mortality (OR = 0.53; 95%CrI 0.31–0.91), while no significant difference existed between other devices and SAVR. Aortic regurgitation was more frequent among TAVI devices compared to SAVR. There was no significant difference between the various THVs and SAVR in cardiovascular mortality, myocardial infarction, NYHA class III-IV, and endocarditis. Conclusions: Newer generation TAVI devices, especially Sapien 3 and Evolut R/Pro are associated with improved outcomes compared to SAVR and other devices of the older generation.
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Affiliation(s)
- Ala Abu Dogosh
- Soroka Medical Center, Heart Institute, Ben-Gurion University of the Negev, Beer Sheva 84101, Israel
| | - Ahlam Adawi
- Soroka Medical Center, Heart Institute, Ben-Gurion University of the Negev, Beer Sheva 84101, Israel
| | - Aref El Nasasra
- Soroka Medical Center, Heart Institute, Ben-Gurion University of the Negev, Beer Sheva 84101, Israel
| | - Carlos Cafri
- Soroka Medical Center, Heart Institute, Ben-Gurion University of the Negev, Beer Sheva 84101, Israel
| | - Orit Barrett
- Soroka Medical Center, Heart Institute, Ben-Gurion University of the Negev, Beer Sheva 84101, Israel
| | - Gal Tsaban
- Soroka Medical Center, Heart Institute, Ben-Gurion University of the Negev, Beer Sheva 84101, Israel
| | - Rami Barashi
- Meir Medical Center, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Edward Koifman
- Meir Medical Center, Tel Aviv University, Tel Aviv 6423906, Israel
- Correspondence: ; Tel.: +972-(0)9-747-1450
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Rajah FT, Alaamiri AA, Mahmoodurrahman M, Alhowaish TS, Aldosari SF, Hussain AO, Masuadi EM, Arifi AA, Balgaith MA, Ayoub KM, Almutairi FQ, Alanazi HA. Incidence, predictors, and clinical outcomes of permanent pacemaker insertion following transcatheter aortic valve implantation in an Arab population. J Interv Card Electrophysiol 2021; 63:545-554. [PMID: 34427830 DOI: 10.1007/s10840-021-01039-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/12/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Conduction defects requiring permanent pacemaker insertion (PPI) are one of the most common complications after transcatheter aortic valve implantation (TAVI). The purpose of this study was to identify the incidence and predictors of this complication as well as to assess clinical outcomes of patients requiring PPI after TAVI in an Arab population. METHODS In this single-center, retrospective cohort analysis, all patients who underwent TAVI from 2010 to 2018 were reviewed; seventy-four independent variables were collected per patient, and multivariate analysis was performed to identify predictors. In-hospital outcomes were examined as well as 30-day and 1-year endpoints as defined by the Valve Academic Research Consortium-2. RESULTS There were 48 of 170 patients (28.2%) who required PPI within 30 days of TAVI. The median time from TAVI to PPI was 2 days (interquartile range: 0 to 5 days). Positive predictors of 30-day PPI were prior right bundle branch block (odds ratio [OR]: 4.10; 95% confidence interval [CI]: 0.37 to 0.79; p < 0.001), post-procedural development of new right bundle branch block (OR: 3.59; 95% CI: 1.07 to 12.03; p = 0.038), post-procedural development of new left bundle branch block (LBBB) (OR: 1.85; 95% CI: 1.21 to 2.84; p = 0.005), post-procedural prolongation of PR interval (OR: 1.02; 95% CI: 1.01 to 1.02; p < 0.001), and post-procedural QRS duration (OR: 1.01; 95% CI: 1.00 to 1.03; p = 0.02). However, post-procedural development of new LBBB no longer remained a significant predictor of PPI after excluding six patients with LBBB who underwent prophylactic PPI (p = 0.093). Negative predictors of 30-day PPI were the presence of diabetes (OR: 0.54; 95% CI: 037 to 0.79; p = 0.001), the use of prosthesis size 29 compared to 23 (OR: 0.55; 95% CI: 0.35 to 0.87; p = 0.010), and the use of prosthesis size 26 compared to 23 (OR: 0.31; 95% CI: 0.20 to 0.50; p < 0.001). PPI was associated with longer median hospital stay, but the result was borderline significant after multivariate adjustment (19 vs. 14 days; p = 0.052). There was no statistically significant difference in 30-day and 1-year clinical outcomes. CONCLUSION One-third of patients required PPI after TAVI. Several risk factors can identify patients at risk for PPI particularly pre-existing right bundle branch block. Further studies are needed to assess the association between PPI and negative clinical outcomes.
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Affiliation(s)
- Fares Tofailahmed Rajah
- Department of Medicine, King Abdulaziz Medical City - Riyadh, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulkhaliq Ali Alaamiri
- Department of Medicine, King Abdulaziz Medical City - Riyadh, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,College of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | - Thamer Saad Alhowaish
- College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Shaya Fahad Aldosari
- College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulwahab Omer Hussain
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Electrophysiology, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Emad Mohammad Masuadi
- College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed A Arifi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Cardiac Surgery, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Ali Balgaith
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Interventional Cardiology, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Kamal Mohammed Ayoub
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Interventional Cardiology, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Fawaz Q Almutairi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Interventional Cardiology, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Haitham Ahmed Alanazi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. .,College of Medicine - Riyadh , King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,Department of Electrophysiology, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia. .,Department of Cardiac Sciences, King Abdulaziz Cardiac Center, Ministry of the National Guard - Health Affairs, P.O. Box: 22490, 1413, Riyadh, Saudi Arabia.
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7
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Pepe M, Corcione N, Petronio AS, Berti S, Iadanza A, Morello A, Nestola PL, Napoli G, Ferraro P, Cimmino M, Bartorelli AL, Bedogni F, Stefanini GG, Trani C, De Giosa M, Biondi-Zoccai G, Giordano A. Assessing the Best Prognostic Score for Transcatheter Aortic Valve Implantation (from the RISPEVA Registry). Am J Cardiol 2021; 144:91-99. [PMID: 33383010 DOI: 10.1016/j.amjcard.2020.12.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 02/08/2023]
Abstract
The ACC/TVT score is a specific predictive model of in-hospital mortality for patients undergoing transcatheter aortic valve implantation (TAVI). The aim of this study was to test its predictive accuracy in comparison with standard surgical risk models (Logistic Euroscore, Euroscore II, and STS-PROM) in the population of TAVI patients included in the multicenter RISPEVA (Registro Italiano GISE sull'impianto di Valvola Aortica Percutanea) registry. The study cohort included 3293 patients who underwent TAVI between 2008 and 2019. The 4 risk scores were calculated for all patients. For all scores, the capability to predict 30-day mortality was assessed by means of several analyses testing calibration and discrimination. The ACC/TVT score showed moderate discrimination, with a C-statistics for 30-day mortality of 0.63, not significantly different from the standard surgical risk models. The ACC/TVT score demonstrated, in contrast, better calibration compared with the other scores, as proved by a greater correspondence between estimated probabilities and the actual observations. However, when the ACC/TVT score was tested in the subgroup of patients treated in a more contemporary period (from 2016 on), it revealed a slight tendency to lose discrimination and to overestimate mortality risk. In conclusion, in comparison with the standard surgical risk models, the ACC/TVT score demonstrated better prediction accuracy for estimation of 30-day mortality in terms of calibration. Nevertheless, its predictive reliability remained suboptimal and tended to worsen in patients treated more recently.
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8
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Çelik M, Milojevic MM, Durko AP, Oei FBS, Bogers AJJC, Mahtab EAF. Mortality in low-risk patients with aortic stenosis undergoing transcatheter or surgical aortic valve replacement: a reconstructed individual patient data meta-analysis. Interact Cardiovasc Thorac Surg 2020; 31:587-594. [DOI: 10.1093/icvts/ivaa179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/28/2020] [Accepted: 07/02/2020] [Indexed: 01/12/2023] Open
Abstract
Abstract
OBJECTIVES
Although the standard of care for patients with severe aortic stenosis at low-surgical risk has included surgical aortic valve replacement (SAVR) since the mid-1960s, many clinical studies have investigated whether transcatheter aortic valve implantation (TAVI) can be a better approach in these patients. As no individual study has been performed to detect the difference in mortality between these 2 treatment strategies, we did a reconstructive individual patient data analysis to study the long-term difference in all-cause mortality.
METHODS
Randomized clinical trials and propensity score-matched studies that included low-risk adult patients with severe aortic stenosis undergoing either SAVR or TAVI and with reports on the mortality rates during the follow-up period were considered. The primary outcome was all-cause mortality of up to 5 years.
RESULTS
In the reconstructed individual patient data analysis, there was no statistically significant difference in all-cause mortality between TAVI and SAVR at 5 years of follow-up [30.7% vs 21.4%, hazard ratio (HR) 1.19, 95% confidence interval (CI) 0.96–1.48; P = 0.104]. However, landmark analyses in patients surviving up to 1 year of follow-up showed significantly higher all-cause mortality at 5 years of follow-up (27.5% vs 17.3%, HR 1.77, 95% CI 1.29–2.43; P < 0.001) in patients undergoing TAVI compared to patients undergoing SAVR, respectively.
CONCLUSIONS
This reconstructed individual patient data analysis in low-risk patients with severe aortic stenosis demonstrates that the 5-year all-cause mortality rates are higher after TAVI than after SAVR, driven by markedly higher mortality rates between 1 and 5 years of follow-up in the TAVI group. The present results call for caution in expanding the TAVI procedure as the treatment of choice for the majority of all low-risk patients until long-term data from contemporary randomized clinical trials are available.
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Affiliation(s)
- Mevlüt Çelik
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Milan M Milojevic
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Andras P Durko
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Frans B S Oei
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Edris A F Mahtab
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
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9
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Akintoye E, Ando T, Sandio A, Adegbala O, Salih M, Zubairu J, Oseni A, Sistla P, Alqasrawi M, Egbe A, Mentias A, Afonso L, Briasoulis A, Panaich S, Desai MY. Aortic Valve Replacement for Severe Aortic Stenosis Before and During the Era of Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 126:73-81. [PMID: 32336533 DOI: 10.1016/j.amjcard.2020.03.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 12/20/2022]
Abstract
Recent positive results of transcatheter aortic valve replacement (TAVI) in clinical trials have sparked debate on whether TAVI should be first line for all patients with aortic stenosis. However, limited evidence exists on the clinical impact of TAVI on a national level. Using the national inpatient sample (NIS) of hospital discharges in the United States from 2001 to 2016, we evaluated the rate of AVR and associated in-hospital outcomes in pre-TAVI and TAVI era. Hierarchical mixed effect modeling was used to assess for trend and calculate risk adjusted estimates. Annual volume of AVR increased from 49,357 in 2001 to 100,050 in 2016 (103% increase). Compared with the pre-TAVI era, mean annual change in volume of AVR was higher in the TAVI era (+2.9% vs +9.4%, respectively, p <0.001). In contrast, rate of in-hospital mortality decreased from 5.4% in 2001 to 2.7% in 2016 (50% decrease). Compared with the pre-TAVI era, magnitude of mean annual change in mortality was higher in TAVI era (-4.0% vs -6.7%, respectively, p = 0.04). Unlike SAVR for which risk-adjusted rate for most outcomes seems to have plateaued, TAVI demonstrated significant improvement from 2012 to 2016 for mortality (4.6% to 1.8%), acute kidney injury (15.1% to 2.6%) and nonroutine home discharge (63.6% to 44.6%). However, no significant change in the rate of stroke (2.4% to 2.1%) and pacemaker implantation remained high (8.1% to 9.4%). Lastly, median length of stay was shorter for TAVI compared with isolated SAVR (3 vs 8 days, respectively). In conclusion, the adoption of TAVI has led to increase in volume of AVR for severe aortic stenosis in the United States with favorable short-term outcome.
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Affiliation(s)
- Emmanuel Akintoye
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa.
| | - Tomo Ando
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Aubin Sandio
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Oluwole Adegbala
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Mohamed Salih
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Josiah Zubairu
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Abdullahi Oseni
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Phanicharan Sistla
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Musab Alqasrawi
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Alexander Egbe
- Division of Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Amgad Mentias
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Luis Afonso
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Sidakpal Panaich
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Milind Y Desai
- Center for Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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10
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Ando T, Villablanca PA, Takagi H, Briasoulis A. Meta-Analysis of Hospital-Volume Relationship in Transcatheter Aortic Valve Implantation. Heart Lung Circ 2020; 29:e147-e156. [DOI: 10.1016/j.hlc.2019.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/12/2019] [Accepted: 10/20/2019] [Indexed: 02/06/2023]
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11
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Schröder J, Almalla M, Saad M, Mezger M, Keszei A, Frick M, Lotfi S, Hoffmann R, Becker M, Altiok E. Distinct pressure half-time values by transthoracic echocardiography for grading of paravalvular regurgitation after transcatheter aortic valve replacement. Sci Rep 2020; 10:2549. [PMID: 32054935 PMCID: PMC7018957 DOI: 10.1038/s41598-020-59211-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 01/23/2020] [Indexed: 11/30/2022] Open
Abstract
Postprocedural aortic regurgitation (AR) has negative impact on patient outcome after transcatheter aortic valve replacement (TAVR). Standard assessment of AR severity by echocardiography is hampered after TAVR. Measurement of pressure half-time (PHT) by echocardiography is not limited in these patients but it may be affected by concomitant left ventricular hypertrophy (LVH). This study sought to evaluate distinct cut-off values of PHT differentiating between patients without and with more than mild LVH for grading of AR after TAVR with cardiac magnetic resonance (CMR) as the reference method for comparison. 71 patients (age 81 ± 6 years) with severe aortic stenosis undergoing TAVR were included into the study. Transthoracic echocardiography (TTE) and CMR were performed after TAVR. Left ventricular mass index was calculated by TTE. PHT was measured by continuous-wave Doppler echocardiography of aortic regurgitation jet. In 18 patients (25%) PHT could not be obtained due to no or very faint Doppler signal. Aortic regurgitant volume and regurgitant fraction were calculated by CMR by flow analysis of the ascending aorta. In 14 of 53 patients (26%) AR after TAVR was moderate or severe as categorized by CMR analysis. More than mild LVH was present in 27 of 53 patients (51%). PHT correlated inversely less to regurgitant fraction by CMR analysis in patients with LVH (r = −0.293; p = 0.138) than in patients without LVH (r = −0.455; p = 0.020). In patients without relevant LVH accuracy of PHT to predict moderate or severe paravalvular regurgitation AUC was 0.813 using a cut-off value of 347 ms and AUC was 0.729 in patients with more than mild LVH using a cut-off value of 420 ms. Analysis of PHT by TTE with distinct cut-off values for patients without and with more than mild LVH allows detection of moderate or severe AR after TAVR as defined by CMR. In none of the patients in which PHT could not be measured AR was categorized as more than trace by CMR analysis.
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Affiliation(s)
- Joerg Schröder
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Mohammad Almalla
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Mohammed Saad
- Department of Medicine - Cardiology, Angiology, Intensive Care Medicine, University Hospital Lübeck, Lübeck, Germany
| | - Matthias Mezger
- Department of Medicine - Cardiology, Angiology, Intensive Care Medicine, University Hospital Lübeck, Lübeck, Germany
| | - Andras Keszei
- Department of Medical Informatics, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Frick
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Shahram Lotfi
- Department of Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Rainer Hoffmann
- Department of Cardiology, St. Bonifatius Hospital, Lingen, Germany
| | - Michael Becker
- Department of Cardiology, Nephrology and Internal Intensive Care Medicine, Rhein-Maas Klinikum, Wuerselen, Germany
| | - Ertunc Altiok
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
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12
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Ueshima D, Nai Fovino L, Brener SJ, Fabris T, Scotti A, Barioli A, Giacoppo D, Pavei A, Fraccaro C, Napodano M, Tarantini G. Transcatheter aortic valve replacement for bicuspid aortic valve stenosis with first- and new-generation bioprostheses: A systematic review and meta-analysis. Int J Cardiol 2020; 298:76-82. [DOI: 10.1016/j.ijcard.2019.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 01/10/2023]
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13
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Abstract
Evidence in transcatheter aortic valve replacement (TAVR) has accumulated rapidly over the last few years and its application to clinical decision making are becoming more important. In this review, we discuss the advances in TAVR for patient selection, expanding indications, complications, and emerging technologies.
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14
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Ando T, Adegbala O, Villablanca P, Akintoye E, Ashraf S, Shokr M, Siddiqui F, Takagi H, Grines CL, Afonso L, Briasoulis A. Incidence and predictors of readmissions to non-index hospitals after transcatheter aortic valve replacement and the impact on in-hospital outcomes: From the nationwide readmission database. Int J Cardiol 2019; 292:50-55. [PMID: 31053244 DOI: 10.1016/j.ijcard.2019.04.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Whether readmission to non-index hospitals (where the initial procedure was not performed) could result in adverse outcomes and increased utilization of healthcare resources compared with readmission to index hospitals after transcatheter aortic valve replacement (TAVR) remains unclear. METHODS From January 2012 to September 2015, a nationwide readmission database was queried to identify those who were older than 50 years and had endovascular TAVR, using the International Classification of Disease, 9th Revision, Clinical Modification code 35.05. Elective readmissions were excluded. In-hospital outcomes were compared between the index and non-index hospital readmissions. A multivariable logistic regression analysis was performed to identify predictors of non-index hospital readmissions. RESULTS A total of 6808 readmissions were identified of which 2564 (37.7%) were readmitted to non-index hospitals. Residents at smaller counties, metropolitan non-teaching hospitals, or hospitals at large metropolitan areas were predictors of non-index readmissions. In-hospital mortality (adjusted odds ratio [aOR] 1.27, p = 0.20), acute myocardial infarction (aOR 0.83, p = 0.53), pacemaker placement (aOR 0.97, p = 0.90), acute kidney injury (aOR 0.98, p = 0.84), and stroke (aOR 1.03, p = 0.90) were similar between index and non-index readmissions but bleeding events requiring transfusions were more frequently observed in readmissions at non-index hospitals (aOR 1.32, p = 0.025). Hospital cost (15,410 dollars vs. 16,390 dollars, p = 0.25) and length of stay (5.70 days vs. 5.65 days, p = 0.85) were comparable between groups. CONCLUSIONS Non-index readmissions post-TAVR was relatively common but did not result in increased hospital mortality or healthcare utilization. Our results are reassuring for TAVR recipients with limited access to index hospitals.
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Affiliation(s)
- Tomo Ando
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, United States.
| | - Oluwole Adegbala
- Department of Internal Medicine, Englewood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, Englewood, NJ, United States
| | - Pedro Villablanca
- Division of Cardiology, Henry Ford Hospital, Detroit, MI, United States
| | - Emmanuel Akintoye
- Division of Cardiology, University of Iowa, Hospitals and Clinics, IA, Iowa, United States
| | - Said Ashraf
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, United States
| | - Mohamed Shokr
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, United States
| | - Fayez Siddiqui
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, United States
| | - Hisato Takagi
- Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Cindy L Grines
- Division of Cardiology, North Shore University Hospital, Hofstra Northwell School of Medicine, Manhasset, NY, United States
| | - Luis Afonso
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, United States
| | - Alexandros Briasoulis
- Division of Cardiology, University of Iowa, Hospitals and Clinics, IA, Iowa, United States
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15
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Takagi H, Hari Y, Nakashima K, Kuno T, Ando T. Network meta-analysis of new-generation valves for transcatheter aortic valve implantation. Heart Vessels 2019; 34:1984-1992. [PMID: 31144096 DOI: 10.1007/s00380-019-01442-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/24/2019] [Indexed: 11/29/2022]
Abstract
To comprehensively compare and rank new-generation valves (NGVs) for transcatheter aortic valve implantation, we performed a network meta-analysis (NMA) of all eligible comparative studies. MEDLINE and EMBASE were searched through September 2018. We included all studies comparing 4 NGVs (ACURATE, Evolut R, Lotus, and SAPIEN 3) and an early generation valve (CoreValve) as the reference transcatheter heart valve (THV) each other and reporting at least one of postprocedural incidence of all-cause death, ≥ moderate aortic regurgitation (AR), and new permanent pacemaker implantation (PMI). To compare different THVs, a random-effects restricted-maximum-likelihood NMA based on a frequentist framework for indirect and mixed comparisons was used. Using surface under the cumulative ranking curve (SUCRA), the relative ranking probability of each THV was estimated and the hierarchy of competing THVs was obtained. We identified 29 eligible studies enrolling a total of 17,817 patients. In accordance with the estimated SUCRA probability, SAPIEN 3 was the best effective for a reduction in death (80.6%) and the second best for decreased ≥ moderate AR (74.4%) and PMI (74.1%) compared with the other THVs. Lotus was ranked the best for a reduction in ≥ moderate AR (94.5%;), whereas the worst for decreased PMI (1.2%) and the second worst for a reduction in mortality (38.6%). ACURATE was the best for decreased PMI (99.2%) and the second best for a reduction in mortality (77.9%). As a whole, SAPIEN 3 may be the best effective NGV among the 4 examined NGVs (ACURATE, Evolut R, Lotus, and SAPIEN 3).
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Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka, 411-8611, Japan. .,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
| | - Yosuke Hari
- Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka, 411-8611, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kouki Nakashima
- Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka, 411-8611, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Toshiki Kuno
- Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - Tomo Ando
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
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Finkelstein A, Rozenbaum Z, Zhitomirsky S, Halkin A, Banai S, Bazan S, Barbash I, Segev A, Guetta V, Danenberg H, Planner D, Orvin K, Assa HV, Assali A, Kornowski R, Steinvil A. Safety outcomes of new versus old generation transcatheter aortic valves. Catheter Cardiovasc Interv 2018; 94:E44-E53. [PMID: 30549227 DOI: 10.1002/ccd.28021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 10/30/2018] [Accepted: 11/19/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare procedural outcomes of transcatheter aortic valve implantation (TAVI) patients who were implanted with older versus newer generation valves. BACKGROUND The current evidence base for improved safety of the newer commercially available TAVI valves is limited. METHODS A retrospective analysis of the Israeli multicenter TAVI registry was performed. Patients were stratified by valve generation of four commercially available devices: Edwards Sapien (ESX) Edwards Sapien S3 (ES3), Medtronic CoreValve (MCV), and Medtronic Evolut R (MER). RESULTS The cohort consisted of 737 patients with new generation valves (NGVs; ES3 n = 223; MER n = 514) and 1,869 with old generation valves (OGVs; MCV n = 1,181; ESX n = 688). Device success rates were significantly higher in NGV (97.5 versus 95.4%), with less post-procedural paravalvular leak (3 versus 5.8%), and valve mal-positioning (1.2 versus 3.4%); all P-values<0.05. There were no differences in rates of permanent pacemaker implantation, stroke or acute kidney injury (AKI) of any stage between the groups, although stage ≥2 AKI was more prevalent in NGV. After adjustment to significant differences in baseline patient and procedural characteristics, device success was higher (OR 1.86, 95% confidence interval (CI) 1.09-3.18, P = 0.023) and the 1-month safety outcome was significantly lower (OR 0.72, 95% CI 0.55-0.96, P = 0.025) for NGV. Device success was driven mainly by improved rates of PVL of ES3, while the safety outcome was mainly driven by improved rates of life-threatening bleeding and valve mal-positioning of MER. CONCLUSION As compared to OGV, use of NGV for TAVI was associated with higher rates of device success and lower rates of adverse events.
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Affiliation(s)
- Ariel Finkelstein
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zach Rozenbaum
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sophia Zhitomirsky
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Halkin
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Banai
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Samuel Bazan
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Barbash
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victor Guetta
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Danenberg
- Cardiology department, Hadassah Medical Center, Jerusalem, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Planner
- Cardiology department, Hadassah Medical Center, Jerusalem, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Katia Orvin
- Cardiology department, Rabin Medical Center, Petach Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Vaknin Assa
- Cardiology department, Rabin Medical Center, Petach Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abid Assali
- Cardiology department, Rabin Medical Center, Petach Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Cardiology department, Rabin Medical Center, Petach Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Steinvil
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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Ando T, Adegbala O, Villablanca PA, Briasoulis A, Takagi H, Grines CL, Schreiber T, Nazif T, Kodali S, Afonso L. In‐hospital outcomes of transcatheter versus surgical aortic valve replacement in non‐teaching hospitals. Catheter Cardiovasc Interv 2018; 93:954-962. [DOI: 10.1002/ccd.27968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/23/2018] [Accepted: 10/16/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Tomo Ando
- Department of Medicine, Division of CardiologyWayne State University/Detroit Medical Center Detroit Michigan
| | - Oluwole Adegbala
- Department of Medicine Department of Internal Medicine, Englewood Hospital and Medical CenterSeton Hall University‐Hackensack Meridian School of Medicine Englewood New Jersey
| | - Pedro A. Villablanca
- Department of Medicine, Division of CardiologyNew York University Langone Medical Center New York New York
| | - Alexandros Briasoulis
- Department of Medicine, Division of Cardiovascular MedicineUniversity of Iowa Hospitals and Clinics Iowa Iowa
| | - Hisato Takagi
- Department of Medicine, Division of Cardiovascular SurgeryShizuoka Medical Center Shizuoka Japan
| | - Cindy L. Grines
- Department of Medicine, Division of CardiologyNorth Shore University Hospital, Hofstra Northwell School of Medicine New York
| | - Theodore Schreiber
- Department of Medicine, Division of CardiologyWayne State University/Detroit Medical Center Detroit Michigan
| | - Tamim Nazif
- Department of Medicine, Division of CardiologyNew York‐Presbyterian Hospital, College of Physicians and Surgeons, Columbia University Medical Center New York New York
| | - Susheel Kodali
- Department of Medicine, Division of CardiologyNew York‐Presbyterian Hospital, College of Physicians and Surgeons, Columbia University Medical Center New York New York
| | - Luis Afonso
- Department of Medicine, Division of CardiologyWayne State University/Detroit Medical Center Detroit Michigan
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Ando T, Akintoye E, Holmes AA, Briasoulis A, Pahuja M, Takagi H, Schreiber T, Grines CL, Afonso L. Clinical End Points of Transcatheter Aortic Valve Implantation Compared With Surgical Aortic Valve Replacement in Patients <65 Years of Age (From the National Inpatient Sample Database). Am J Cardiol 2018; 122:279-283. [PMID: 29880287 DOI: 10.1016/j.amjcard.2018.03.356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/16/2018] [Accepted: 03/21/2018] [Indexed: 11/28/2022]
Abstract
It is unknown if transcatheter aortic valve implantation (TAVI) is a safe alternative to surgical aortic valve replacement (SAVR) in patients <65 years old. Data from the National Inpatient Sample database were utilized. Patients from 2011 to 2015, ages 18 to 64 years old (inclusive) who underwent TAVI and SAVR were included. Patients who underwent SAVR and who also received a concomitant nonaortic valve surgery were excluded. A propensity score analysis was used. A total of 18,970 (528 TAVI and 18,442 SAVR) patients were identified. Patients who underwent TAVI were older (57 ± 7 vs 54 ± 10 years old, p <0.001) with more frequent co-morbidities. Overall in-hospital mortality was similar between TAVI and SAVR (odds ratio [OR] = 0.52, p = 0.12). Postprocedure stroke (OR = 0.50, p = 0.24), acute kidney injury (OR = 0.98, p = 0.89), acute myocardial infarction (OR = 0.48, p = 0.08), and vascular complication requiring surgery (OR = 0.20, p = 0.11) were similar between patients who underwent TAVI and SAVR. Bleeding requiring transfusion (OR = 0.32, p <0.01) was less frequent in patients who underwent TAVI, but new pacemakers (OR = 1.7, p = 0.02) were more frequent in these patients. Patients who underwent TAVI had shorter hospital stays (7.9 vs 10.0 days, p <0.001) and were more likely to be discharged to home. Cost between TAVI and SAVR was similar ($49,014 vs $42,907, respectively, p = 0.82). In the <65 years old patient population, TAVI also conferred similar overall in-hospital mortality compared with patients who underwent SAVR. TAVI resulted in fewer major complications, shorter hospital stay, and more frequent discharge to home, but higher rates of pacemaker implantation compared with SAVR. Therefore, TAVI appears to be a safe alternative to SAVR in patients <65 years old.
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Affiliation(s)
- Tomo Ando
- Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, Michigan.
| | - Emmanuel Akintoye
- Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, Michigan
| | - Anthony A Holmes
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York
| | - Alexandros Briasoulis
- Divison of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa, Iowa
| | - Mohit Pahuja
- Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, Michigan
| | - Hisato Takagi
- Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Theodore Schreiber
- Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, Michigan
| | - Cindy L Grines
- Division of Cardiology, North Shore University Hospital, Hofstra Norwell School of Medicine, Manhasset, New York
| | - Luis Afonso
- Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, Michigan
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Ando T, Akintoye E, Telila T, Briasoulis A, Takagi H, Schreiber T, Afonso L, Grines CL. Hospital outcomes of transcatheter versus surgical aortic valve replacement in female in the United States. Catheter Cardiovasc Interv 2017; 91:813-819. [DOI: 10.1002/ccd.27362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/02/2017] [Accepted: 09/09/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Tomo Ando
- Wayne State University, Harper hospital/Detroit Medical Center, Division of Cardiology; Detroit Michigan
| | - Emmanuel Akintoye
- Wayne State University, Harper hospital/Detroit Medical Center, Division of Cardiology; Detroit Michigan
| | - Tesfaye Telila
- Wayne State University, Harper hospital/Detroit Medical Center, Division of Cardiology; Detroit Michigan
| | | | - Hisato Takagi
- Shizuoka Medical Center, Division of Cardiovascular Surgery; Shizuoka Japan
| | - Theodore Schreiber
- Wayne State University, Harper hospital/Detroit Medical Center, Division of Cardiology; Detroit Michigan
| | - Luis Afonso
- Wayne State University, Harper hospital; Michigan
| | - Cindy L. Grines
- North Shore University Hospital, Northwell Health System, Department of Internal Medicine, Division of Cardiology, Manhasset; New York, United States
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