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Yifan D, Zhen F, Yue M, Xun S, Jiapei G, Li Z, Jing Z. Safety and efficacy of minimal transcatheter aortic valve replacement: A systematic review and meta-analysis. Heart Lung 2024; 67:158-168. [PMID: 38788303 DOI: 10.1016/j.hrtlng.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/10/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is a preferred treatment for patients with highly critical aortic stenosis (AS), which is a difficult and complicated procedure, leaving a heavy economical burden on patients and national health insurance. Minimalist TAVR can simplify a part of the operation procedures, but the surgical efficacy and safety are still under debated. OBJECTIVES Explore the effectiveness and safety of minimalist TAVR in the treatment of patients with aortic stenosis. METHODS A systematic search of PubMed, Web of Science, and Embase databases was conducted for studies involving application of minimalist TAVR in patients with severe aortic stenosis, two researchers independently screened the literature, extracted data and Meta-analysis was performed using STATA 16.0 software. RESULTS Nine studies, involving a total of 3,148 AS patients, were included. Minimalist TAVR has similar surgical success rates compared to standardized TAVR, intraoperative fluoroscopy time, dosage of contrast agent, and total operative time were superior to standard TAVR. Regarding surgical complications, the incidence of permanent pacemaker placement and moderate to severe paravalvular leakage were similar for both TAVR, the risk of major vascular complications and major bleeding events in the minimalist TAVR was significantly lower than the standard TAVR. The risk of overall death, stroke, and cardiovascular-related readmission within 30 days was similar in both procedures. CONCLUSION Patients with severe aortic stenosis treated with minimalist TAVR have similar short-term efficacy as well as 30-day clinical outcomes to standard TAVR, while minimalist TAVR could reduce the risk of major vascular complications and bleeding complications.
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Affiliation(s)
- Deng Yifan
- Clinical Medical College, Yangzhou University, Yangzhou 225001, PR China; Taizhou People's Hospital affiliated to Nanjing Medical University, Tai zhou 225300, PR China; Medical College of Yangzhou University, Yang zhou 225001, PR China
| | - Fang Zhen
- Clinical Medical College, Yangzhou University, Yangzhou 225001, PR China; Medical College of Yangzhou University, Yang zhou 225001, PR China
| | - Ma Yue
- Clinical Medical College, Yangzhou University, Yangzhou 225001, PR China; Medical School of Nanjing University, Nanjing, 21000, PR China
| | - Sun Xun
- Clinical Medical College, Yangzhou University, Yangzhou 225001, PR China; alian Medical University, Dalian 116000, PR China
| | - Gao Jiapei
- Clinical Medical College, Yangzhou University, Yangzhou 225001, PR China; Medical College of Yangzhou University, Yang zhou 225001, PR China
| | - Zhu Li
- Clinical Medical College, Yangzhou University, Yangzhou 225001, PR China; Taizhou People's Hospital affiliated to Nanjing Medical University, Tai zhou 225300, PR China; Medical College of Yangzhou University, Yang zhou 225001, PR China.
| | - Zhang Jing
- Clinical Medical College, Yangzhou University, Yangzhou 225001, PR China; Northern Jiangsu People's Hospital, Yangzhou 225001, PR China.
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Danenberg HD. Editorial: Procedural echo in TAVR: Mandatory, optional or redundant? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00520-7. [PMID: 38849265 DOI: 10.1016/j.carrev.2024.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024]
Affiliation(s)
- Haim D Danenberg
- Department of Cardiology, E. Wolfson Medical Center, Holon, Israel.
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3
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Fadah K, Khalafi S, Corey M, Sotelo J, Farag A, Siddiqui T, Abolbashari M. Optimizing Anesthetic Selection in Transcatheter Aortic Valve Replacement: Striking a Delicate Balance between Efficacy and Minimal Intervention. Cardiol Res Pract 2024; 2024:4217162. [PMID: 38454917 PMCID: PMC10919973 DOI: 10.1155/2024/4217162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/27/2024] [Indexed: 03/09/2024] Open
Abstract
Patients with severe calcific native aortic valve stenosis (AS) who require valve replacement have two options, surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). TAVR was approved in late 2011 for extremely high-risk patients and was subsequently approved for high-risk (2012), intermediate-risk (2016), and low-risk (2019) patients. In 2019, TAVR procedures surpassed SAVR procedures for the first time in the United States. The approach to anesthesia for this procedure has also evolved. Initially, general anesthesia (GA) was preferred, but currently, conscious sedation (CS) is favored. This review aims to clarify the indications and contraindications for both approaches, as well as the advantages of one approach over the other. Recent studies show that conscious sedation has better outcomes in terms of all-cause mortality, procedure complications such as stroke, myocardial infarction, infection requiring antibiotics, acute kidney injury, and the need for inotropes or vasopressors.
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Affiliation(s)
- Kahtan Fadah
- Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905, USA
| | - Seyed Khalafi
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, 5001 El Paso Drive, El Paso, TX 79905, USA
| | - Miller Corey
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, 5001 El Paso Drive, El Paso, TX 79905, USA
| | - Jose Sotelo
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905, USA
| | - Ahmed Farag
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905, USA
| | - Tariq Siddiqui
- Tash Medical Clinic, 7812 Gateway Blvd E, El Paso, TX 79915, USA
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Vovk Racman P, Kšela J, Racman M, Žerjav U, Šoštarič M. Comparison of Procedural Sedation With Propofol and Dexmedetomidine During Transcatheter Aortic Valve Replacement Using the Transfemoral Approach. J Cardiothorac Vasc Anesth 2023; 37:1894-1900. [PMID: 37225545 DOI: 10.1053/j.jvca.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/24/2023] [Accepted: 05/03/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Although procedural sedation is an established method of anesthesia for transcatheter aortic valve replacement (TAVR), reliable evidence to guide the choice of a suitable sedative agent remains scarce. Accordingly, this trial aimed to compare the effect of procedural sedation with dexmedetomidine versus propofol on postoperative neurocognitive and related clinical outcomes in patients undergoing TAVR. DESIGN Prospective, randomized, double-blind clinical trial. SETTING The study was conducted at the University Medical Centre Ljubljana, Slovenia. PARTICIPANTS The study enrolled 78 patients who underwent TAVR under procedural sedation between January 2019 and June 2021. Seventy-one patients randomized into the propofol group (n = 34) and dexmedetomidine group (n = 37) were included in the final analysis. INTERVENTIONS Patients in the propofol group received sedation with propofol (continuous intravenous infusion of 0.5-2.5 mg/kg/h), whereas patients in the dexmedetomidine group received sedation with dexmedetomidine (loading dose of 0.5 µg/kg over 10 minutes followed by continuous intravenous infusion of 0.2-1.0 µg/kg/h). MEASUREMENTS AND MAIN RESULTS Minimental state examination (MMSE) was performed before and 48 hours after TAVR. There was no statistically significant difference in MMSE scores between groups before TAVR (p = 0.253), but the MMSE after the procedure revealed a significantly lower incidence of delayed neurocognitive recovery (p = 0.005) and thus better cognitive outcomes in the dexmedetomidine group (p = 0.022). CONCLUSIONS Compared with propofol, procedural sedation with dexmedetomidine in TAVR was associated with a significantly lower incidence of delayed neurocognitive recovery.
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Affiliation(s)
- Pia Vovk Racman
- Clinical Department of Anaesthesiology and Perioperative Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Juš Kšela
- Clinical Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia; University of Ljubljana Faculty of Medicine, Ljubljana, Slovenia
| | - Mark Racman
- Clinical Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Urška Žerjav
- Clinical Department of Anaesthesiology and Perioperative Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Maja Šoštarič
- Clinical Department of Anaesthesiology and Perioperative Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia; University of Ljubljana Faculty of Medicine, Ljubljana, Slovenia.
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Agricola E, Ingallina G, Ancona F, Biondi F, Margonato D, Barki M, Tavernese A, Belli M, Stella S. Evolution of interventional imaging in structural heart disease. Eur Heart J Suppl 2023; 25:C189-C199. [PMID: 37125282 PMCID: PMC10132629 DOI: 10.1093/eurheartjsupp/suad044] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Treatments for structural heart diseases (SHD) have been considerably evolved by the widespread of transcatheter approach in the last decades. The progression of transcatheter treatments for SHD was feasible due to the improvement of devices and the advances in imaging techniques. In this setting, the cardiovascular imaging is pivotal not only for the diagnosis but even for the treatment of SHD. With the aim of fulfilling these tasks, a multimodality imaging approach with new imaging tools for pre-procedural planning, intra-procedural guidance, and follow-up of SHD was developed. This review will describe the current state-of-the-art imaging techniques for the most common percutaneous interventions as well as the new imaging tools. The imaging approaches will be addressed describing the use in pre-procedural planning, intra-procedural guidance, and follow-up.
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Affiliation(s)
| | - Giacomo Ingallina
- Cardiothoracic Department, Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy
| | - Francesco Ancona
- Cardiothoracic Department, Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy
| | - Federico Biondi
- Cardiothoracic Department, Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy
| | - Davide Margonato
- Cardiothoracic Department, Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy
| | - Monica Barki
- Cardiothoracic Department, Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy
| | - Annamaria Tavernese
- Cardiothoracic Department, Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy
| | - Martina Belli
- Cardiothoracic Department, Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy
| | - Stefano Stella
- Cardiothoracic Department, Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy
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Yashige M, Zen K, Nakamura S, Fujimoto T, Takamatsu K, Ito N, Kadoya Y, Yamano M, Yamano T, Nakamura T, Yaku H, Matoba S. Incidence and predictors of transcatheter aortic valve replacement device emboligenic matter detected by transesophageal echocardiography. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1741-1750. [PMID: 35211830 DOI: 10.1007/s10554-022-02567-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/12/2022] [Indexed: 11/05/2022]
Abstract
During transfemoral (TF) or transcatheter aortic valve replacement (TAVR), transesophageal echocardiography (TEE) sometimes reveals an unexpected mobile membranous mass on the catheter tip within the proximal part of the descending thoracic aorta. Such mobile masses may cause critical embolic events if the TAVR device advances into the ascending aorta in the absence of preventive measures. This study aimed to investigate the incidence and predictors of emboligenic matter (EM) during TAVR, impact of EM on the procedure, and incidence of symptomatic ischemic stroke post procedure. Among 436 consecutive patients who underwent TF-TAVR, 407 were evaluated in this study. The primary end point was incidence of symptomatic ischemic stroke within 24 h post procedure while taking appropriate preventive measures. Incidence of EM, factors associated with EM, and the impact of EM on the procedure were also investigated. Among the 407 cases, 15 cases (3.7%) of EM were identified but no ischemic stroke occurred in the EM (+) group (0% vs. 2.04%, p = 1.00). In the EM (+) group, a self-expandable valve was used in all 15 cases (100% vs. 42.6%, p < 0.0001) while 14 cases used a CoreValve's InLine sheath system initially (93.3% vs. 27.3%, p < 0.0001). CoreValve's InLine sheath system usage was the only independent predictor of EM. The CoreValve's InLine delivery system was identified as a predictor of EM during TF-TAVR, but symptomatic ischemic stroke was avoided while taking appropriate embolization preventive measures.
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Affiliation(s)
- Masaki Yashige
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Shunsuke Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tomotaka Fujimoto
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuaki Takamatsu
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Nobuyasu Ito
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yoshito Kadoya
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tetsuhiro Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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Cantey C. Transcatheter Aortic Valve Replacement: Clinical Update for Nurse Practitioners. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Wunderlich NC, Honold J, Swaans MJ, Siegel RJ. How to Image and Manage Prosthesis-Related Complications After Transcatheter Aortic Valve Replacement. Curr Cardiol Rep 2021; 23:94. [PMID: 34196775 DOI: 10.1007/s11886-021-01522-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW In this review, we provide an overview of potential prosthesis - related complications after transcatheter aortic valve replacement, their incidences, the imaging modalities best suited for detection, and possible strategies to manage these complications. RECENT FINDINGS Therapy for severe aortic valve stenosis requiring intervention has increasingly evolved toward transcatheter aortic valve replacement over the past decade, and the number of procedures performed has increased steadily in recent years. As more and more centers favor a minimalistic approach and largely dispense with general anesthesia and intra-procedural imaging by transesophageal echocardiography, post-procedural imaging is becoming increasingly important to promptly detect dysfunction of the transcatheter valve and potential complications. Complications after transcatheter aortic valve replacement must be detected immediately in order to initiate adequate therapeutic measures, which require a profound knowledge of possible complications that may occur after transcatheter aortic valve replacement, the imaging modalities best suited for detection, and available treatment options.
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Affiliation(s)
| | - Jörg Honold
- Cardiovascular Center Darmstadt, Darmstadt, Germany
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Charlesworth M, Williams BG, Buch MH. Advances in transcatheter aortic valve implantation, part 2: perioperative care. BJA Educ 2021; 21:264-269. [PMID: 34178383 DOI: 10.1016/j.bjae.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- M Charlesworth
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - B G Williams
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - M H Buch
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Qureshi WT, Kundu A, Mir T, Khan A, Anwaruddin S, Sattar Y, Ogunsua A, Dutta A, Majeed CN, Walker J, Kakouros N. Meta-analysis of minimalist versus standard care approach for transcatheter aortic valve replacement. Expert Rev Cardiovasc Ther 2021; 19:565-574. [PMID: 33896312 DOI: 10.1080/14779072.2021.1920926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The change in practice of transcatheter aortic valve replacement (TAVR) to a minimalist approach is a debate. METHODS Online database search for studies that compared the minimalist approach with the standard approach for TAVR were searched from inception through September 2020. We calculated pooled odds ratios (ORs) and 95% confidence intervals (CIs) using the fixed or random-effects model. RESULTS A total of 9 studies with 2,880 TAVR patients (minimalist TAVR;1066 and standard TAVR; 1,814) were included. Compared to standard approach, there were no significant differences in in-hospital mortality, 30-day mortality, or hospital readmissions. However, there was a reduced risk of acute kidney injury (OR0.49;95%CI0.27-0.89), major bleeding (OR0.21;95%CI0.12-0.38) and major vascular complications (OR0.60,95%CI0.39-0.91) associated with the minimalist TAVR group. There was comparatively shorter hospital length of stay (mean difference -2.41;95%CI-2.99,-1.83) days, procedural time (mean difference -43.99;95%CI-67.25,-20.75) minutes, fluoroscopy time (mean difference -2.69;95%CI-3.44,-1.94) minutes and contrast volume (mean difference -26.98;95%CI-42.18,-11.79) ml in the minimalist TAVR group. CONCLUSIONS This meta-analysis demonstrated potential benefits of the minimalist TAVR approach over the standard approach regarding some adverse clinical outcomes as well as procedural outcomes without significant differences in mortality or readmission rates.
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Affiliation(s)
- Waqas T Qureshi
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Amartya Kundu
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Tanveer Mir
- Department of Internal Medicine, Detroit Medical Centre, Wayne State University, Detroit USA
| | - Amna Khan
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Saif Anwaruddin
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Yasar Sattar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst Hospital, Queens, NY, USA
| | - Adedotun Ogunsua
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Abhishek Dutta
- Department of Critical Care Medicine, Memorial Sloan Kettering, NY, USA
| | - Chaudry Nasir Majeed
- Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jennifer Walker
- Division of Cardiothoracic Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nikolaos Kakouros
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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2020 update of the Austrian Society of Cardiology (ÖKG) and the Austrian Society of Cardiac Surgery (ÖGHTG) on the position statement of the ÖKG and ÖGHTG for transcatheter aortic valve implantation 2011. Wien Klin Wochenschr 2021; 133:750-761. [PMID: 33755758 DOI: 10.1007/s00508-021-01820-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 01/21/2021] [Indexed: 10/21/2022]
Abstract
This position statement is an update to the 2011 consensus statement of the Austrian Society of Cardiology (ÖKG) and the Austrian Society of Cardiac Surgery (ÖGTHG) for transfemoral transcatheter aortic valve implantation.Due to a number of recently published studies, broadening of indications and recommendations of medical societies and our own national developments, the ÖKG and the ÖGHTG wish to combine the 2017 ESC/EACTS guidelines for the management of valvular heart disease with a national position paper and to focus on certain details for the application in Austria. Thus, this position statement serves as a supplement and further interpretation of the international guidelines.
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12
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Modolo R, van Mourik M, El Bouziani A, Kawashima H, Rosseel L, Abdelghani M, Aben JP, Slots T, Sahyoun C, Baan J, Henriques JPS, Koch KT, Vis M, Soliman O, Onuma Y, Wykrzykowska J, de Winter R, Serruys PW. Online Quantitative Aortographic Assessment of Aortic Regurgitation After TAVR: Results of the OVAL Study. JACC Cardiovasc Interv 2021; 14:531-538. [PMID: 33582086 DOI: 10.1016/j.jcin.2020.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the online assessment feasibility of aortography using videodensitometry in the catheterization laboratory during transcatheter aortic valve replacement (TAVR). BACKGROUND Quantitative assessment of regurgitation after TAVR through aortography using videodensitometry is simple, reproducible, and validated in vitro, in vivo, in clinical trials, and in "real-world" patients. However, thus far the assessment has been done offline. METHODS This was a single center, prospective, proof-of-principle, feasibility study. One hundred consecutive patients with aortic stenosis and indications to undergo TAVR were enrolled. All final aortograms were analyzed immediately after acquisition in the catheterization laboratory and were also sent to an independent core laboratory for blinded offline assessment. The primary endpoint of the study was the feasibility of the online assessment of regurgitation (percentage of analyzable cases). The secondary endpoint was the reproducibility of results between the online assessment and the offline analysis by the core laboratory. RESULTS Patients' mean age was 81 ± 7 years, and 56% were men. The implanted valves were either SAPIEN 3 (97%) or SAPIEN 3 Ultra (3%). The primary endpoint of online feasibility of analysis was 92% (95% confidence interval [CI]: 86% to 97%) which was the same feasibility encountered by the core laboratory (92%; 95% CI: 86% to 97%). Reproducibility assessment showed a high correlation between online and core laboratory evaluations (R2 = 0.87, p < 0.001), with an intraclass correlation coefficient of 0.962 (95% CI: 0.942 to 0.975; p < 0.001). CONCLUSIONS This study showed high feasibility of online quantitative assessment of regurgitation and high agreement between the online examiner and core laboratory. These results may pave the way for the application of videodensitometry in the catheterization laboratory after TAVR. (Online Videodensitometric Assessment of Aortic Regurgitation in the Cath-Lab [OVAL]; NCT04047082).
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Affiliation(s)
- Rodrigo Modolo
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, the Netherlands; Department of Internal Medicine, Cardiology Division, University of Campinas, Campinas, Brazil; Department of Cardiology, Hospital Vera Cruz de Campinas, Campinas, Brazil
| | - Martijn van Mourik
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Abdelhak El Bouziani
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Hideyuki Kawashima
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Liesbeth Rosseel
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Mohammad Abdelghani
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, Al-Azhar University, Cairo, Egypt
| | | | | | | | - Jan Baan
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Jose P S Henriques
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Karel T Koch
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Marije Vis
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Osama Soliman
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Joanna Wykrzykowska
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Robbert de Winter
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; Department of Cardiology, Imperial College of London, London, United Kingdom.
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Rao RS, Sharma S, Mehta N, Bana A, Chaturvedi H, Gupta R, Varshney P, Gadhwal K, Saran D, Diwedi P. Single-center experience of 105-minimalistc transfemoral transcatheter aortic valve replacement and its outcome. Indian Heart J 2021; 73:301-306. [PMID: 34154746 PMCID: PMC8322745 DOI: 10.1016/j.ihj.2021.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/11/2020] [Accepted: 01/29/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) increases worldwide, and indications expand from high-risk aortic stenosis patients to low-risk aortic stenosis. Studies have shown that minimalistic TAVR done under conscious sedation is safe and effective. We report single-operator, the single-center outcome of 105 minimalist transfemoral, conscious sedation TAVR patients, analyzed retrospectively. METHODS All patients underwent TAVR in cardiac catheterization lab via percutaneous transfemoral, conscious sedation approach. A dedicated cardiac anesthetist team delivered the conscious sedation with a standard protocol described in the main text. The outcomes were analyzed as per VARC-2 criteria and compared with the latest low-risk TAVR trials. RESULTS A total of 105 patients underwent transcatheter aortic valve replacement between July 2016 to February 2020. The mean age of the population was 73 years, and the mean STS score was 3.99 ± 2.59. All patients underwent a percutaneous transfemoral approach. Self-expanding valve was used in 40% of cases and balloon-expandable valve in 60% (Sapien3™ in 31% and MyVal™ in 29%) of cases. One patient required conversion to surgical aortic valve replacement. The success rate was 99 percent. The outcomes were: all-cause mortality: 0.9%, stroke rate 1.9%, New pacemaker rate 5.7%, 87.6% had no paravalvular leak. The mild and moderate paravalvular leak was seen in 2.8% and 1.9%, respectively. The mean gradient decreased from 47.5 mmHg to 9 mmHg. The average ICU stay was 26.4 h, and the average hospital stay was 5.4 days. Our outcomes are comparable with the latest published low-risk trial. CONCLUSION Minimalist, conscious sedation, transfemoral transcatheter aortic valve replacement when done following a standard protocol is safe and effective.
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Affiliation(s)
- Ravinder Singh Rao
- Structural Heart Disease and TAVR Program, Interventional Cardiology, Eternal Hospital, Jaipur, India.
| | - Samin Sharma
- Eternal Hospital Jaipur, International Clinical Affiliations, Clinical and Interventional Cardiology, Mount Sinai Hospital, New York, USA
| | - Navneet Mehta
- Department of Cardiac Anesthesia, Eternal Hospital, Jaipur, India
| | - Ajeet Bana
- Department of Cardiothoracic Surgery, Eternal Hospital, Jaipur, India
| | - Hemant Chaturvedi
- Department of Non-Invasive Cardiology, Eternal Hospital, Jaipur, India
| | - Rajeev Gupta
- Department of Internal Medicine, Eternal Hospital, Jaipur, India
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Belani K, Mahmood F, Ortoleva J. Beyond the Third Dimension: Intracardiac Echocardiography-The Next Frontier for Cardiac Anesthesiologists. J Cardiothorac Vasc Anesth 2020; 35:979-981. [PMID: 33342736 DOI: 10.1053/j.jvca.2020.11.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Kiran Belani
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Boston, MA.
| | - Feroze Mahmood
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Boston, MA
| | - Jamel Ortoleva
- Tufts Medical Center, Department of Anesthesiology and Perioperative Medicine, Boston, MA
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Modolo R, Chang CC, Onuma Y, Schultz C, Tateishi H, Abdelghani M, Miyazaki Y, Aben JP, Rutten MC, Pighi M, El Bouziani A, van Mourik M, Lemos PA, Wykrzykowska JJ, Brito FS, Sahyoun C, Piazza N, Eltchaninoff H, Soliman O, Abdel-Wahab M, Van Mieghem NM, de Winter RJ, Serruys PW. Quantitative aortography assessment of aortic regurgitation. EUROINTERVENTION 2020; 16:e738-e756. [DOI: 10.4244/eij-d-19-00879] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abbett SK, Urman RD, Resor CD, Brovman EY. The Effect of Anesthesia Type on Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2020; 35:429-435. [PMID: 33023815 DOI: 10.1053/j.jvca.2020.09.083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To assess postoperative outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) either under general anesthesia (GA) or monitored anesthesia care (MAC) as the primary anesthetic. DESIGN A retrospective, propensity-matched, cohort study, with univariate logistic regression to assess postoperative outcomes. SETTING Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). PARTICIPANTS The study comprised 559 patients who underwent a TAVR procedure under GA or MAC. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS After propensity score matching, there were no significant differences between the two cohorts in age, sex, race, body mass index, functional status, American Society of Anesthesiologists physical status, and other comorbidities. There were no significant differences in 30-day mortality between the two cohorts, or in the number of complications at 30 days. However, hospital length of stay was significantly shorter in the MAC cohort compared with the GA cohort. CONCLUSIONS Patients undergoing TAVR under MAC may have similar 30-day mortality and complications, but shorter hospital length of stay, than patients undergoing TAVR under GA.
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Affiliation(s)
- Sarah K Abbett
- Department of Anesthesiology, Milford Regional Medical Center, Milford, MA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA; Center for Perioperative Research, Brigham and Women's Hospital, Boston, MA
| | | | - Ethan Y Brovman
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA.
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Khan JM, Khalid N, Shlofmitz E, Forrestal BJ, Yerasi C, Case BC, Chezar-Azerrad C, Musallam A, Rogers T, Waksman R. Guidelines for Balancing Priorities in Structural Heart Disease During the COVID-19 Pandemic. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1030-1033. [PMID: 32736981 PMCID: PMC7261108 DOI: 10.1016/j.carrev.2020.05.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 12/01/2022]
Abstract
During the novel coronavirus disease 2019 (COVID-19) pandemic, many hospitals have been asked to postpone elective and surgical cases. This begs the question, “What is elective in structural heart disease intervention?” The recently proposed Society for Cardiovascular Angiography and Interventions/American College of Cardiology consensus statement is, unfortunately, non-specific and insufficient in its scope and scale of response to the COVID-19 pandemic. We propose guidelines that are practical, multidisciplinary, implementable, and urgent. We believe that this will provide a helpful framework for our colleagues to manage their practices during the surge and peak phases of the pandemic. General principles that apply across structural heart disease interventions include tracking and reporting cardiovascular outcomes, “healthcare distancing,” preserving vital resources and personnel, shared decision-making between the heart team and hospital administration on resource-intensive cases, and considering delaying research cases. Specific guidance for transcatheter aortic valve replacement and MitraClip procedures varies according to pandemic phase. During the surge phase, treatment should broadly be limited to those at increased risk of complications in the near term. During the peak phase, treatment should be limited to inpatients for whom it may facilitate discharge. Keeping our patients and ourselves safe is paramount, as well as justly rationing resources. Many elective and surgical cases have been postponed during the COVID-19 pandemic. We propose guidelines for managing structural heart disease during the pandemic. General principles include preserving vital resources and personnel. Specific guidance for TAVR and mitral valve repair changes with pandemic phase. Keeping our patients and ourselves safe and justly rationing resources is paramount.
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Affiliation(s)
- Jaffar M Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Nauman Khalid
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Evan Shlofmitz
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Chava Chezar-Azerrad
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Anees Musallam
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
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Goudzwaard JA, de Ronde-Tillmans MJAG, de Jager TAJ, Lenzen MJ, Nuis RJ, van Mieghem NM, Daemen J, de Jaegere PPT, Mattace-Raso FUS. Incidence, determinants and consequences of delirium in older patients after transcatheter aortic valve implantation. Age Ageing 2020; 49:389-394. [PMID: 32091096 PMCID: PMC7577406 DOI: 10.1093/ageing/afaa001] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/15/2019] [Accepted: 01/07/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND delirium is an event leading to negative health outcomes and increased mortality in patients. The aim of this study is to investigate the incidence, determinants and consequences of post-operative delirium (POD) in older patients undergoing transcatheter aortic valve implantation (TAVI). METHODS The TAVI Care and Cure program is a prospective, observational registry in patients referred for TAVI at Erasmus University Medical Centre. The presence of delirium was evaluated by daily clinical assessment by a geriatrician pre- and up to 3 days post-TAVI. Mortality data were obtained from the Dutch Civil Registry. RESULTS A total of 543 patients underwent TAVI between January 2014 and December 2017. Overall, the incidence of POD was 14% (75/543 patients) but declined from 18% in 2014 to 7% in 2017 (P = 0.009). Patients who developed POD were older (81.9 ± 5.8 versus 78.6 ± 8.3 years, P < 0.001), had higher prevalence of renal dysfunction and prior stroke (54% versus 40%, P = 0.02; 31% versus 18%, P = 0.01) and were more often frail (32% versus 25%, P = 0.02). From a procedural perspective, general anesthesia (odds ratios (OR), 2.31; 95% CI, 1.40-3.83; P = 0.001), non-transfemoral access (OR, 2.37; 95% CI, 1.20-4.70; P = 0.01) and longer procedural time (OR, 1.01; 95% CI, 1.01-1.02; P < 0.001) were significantly associated with POD. One-year survival rate was 68% among patients who had suffered a POD and was 85% in patients without a POD (hazard ratio's 1.8 (95% CI 1.01-3.10), P = 0.045). CONCLUSION POD frequently occurs after TAVI and is associated with increased mortality. It might be speculated that patient selection and the minimalistic approach of TAVI may reduce the frequency of delirium.
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Affiliation(s)
- Jeannette A Goudzwaard
- Erasmus MC University Medical Center, Section of Geriatrics, Department of Internal Medicine, Rotterdam, The Netherlands
| | | | - Tom A J de Jager
- Erasmus MC University Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
| | - Mattie J Lenzen
- Erasmus MC University Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
| | - Rutger-Jan Nuis
- Erasmus MC University Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
| | - Nicolas M van Mieghem
- Erasmus MC University Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
| | - Joost Daemen
- Erasmus MC University Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
| | - Peter P T de Jaegere
- Erasmus MC University Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
| | - Francesco U S Mattace-Raso
- Erasmus MC University Medical Center, Section of Geriatrics, Department of Internal Medicine, Rotterdam, The Netherlands
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Droppa M, Borst O, Katzenberger T, Krause R, Grasshoff C, Gawaz M, Geisler T. Comparison of safety and periprocedural complications of transfemoral aortic valve replacement under local anaesthesia: minimalist versus complete Heart Team. EUROINTERVENTION 2019; 14:e1819-e1825. [DOI: 10.4244/eij-d-18-00795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Williams JV, Flynn Makic MB. Postoperative Care for Transcatheter Aortic Valve Replacement. J Perianesth Nurs 2019; 34:431-434. [PMID: 30819598 DOI: 10.1016/j.jopan.2018.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/31/2018] [Indexed: 11/28/2022]
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21
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Burns MR, Schneider LM, Sorajja P, Garberich RF, Rush PS, Foag K, Strauss CE, Perry T, Sweeney Claussen A, Farivar RS, Gössl M. Clinical and Economic Outcomes of the Minimalist Approach for Transcatheter Aortic Valve Replacement. STRUCTURAL HEART 2019. [DOI: 10.1080/24748706.2018.1560520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Marcus R. Burns
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Lynelle M. Schneider
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Ross F. Garberich
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Pamela S. Rush
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Katie Foag
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Craig E. Strauss
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Tjorvi Perry
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Andrea Sweeney Claussen
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - R. Said Farivar
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Mario Gössl
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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22
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Chopra M, Luk NHV, De Backer O, Søndergaard L. Simplification and optimization of transcatheter aortic valve implantation - fast-track course without compromising safety and efficacy. BMC Cardiovasc Disord 2018; 18:231. [PMID: 30526521 PMCID: PMC6288866 DOI: 10.1186/s12872-018-0976-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/03/2018] [Indexed: 01/09/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has become an established therapeutic option for patients with symptomatic, severe aortic valve stenosis. Ageing of the Western and Asian population and expansion of indications for TAVI will lead to a substantial increase in the number of TAVI procedures performed worldwide within the next decades. In line with the maturation of TAVI over the past few years, there has also been a significant simplification and optimisation of the TAVI procedure. A minimalist TAVI procedure and fast-track TAVI course have been shown to have distinct advantages over the more traditional TAVI approach. The aim of this manuscript is to discuss strategies of TAVI simplification and optimization, with special focus on fast-track TAVI, without compromising safety and efficacy.
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Affiliation(s)
- Manik Chopra
- The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Ngai H V Luk
- The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Kinno M, Cantey EP, Rigolin VH. The transition from transesophageal to transthoracic echocardiography during transcatheter aortic valve replacement: an evolving field. J Echocardiogr 2018; 17:25-34. [DOI: 10.1007/s12574-018-0409-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022]
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Transcatheter Aortic Valve Replacement in the Catheterization Laboratory Versus Hybrid Operating Room. JACC Cardiovasc Interv 2018; 11:2195-2203. [DOI: 10.1016/j.jcin.2018.06.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/14/2018] [Accepted: 06/26/2018] [Indexed: 11/23/2022]
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25
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McKiernan M, Lisko J, Grubb KJ. Alternative TAVR Access: Is It Time to Alter Your Alternative Access Strategy? Semin Thorac Cardiovasc Surg 2018; 31:181-182. [PMID: 30359731 DOI: 10.1053/j.semtcvs.2018.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/16/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Maureen McKiernan
- Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - John Lisko
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Kendra J Grubb
- Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
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