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Yamamoto M, Yashima F, Shirai S, Tada N, Naganuma T, Yamawaki M, Yamanaka F, Mizutani K, Noguchi M, Ueno H, Takagi K, Ohno Y, Izumo M, Nishina H, Suzuyama H, Yamasaki K, Nishioka K, Hachinohe D, Fuku Y, Otsuka T, Asami M, Watanabe Y, Hayashida K, Ocean-Tavi Investigators OBOT. Performance and outcomes of the SAPIEN 3 Ultra RESILIA transcatheter heart valve in the OCEAN-TAVI registry. EUROINTERVENTION 2024; 20:579-590. [PMID: 38726714 PMCID: PMC11067722 DOI: 10.4244/eij-d-23-00996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/14/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Data on the performance of the latest-generation SAPIEN 3 Ultra RESILIA (S3UR) valve in patients who undergo transcatheter aortic valve replacement (TAVR) are scarce. AIMS We aimed to assess the clinical outcomes, including valve performance, of the S3UR. METHODS Registry data of 618 consecutive patients with S3UR and of a historical pooled cohort of 8,750 patients who had a SAPIEN 3 (S3) valve and underwent TAVR were collected. The clinical outcomes and haemodynamics, including patient-prosthesis mismatch (PPM), were compared between the 2 groups and in a propensity-matched cohort. RESULTS The incidence of in-hospital death, vascular complications, and new pacemaker implantation was similar between the S3UR and the S3 groups (allp>0.05). However, both groups showed significant differences in the degrees of paravalvular leakage (PVL) (none-trivial: 87.0% vs 78.5%, mild: 12.5% vs 20.5%, ≥moderate: 0.5% vs 1.1%; p<0.001) and the incidence of PPM (none: 94.3% vs 85.1%, moderate: 5.2% vs 12.8%, severe: 0.5% vs 2.0%; p<0.001). The prevalence of a mean pressure gradient ≥20 mmHg was significantly lower in the S3UR group (1.6% vs 6.2%; p<0.001). Better haemodynamics were observed with the smaller 20 mm and 23 mm S3UR valves. The results were consistent in a matched cohort of patients with S3UR and with S3 (n=618 patients/group). CONCLUSIONS The S3UR has equivalent procedural complications to the S3 but with lower rates of PVL and significantly better valve performance. The better valve performance of the S3UR, particularly in smaller valve sizes, overcomes the remaining issue of balloon-expandable valves after TAVR.
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Affiliation(s)
- Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kazuki Mizutani
- Department of Medicine, Division of Cardiology, Kindai University, Osaka, Japan
| | - Masahiko Noguchi
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Hiroshi Ueno
- Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Kensuke Takagi
- Department of Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Masaki Izumo
- Department of Cardiology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Hidetaka Nishina
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Hiroto Suzuyama
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Kazumasa Yamasaki
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Kenji Nishioka
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Daisuke Hachinohe
- Cardiovascular Medicine, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Yasushi Fuku
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
- Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Koga M, Izumo M, Kobayashi Y, Kai T, Okuno T, Sato Y, Kuwata S, Okuyama K, Ishibashi Y, Tanabe Y, Akashi YJ. Safety and feasibility of zero-contrast transcatheter aortic valve implantation using balloon-expandable valves in patients with aortic stenosis and severe renal impairment: A single-center study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 58:68-76. [PMID: 37500393 DOI: 10.1016/j.carrev.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/23/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Aortic stenosis (AS) and chronic kidney disease (CKD) can coexist. Repeat exposure to contrast media in patients undergoing transcatheter aortic valve implantation (TAVI) has latent mortality risks and increased risk for acute kidney injury. We aimed to assess our "zero-contrast TAVI" protocol for patients with advanced CKD. METHODS Consecutive patients with severe AS who underwent TAVI at a single center registry were enrolled. Zero-contrast TAVI group included patients who underwent TAVI without contrast and who had an estimated glomerular filtration rate <30 mL/min/1.73 m2. Conventional TAVI group included patients who underwent the regular TAVI procedure. Patients using balloon-expandable valves via transfemoral approach were analyzed. Baseline clinical and procedural characteristics and clinical outcomes were compared between two groups. The primary outcome was early safety as defined by Valve Academic Research Consortium Criteria. Secondary outcomes included the presence of severe prosthesis-patient mismatch, moderate or greater perivalvular leakage, and requirement for new dialysis (within 3 months). RESULTS A total of 520 patients were analyzed. Among these, 32 (6 %) underwent zero-contrast TAVI and 488 (94 %) conventional TAVI. In the zero-contrast TAVI group, 12 patients (37.5 %) had to use 20.7 (11.0-31.2) mL of contrast media. There were no significant differences in the primary and secondary outcomes between zero-contrast TAVI and conventional TAVI groups (78.1 % vs. 86.8 %, P = 0.184 and 9.4 % vs. 8.1 %, P = 0.738 for the primary and secondary outcomes, respectively). CONCLUSIONS Zero-contrast TAVI is feasible, safe, and effective in patients with AS and stage 4 CKD.
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Affiliation(s)
- Masashi Koga
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan.
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Yoshikuni Kobayashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Takahiko Kai
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Taishi Okuno
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Yukio Sato
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Shingo Kuwata
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Kazuaki Okuyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Yuki Ishibashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Yasuhiro Tanabe
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
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3
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Inohara T, Otsuka T, Watanabe Y, Shirai S, Tada N, Yamanaka F, Ueno H, Ohno Y, Tabata M, Suzuyama H, Asami M, Yamawaki M, Izumo M, Yamasaki K, Nishina H, Fuku Y, Mizutani K, Yashima F, Yamamoto M, Hayashida K. Rationale and design of Non-antithrombotic Therapy After Transcatheter Aortic Valve Implantation (NAPT) Trial. Contemp Clin Trials 2023; 134:107358. [PMID: 37852534 DOI: 10.1016/j.cct.2023.107358] [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: 06/20/2023] [Revised: 10/05/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Despite the wide implementation of transcatheter aortic valve implantation (TAVI), the optimal antithrombotic therapy after TAVI has not been established yet. Owing to the accumulating evidence supporting the efficacy and safety of single antiplatelet therapy (SAPT) over dual antiplatelet therapy, the latest guideline recommends life-long SAPT. However, there is scarce evidence supporting SAPT compared with non-antithrombotic therapy. Given the vulnerability of patients undergoing TAVI in terms of high bleeding risk, the benefit of SAPT may be canceled out by its potential increased bleeding risk. STUDY DESIGN AND OBJECTIVES Non-antithrombotic Therapy After Transcatheter Aortic Valve Implantation (NAPT) Trial is a prospective, randomized controlled, open-label blinded endpoint multicenter trial conducted in Japan, testing the non-inferiority of non-antithrombotic therapy compared with aspirin monotherapy in patients who underwent TAVI and had no indications for long-term oral anticoagulation therapy (OAC). Patients who successfully underwent trans-femoral TAVI for severe aortic stenosis with either balloon-expandable or self-expandable valves are eligible for inclusion. Key exclusion criteria are (i) occurrence of perioperative complications (ii) indications of taking antithrombotic drugs for other reasons; (iii) eGFR <30 ml/min/1.73 m2 or hemodialysis or peritoneal dialysis. A total of 360 patients will be randomized (1:1) to aspirin monotherapy vs. non-antithrombotic therapy. The primary outcome is a composite of all-cause mortality, myocardial infarction, stroke, and bleeding. All bleeding events based on the Valve Academic Research Consortium 3 are included as a component of the primary outcome. CONCLUSION The NAPT trial will determine the non-inferiority of a non-antithrombotic therapy compared with aspirin monotherapy after TAVI.
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Affiliation(s)
- Taku Inohara
- Department of Cardiology, Keio University of School of Medicine, Tokyo, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan; Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Miyagi, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hiroshi Ueno
- Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Yohei Ohno
- Department of Cardiology, Tokai University, Isehara, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Hiroto Suzuyama
- Department of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Masahiko Asami
- Department of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohamashi City Eastern Hospital, Kanagawa, Japan
| | - Masaki Izumo
- Department of Cardiology, St. Marianna University Hospital, Kanagawa, Japan
| | - Kazumasa Yamasaki
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Hokkaido, Japan
| | - Hidetaka Nishina
- Department of Cardiology, Tsukuba Medical Center, Ibaraki, Japan
| | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan
| | - Kazuki Mizutani
- Department of Cardiology, Kindai University Hospital, Osaka, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan; Department of Cardiology, Gifu Heart Center, Gifu, Japan; Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University of School of Medicine, Tokyo, Japan.
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4
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Hiraoka E, Tanabe K, Izuta S, Kubota T, Kohsaka S, Kozuki A, Satomi K, Shiomi H, Shinke T, Nagai T, Manabe S, Mochizuki Y, Inohara T, Ota M, Kawaji T, Kondo Y, Shimada Y, Sotomi Y, Takaya T, Tada A, Taniguchi T, Nagao K, Nakazono K, Nakano Y, Nakayama K, Matsuo Y, Miyamoto T, Yazaki Y, Yahagi K, Yoshida T, Wakabayashi K, Ishii H, Ono M, Kishida A, Kimura T, Sakai T, Morino Y. JCS 2022 Guideline on Perioperative Cardiovascular Assessment and Management for Non-Cardiac Surgery. Circ J 2023; 87:1253-1337. [PMID: 37558469 DOI: 10.1253/circj.cj-22-0609] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Affiliation(s)
- Eiji Hiraoka
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital
| | | | - Tadao Kubota
- Department of General Surgery, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Amane Kozuki
- Division of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | | | | | - Toshiro Shinke
- Division of Cardiology, Showa University School of Medicine
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Susumu Manabe
- Department of Cardiovascular Surgery, International University of Health and Welfare Narita Hospital
| | - Yasuhide Mochizuki
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Taku Inohara
- Department of Cardiovascular Medicine, Keio University Graduate School of Medicine
| | - Mitsuhiko Ota
- Department of Cardiovascular Center, Toranomon Hospital
| | | | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital
| | - Yumiko Shimada
- JADECOM Academy NP·NDC Training Center, Japan Association for Development of Community Medicine
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tomofumi Takaya
- Department of Cardiovascular Medicine, Hyogo Prefectural Himeji Cardiovascular Center
| | - Atsushi Tada
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Kazuya Nagao
- Department of Cardiology, Osaka Red Cross Hospital
| | - Kenichi Nakazono
- Department of Pharmacy, St. Marianna University Yokohama Seibu Hospital
| | | | | | - Yuichiro Matsuo
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center
| | | | | | | | | | | | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiovascular Surgery, Graduate School of Medicine, The University of Tokyo
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Tetsuro Sakai
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
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5
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Kobari Y, Hayashida K. Racial Difference in Mortality After Transcatheter Aortic Valve Replacement. JACC. ASIA 2023; 3:388-389. [PMID: 37323863 PMCID: PMC10261882 DOI: 10.1016/j.jacasi.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
| | - Kentaro Hayashida
- Address for correspondence: Dr Kentaro Hayashida, Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan.
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Inohara T, Tabata M, Isotani A, Ohno Y, Izumo M, Imamura T, Iida Y, Kataoka A, Koyama Y, Otsuka T, Watanabe Y, Yamamoto M, Hayashida K. Appropriate Use Criteria for the Management of Aortic Stenosis: Insight From the Japanese Expert Panel. JACC. ASIA 2023; 3:255-267. [PMID: 37181396 PMCID: PMC10167517 DOI: 10.1016/j.jacasi.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 05/16/2023]
Abstract
Background The indication for transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS) significantly varies among physicians and institutions. Objectives This study aims to develop a set of appropriate use criteria for AS management to assist physicians in decision-making. Methods The RAND-modified Delphi panel method was used. A total of >250 common clinical scenarios were identified in terms of whether to perform the intervention for AS and the mode of intervention (surgical aortic valve replacement vs TAVR). Eleven nationally representative expert panelists independently rated the clinical scenario appropriateness on a scale of 1-9, as "appropriate" (7-9), "may be appropriate" (4-6), or "rarely appropriate" (1-3); the median score of the 11 experts was then assigned to an appropriate-use category. Results The panel identified 3 factors that were associated with a rarely appropriate rating in terms of performing the intervention: 1) limited life expectancy; 2) frailty; and 3) pseudo-severe AS on dobutamine stress echocardiography. Clinical scenarios that were deemed rarely appropriate for TAVR were also identified: 1) patients with low surgical risk and high TAVR procedural risk; 2) patients with coexistent severe primary mitral regurgitation or rheumatic mitral stenosis; and 3) bicuspid aortic valve that was not suitable for TAVR. Importantly, any TAVRs for patients who were older than 75 years of age were not rated as rarely appropriate. Conclusions These appropriate use criteria provide a practical guide for physicians regarding clinical situations commonly encountered in daily practice and elucidates scenarios deemed rarely appropriate that are clinical challenges for TAVR.
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Affiliation(s)
- Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
| | - Akihiro Isotani
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Masaki Izumo
- Department of Cardiology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Yasunori Iida
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Akihisa Kataoka
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yutaka Koyama
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
- Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Nagoya Heart Center, Aichi, Japan
- Department of Cardiology, Toyohashi Heart Center, Aichi, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - OCEAN-SHD Investigators
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
- Department of Cardiology, St Marianna University School of Medicine, Kawasaki, Japan
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
- Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
- Department of Cardiology, Nagoya Heart Center, Aichi, Japan
- Department of Cardiology, Toyohashi Heart Center, Aichi, Japan
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7
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Fujita H, Ito T, Kikuchi S, Seo Y. Postprocedural ascending aortic dissection after transcatheter aortic valve implantation: a case report. Eur Heart J Case Rep 2022; 7:ytac486. [PMID: 36685099 PMCID: PMC9843675 DOI: 10.1093/ehjcr/ytac486] [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: 03/17/2022] [Revised: 05/10/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022]
Abstract
Background Transcatheter aortic valve implantation (TAVI) has been established as an effective and safe treatment for patients with severe aortic stenosis (AS). It is reported that vascular complications, especially aortic dissection, are rare. However, aortic dissection may be a serious consequence if it occurs. We experienced a case of delayed onset of ascending aortic dissection after TAVI. Case summary An 82-year-old woman presented with dyspnoea and general fatigue. Echocardiography revealed severe AS and she was diagnosed with heart failure associated with AS. She had difficulty controlling heart failure and required the intervention of the aortic valve. We evaluated the aortic valve and access routes with contrast-enhanced computed tomography (CT), which showed marked dilatation of the ascending aorta. Transcatheter aortic valve implantation was performed and the procedure was completed without major complications. Transoesophageal echocardiography during the procedure did not detect any obvious arterial injury. However, on the second postoperative day, the patient suddenly became unconscious and a CT indicated an ascending aortic dissection. Unfortunately, she passed away. An autopsy revealed the fragility of the ascending aorta. Conclusion Patients with AS and aortic root dilatation may develop delayed onset of ascending aortic dissection after TAVI.
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Affiliation(s)
| | - Tsuyoshi Ito
- Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Shohei Kikuchi
- Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
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Ten Berg J, Rocca B, Angiolillo DJ, Hayashida K. The search for optimal antithrombotic therapy in transcatheter aortic valve implantation: facts and uncertainties. Eur Heart J 2022; 43:4616-4634. [PMID: 36130256 DOI: 10.1093/eurheartj/ehac385] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 06/24/2022] [Accepted: 07/05/2022] [Indexed: 01/05/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure, which is used frequently in patients with symptomatic severe aortic valve stenosis. Most patients undergoing TAVI are over 80 years of age with a high bleeding as well as thrombotic risk. Despite the increasing safety of the procedure, thromboembolic events [stroke, (subclinical) valve thrombosis] remain prevalent. As a consequence, antithrombotic prophylaxis is routinely used and only recently new data on the efficacy and safety of antithrombotic drugs has become available. On the other hand, these antithrombotic drugs increase bleeding in a population with unique aortic stenosis-related bleeding characteristics (such as acquired von Willebrand factor defect and angiodysplasia). In this review, we discuss the impact of thromboembolic and bleeding events, the current optimal antithrombotic therapy based on registries and recent randomized controlled trials, as well as try to give a practical guide how to treat these high-risk patients. Finally, we discuss knowledge gaps and future research needed to fill these gaps.
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Affiliation(s)
- Jurrien Ten Berg
- Department of Cardiology and Center for Platelet Function Research, St Antonius Hospital, Nieuwegein, The Netherlands.,The Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Bianca Rocca
- Department of Safety and Bioethics, Section of Pharmacology, Catholic University School of Medicine, Rome, Italy
| | - Dominick J Angiolillo
- Division of Cardiology, Department of Internal Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Butala NM, Wood DA, Li H, Chinnakondepalli K, Lauck SB, Sathananthan J, Cairns JA, Magnuson EA, Barker M, Webb JG, Welsh R, Cheung A, Ye J, Velianou JL, Wijeysundera HC, Asgar A, Kodali S, Thourani VH, Cohen DJ. Economics of Minimalist Transcatheter Aortic Valve Replacement: Results From the 3M-TAVR Economic Study. Circ Cardiovasc Interv 2022; 15:e012168. [PMID: 36256698 PMCID: PMC9575578 DOI: 10.1161/circinterventions.122.012168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The 3M-TAVR trial (3M-Transcatheter Aortic Valve Replacement) demonstrated the feasibility and safety of next-day hospital discharge after transfemoral TAVR with implementation of a minimalist pathway. However, the economic impact of this approach is unknown. Therefore, we evaluated costs for patients undergoing minimalist TAVR compared with conventional TAVR. METHODS We used propensity matching to compare resource utilization and costs (from a US health care system perspective) for patients in the 3M-TAVR trial with those for transfemoral TAVR patients enrolled in the contemporaneous S3i trial (PARTNER SAPIEN-3 Intermediate Risk). Procedural costs were estimated using measured resource utilization for both groups. For the S3i group, all other costs through 30-day follow-up were assessed by linkage with Medicare claims; for 3M, these costs were assessed using regression models derived from S3i cost and resource utilization data. RESULTS After 1:1 propensity matching, 351 pairs were included in our study (mean age 82, mean Society of Thoracic Surgery risk score 5.3%). There were no differences in death, stroke, or rehospitalization between the 3M-TAVR and S3i groups through 30-day follow-up. Index hospitalization costs were $10 843/patient lower in the 3M-TAVR cohort, driven by reductions in procedure duration, anesthesia costs, and length of stay. Between discharge and 30 days, costs were similar for the 2 groups such that cumulative 30-day costs were $11 305/patient lower in the 3M-TAVR cohort compared with the S3i cohort ($49 425 versus $60 729, 95% CI for difference $9378 to $13 138; P<0.001). CONCLUSIONS Compared with conventional transfemoral TAVR, use of a minimalist pathway in intermediate-risk patients was associated with similar clinical outcomes and substantial in-hospital cost savings, which were sustained through 30 days. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02287662.
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Affiliation(s)
- Neel M. Butala
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (N.M.B.)
| | - David A. Wood
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada (D.A.W., S.B.L., J.S., J.A.C., M.B., J.G.W., A.C., J.Y.)
| | - Haiyan Li
- St Luke’s Mid-America Heart Institute, Kansas City, MO (H.L., K.C., E.A.M.)
| | | | - Sandra B. Lauck
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada (D.A.W., S.B.L., J.S., J.A.C., M.B., J.G.W., A.C., J.Y.)
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada (D.A.W., S.B.L., J.S., J.A.C., M.B., J.G.W., A.C., J.Y.)
| | - John A. Cairns
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada (D.A.W., S.B.L., J.S., J.A.C., M.B., J.G.W., A.C., J.Y.)
| | | | - Madeleine Barker
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada (D.A.W., S.B.L., J.S., J.A.C., M.B., J.G.W., A.C., J.Y.)
| | - John G. Webb
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada (D.A.W., S.B.L., J.S., J.A.C., M.B., J.G.W., A.C., J.Y.)
| | - Robert Welsh
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (R.W.)
| | - Anson Cheung
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada (D.A.W., S.B.L., J.S., J.A.C., M.B., J.G.W., A.C., J.Y.)
| | - Jian Ye
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada (D.A.W., S.B.L., J.S., J.A.C., M.B., J.G.W., A.C., J.Y.)
| | - James L. Velianou
- Division of Cardiology, Department of Medicine, Hamilton Health Sciences, McMaster University, Ontario, Canada (J.L.V.)
| | | | - Anita Asgar
- Montreal Heart Institute, Quebec, Canada (A.A.)
| | - Susheel Kodali
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (S.K.)
| | | | - David J. Cohen
- Cardiovascular Research Foundation, New York, NY (D.J.C.).,St Francis Hospital and Heart Center, Roslyn, NY (D.J.C.)
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10
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Maeda K, Kumamaru H, Kohsaka S, Shimamura K, Mizote I, Yamashita K, Kawamura A, Mukai T, Nakamura D, Takeda Y, Shimizu H, Sakata Y, Kuratani T, Miyagawa S, Sawa Y. A Risk Model for 1-Year Mortality After Transcatheter Aortic Valve Replacement From the J-TVT Registry. JACC. ASIA 2022; 2:635-644. [PMID: 36518724 PMCID: PMC9743452 DOI: 10.1016/j.jacasi.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/09/2022] [Accepted: 06/06/2022] [Indexed: 01/11/2023]
Abstract
Background Although transcatheter aortic valve replacement (TAVR) has demonstrated favorable outcomes in randomized studies, there remains a sizable group of patients in whom TAVR may be futile. Characterizing the survival rate in a wide array of patients undergoing TAVR can help develop effective strategies for improving the allocation of medial resources. Objectives The aim of this study was to develop a risk model to estimate 1-year mortality after TAVR from a representative nationwide registry in Japan. Methods The J-TVT (Japan Transcatheter Valve Therapies) registry contains complete data, including 1-year outcomes, on patients undergoing TAVR in Japan. A total of 17,655 patients underwent TAVR between 2013 and 2018. They were randomly divided into 2 groups in a 7:3 ratio to form a derivation cohort of 12,316 patients and a validation cohort of 5,339 patients. A risk model was constructed for 1-year mortality in the derivation cohort, and its discrimination and calibration were assessed in the validation cohort. Results The mean age of all registered patients was 84.4 years, and 68.8% were women. The mean body size area was 1.43 m2, and the mean Society of Thoracic Surgeons Predicted Risk of Mortality score was 7.3%. The estimated 1-year survival was 91.8%; 202 and 1,316 deaths were observed at 30 days and 1 year, respectively; The estimated C index for the developed model was 0.733 (95% CI: 0.709-0.757) in the validation cohort, with good calibration. Conclusions A prediction model for 1-year survival following TAVR derived from a national clinical database performed well and should aid physicians managing TAVR patients.
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Affiliation(s)
- Koichi Maeda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Isamu Mizote
- Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kizuku Yamashita
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ai Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Mukai
- Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Nakamura
- Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasuharu Takeda
- Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yasushi Sakata
- Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan,Address for correspondence: Dr Yoshiki Sawa, Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
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11
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Yamamoto M, Otsuka T, Shimura T, Yamaguchi R, Adachi Y, Kagase A, Tokuda T, Tsujimoto S, Koyama Y, Yashima F, Tada N, Naganuma T, Yamawaki M, Yamanaka F, Shirai S, Mizutani K, Tabata M, Ueno H, Takagi K, Watanabe Y, Hayashida K. Incidence, Timing, and Causes of Late Bleeding After TAVR in an Asian Cohort. JACC. ASIA 2022; 2:622-632. [PMID: 36393917 PMCID: PMC9660329 DOI: 10.1016/j.jacasi.2022.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 04/05/2022] [Accepted: 04/26/2022] [Indexed: 04/25/2023]
Abstract
BACKGROUND Data regarding the incidence, predictive factors, and clinical outcomes of post-transcatheter aortic valve replacement (TAVR) bleeding is limited in the Asian cohort. OBJECTIVES This study sought to assess the predictors and prognostic impact of post-TAVR late bleeding. METHODS This study used the Japanese multicenter registry data to analyze 2,518 patients (mean age: 84.3 ± 5.2 years) who underwent TAVR. Late bleeding was defined as any postdischarge bleeding events after TAVR. Baseline characteristics, predictive factors, and clinical outcomes including death and rehospitalization were assessed in patients with and without late bleeding events. RESULTS The cumulative incidence rate of all and major late bleeding and ischemic stroke were 7.4%, 5.2%, and 3.4%, respectively, 3 years after TAVR. The independent predictive factors of late bleeding were low platelet count, high score (≥4) on the clinical frailty scale, and a New York Heart Association functional class III/IV. The cumulative mortality rates up to 3 years were significantly higher in patients with late bleeding than in those without bleeding (P < 0.001). The multivariate Cox regression analysis revealed that late bleeding, included as a time-varying covariate in the model, was associated with an increased risk of mortality following TAVR (HR: 5.63; 95% CI: 4.28-7.41; P < 0.001). CONCLUSIONS Late bleeding after TAVR was not a rare complication, and it significantly increased long-term mortality. It should be carefully managed, especially when it is predictable in the high-risk cohort, and efforts should be taken to reduce bleeding complications even after a successful procedure.
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Key Words
- AF, atrial fibrillation
- BARC, Bleeding Academic Research Consortium
- CFS, clinical frailty scale
- DAPT, dual antiplatelet therapy
- GI, gastrointestinal
- NYHA, New York Heart Association
- OAC, oral anticoagulant
- OR, odds ratio
- PCI, percutaneous coronary intervention
- SPAT, single antiplatelet therapy
- TAVR, transcatheter aortic valve replacement
- clinical outcome
- late bleeding
- transcatheter aortic valve replacement
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Affiliation(s)
- Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
- Address for correspondence: Dr Masanori Yamamoto, Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyamachyo, Toyohashi, Aichi 441-8530, Japan.
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
- Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
| | - Tetsuro Shimura
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Ryo Yamaguchi
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Yuya Adachi
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Ai Kagase
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | | | - Yutaka Koyama
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | | | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Hiroshi Ueno
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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12
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The Usefulness of the Modified Essential Frailty Toolset to Predict Late Bleeding Events after Transcatheter Aortic Valve Implantation. Am J Cardiol 2022; 184:111-119. [PMID: 36153179 DOI: 10.1016/j.amjcard.2022.08.024] [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: 04/21/2022] [Revised: 07/10/2022] [Accepted: 08/18/2022] [Indexed: 11/23/2022]
Abstract
Frailty is strongly associated with poor short- and long-term prognoses in patients who undergo transcatheter aortic valve implantation (TAVI). However, limited data are available regarding the association between frailty and late bleeding events after TAVI. Of the 2,518 patients in the Japanese multicenter TAVI registry, 1371 patients with complete data on frailty parameters were analyzed. We developed a modified Essential Frailty Toolset (EFT) using 4 frailty parameters-gait speed, Mini-Mental State Examination (MMSE), anemia, and hypoalbuminemia-that are significant predictors of late bleeding events in this cohort. The predictive value of the modified EFT for late bleeding after TAVI was assessed in comparison with other clinical variables. Late bleeding events after TAVI occurred in 80 patients (5.8%). Gait speed, MMSE, anemia, and hypoalbuminemia were significantly associated with late bleeding. A modified EFT was developed to include these parameters, which were scored from 0 to 5 points comprising the following 4 items: gait speed (0: >1.5 m/s, 1: 1.5 to 0.75 m/s, 2: <0.75 m/s), cognition (1: MMSE <18), anemia (1: hemoglobin <13 g/100 ml in men or <12 g/100 ml in women), and malnutrition (1: albumin <3.5 g/100 ml). Multivariate Cox regression analysis revealed that the modified EFT was an independent predictor of late bleeding (adjusted hazard ratio 1.51, 95% confidence interval [CI] 1.19 to 1.92, p <0.001) In conclusion, the modified EFT was found to be a significant predictive factor for late bleeding events after TAVI. Assessment of frailty is important to predict patients with high bleeding risk after TAVI.
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13
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Katagiri Y, Yamasaki K, Hatanaka N, Bota H, Tani T, Koga T, Setogawa Y, Misawa M, Ueda T, Yamazaki S. Revisiting the Aortic Valve Calcium Score in Evaluating the Severity of Aortic Stenosis in Japanese Patients - A Single-Center Study. Circ Rep 2022; 4:274-284. [PMID: 35774077 PMCID: PMC9168510 DOI: 10.1253/circrep.cr-22-0035] [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: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background: In patients with aortic stenosis (AS), measurement of aortic valve calcification (AVC) using computed tomography (CT) is recommended in cases where echocardiographic measurements are inconclusive. However, sex-specific AVC thresholds proposed in the guidelines for predicting severe AS (women: 1,200 arbitrary units [AU]; men: 2,000 AU) are based on studies from Western countries. Methods and Results: We retrospectively included 512 Japanese patients with at least moderate AS who underwent transthoracic echocardiography and CT. AVC was quantified using the Agatston method. AVC was positively correlated with peak aortic jet velocity and mean transvalvular gradient (mPG), and negatively correlated with aortic valve area (AVA) and the AVA index (AVAi). In 257 patients with concordant AS grading (152 severe AS [AVAi ≤0.6 cm2/m2, mPG ≥40 mmHg], 105 moderate AS [AVAi >0.6 cm2/m2, mPG <40 mmHg]), receiver operating characteristic curve analysis of AVC predicting severe AS yielded an area under the curve of 0.91 (95% confidence interval [CI] 0.87-0.95; P<0.001) in women and 0.86 (95% CI 0.75-0.98; P<0.001) in men. The optimal thresholds (women: 1,379 AU; men: 1,802 AU) were close to those proposed in the guidelines. The diagnostic accuracy of the thresholds in the guidelines was similar to that of the optimal thresholds. Conclusions: The sex-specific AVC thresholds proposed in international guidelines can be applied to Japanese AS patients, yielding similar diagnostic accuracy as the optimal cut-off derived from the study patients.
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Affiliation(s)
- Yuki Katagiri
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital Sapporo Japan
| | - Kazumasa Yamasaki
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital Sapporo Japan
| | - Noriyuki Hatanaka
- Department of Cardiovascular Surgery, Sapporo Higashi Tokushukai Hospital Sapporo Japan
| | - Hiroki Bota
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital Sapporo Japan
| | - Tomoyuki Tani
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital Sapporo Japan
| | - Tomonori Koga
- Department of Cardiovascular Surgery, Sapporo Higashi Tokushukai Hospital Sapporo Japan
| | - Yuki Setogawa
- Department of Cardiovascular Surgery, Sapporo Higashi Tokushukai Hospital Sapporo Japan
| | - Manabu Misawa
- Department of Anesthesia, Sapporo Higashi Tokushukai Hospital Sapporo Japan
| | - Takashi Ueda
- Department of Cardiovascular Surgery, Sapporo Higashi Tokushukai Hospital Sapporo Japan
| | - Seiji Yamazaki
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital Sapporo Japan
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14
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Chronic kidney disease and transcatheter aortic valve implantation. Cardiovasc Interv Ther 2022; 37:458-464. [PMID: 35511340 DOI: 10.1007/s12928-022-00859-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 11/02/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an established treatment option for patients with severe aortic stenosis. Patients with aortic stenosis have a higher prevalence of chronic kidney disease (CKD). CKD is generally associated with an increased risk of mortality, cardiovascular events, and readmission for heart failure; this supports the concept of a cardio-renal syndrome (CRS). CRS encompasses a spectrum of disorders of the heart and kidneys, wherein dysfunction in one organ may cause dysfunction in the other. TAVI treatment is expected to break this malignant cycle of CRS and improve cardio-renal function after the procedure. However, several reports demonstrate that patients with CKD have been associated with poor outcomes after the procedure. In addition, TAVI treatments for patients with advanced CKD and those with end-stage renal disease on hemodialysis are considered more challenging. Adequate management to preserve cardio-renal function in patients undergoing TAVI may reduce the risk of cardio-renal adverse events and improve the long-term prognosis. The current comprehensive review article aims to assess the prognostic impact of CKD after TAVI and seek optimal care in patients with CKD even after successful TAVI.
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15
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Tayama E, Saku K, Anegawa T, Oryoji A, Negoto S. Prosthetic cardiac valves: history and review of cardiac prostheses clinically available in Japan. Surg Today 2022; 52:521-531. [PMID: 34435247 DOI: 10.1007/s00595-021-02361-y] [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: 12/14/2020] [Accepted: 04/10/2021] [Indexed: 10/20/2022]
Abstract
Recently developed prosthetic valves are reliable and essential for the treatment of valvular heart disease. The mechanical valve evolved remarkably following the introduction of pyrolite carbon material, which enabled the creation of a bileaflet form incorporated with a pivot mechanism. The improved durability of the biological valve is attributed mainly to the development of a tissue fixation process and anti-calcification treatments. However, optimal antithrombogenicity and durability have not yet been achieved for either prosthetic valve type. To select the most suitable prosthetic valve for each individual patient from among the many clinically available prosthetic valves, it is necessary to have a thorough understanding of the characteristics of each valve.
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Affiliation(s)
- Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan.
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Tomoyuki Anegawa
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Atsunobu Oryoji
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Shinya Negoto
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
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16
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Lee CH, Inohara T, Hayashida K, Park DW. Transcatheter Aortic Valve Replacement in Asia: Present Status and Future Perspectives. JACC. ASIA 2021; 1:279-293. [PMID: 36341218 PMCID: PMC9627874 DOI: 10.1016/j.jacasi.2021.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/01/2021] [Accepted: 10/07/2021] [Indexed: 05/28/2023]
Abstract
Over the last decade, based on evidence from multiple randomized clinical trials, transcatheter aortic valve replacement (TAVR) has become the established treatment for patients with symptomatic severe aortic stenosis. Despite the overwhelming expansion of TAVR in Western countries, the initial uptake and widespread adoption of this procedure have been relatively delayed in Asian countries, owing to the high cost of devices; limited local health and reimbursement policies; and lack of specific training/proctoring program, specialized heart team, or dedicated infrastructure. Furthermore, it has not yet been determined whether there are substantial interracial and ethnic differences in the clinical characteristics, comorbidities, and anatomic features, as well as procedural and long-term outcomes, in patients receiving TAVR. In this review, we provide not only a comprehensive look at the current status and outcomes of TAVR in Asian populations compared with those of Western populations but also a perspective on the future of TAVR in Asia.
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Key Words
- AR, aortic regurgitation
- AS, aortic stenosis
- BAV, bicuspid aortic valve
- BSA, body surface area
- PPI, permanent pacemaker insertion
- PPM, patient-prosthesis mismatch
- PVL, paravalvular leak
- RCT, randomized clinical trial
- SAVR, surgical aortic valve replacement
- STS, Society of Thoracic Surgeons
- TAVR, transcatheter aortic valve replacement
- VHD, valvular heart disease
- aortic stenosis
- outcomes
- race and ethnicity
- valvular disease
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Affiliation(s)
- Cheol Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Deagu, South Korea
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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17
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Yoshijima N, Saito T, Inohara T, Anzai A, Tsuruta H, Shimizu H, Fukuda K, Naganuma T, Mizutani K, Yamawaki M, Tada N, Yamanaka F, Shirai S, Tabata M, Ueno H, Takagi K, Watanabe Y, Yamamoto M, Hayashida K. Predictors and clinical outcomes of poor symptomatic improvement after transcatheter aortic valve replacement. Open Heart 2021; 8:openhrt-2021-001742. [PMID: 34810275 PMCID: PMC8609939 DOI: 10.1136/openhrt-2021-001742] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/08/2021] [Indexed: 02/05/2023] Open
Abstract
Objective Transcatheter aortic valve replacement (TAVR) improves clinical symptoms in most patients with severe aortic stenosis (AS). However, some patients do not benefit from the symptom-reducing effects of TAVR. We assessed the predictors and clinical outcomes of poor symptomatic improvement (SI) after TAVR. Methods A total of 1749 patients with severe symptomatic AS undergoing transfemoral TAVR were evaluated using the Japanese multicentre TAVR registry. Poor SI was defined as readmission for heart failure (HF) within 1 year after TAVR or New York Heart Association (NYHA) class ≥3 after 1 year. A logistic regression model was used to identify predictors of poor SI. One-year landmark analysis after TAVR was used to evaluate the association between poor SI and clinical outcomes. Results Among the overall population (mean age, 84.5 years; female, 71.3%; mean STS score, 6.3%), 6.6% were categorised as having poor SI. Atrial fibrillation, chronic obstructive pulmonary disease, Clinical Frailty Scale ≥4, chronic kidney disease and moderate to severe mitral regurgitation were independent predictors of poor SI. One-year landmark analysis demonstrated that poor SI had a higher incidence of all-cause death and readmission for HF compared with SI (p<0.001). Poor SI with preprocedural NYHA class 2 had a worse outcome than SI with preprocedural NYHA class ≥3. Conclusions Poor SI was associated with worse outcomes 1 year after the procedure. It had a greater impact on clinical outcomes than baseline symptoms. TAVR may be challenging for patients with many predictors of poor SI. Trial registration number This registry, associated with the University Hospital Medical Information Network Clinical Trials Registry, was accepted by the International Committee of Medical Journal Editors (UMIN-ID: 000020423).
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Affiliation(s)
- Nobuhiro Yoshijima
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuya Saito
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Atsushi Anzai
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hikaru Tsuruta
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Kazuki Mizutani
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonankamakura General Hospital, Kamakura, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Hiroshi Ueno
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.,Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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18
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Yokoyama H, Yamanaka F, Shishido K, Ochiai T, Yokota S, Moriyama N, Watanabe Y, Shirai S, Tada N, Araki M, Yashima F, Naganuma T, Ueno H, Tabata M, Mizutani K, Takagi K, Yamamoto M, Saito S, Hayashida K. Prognostic Value of Ventricular-Arterial Coupling After Transcatheter Aortic Valve Replacement on Midterm Clinical Outcomes. J Am Heart Assoc 2021; 10:e019267. [PMID: 34533038 PMCID: PMC8649497 DOI: 10.1161/jaha.120.019267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Ventricular‐arterial coupling predicts outcomes in patients with heart failure. The arterial elastance to end‐systolic elastance ratio (Ea/Ees) is a noninvasively assessed index that reflects ventricular‐arterial coupling. We aimed to determine the prognostic value of ventricular‐arterial coupling assessed through Ea/Ees after transcatheter aortic valve replacement to predict clinical events. Methods and Results We retrieved data on 1378 patients (70% women) who underwent transcatheter aortic valve replacement between October 2013 and May 2017 from the OCEAN‐TAVI (Optimized transCathEter vAlvular iNtervention) Japanese multicenter registry. We determined the association between Ea/Ees and the composite end point of hospitalization for heart failure and cardiovascular death by classifying the patients into quartiles based on Ea/Ees values (group 1: <0.326; group 2: 0.326–0.453; group 3: 0.453–0.666; and group 4: >0.666) during the midterm follow‐up after transcatheter aortic valve replacement. During a median follow‐up period of 736 days (interquartile range, 414–956), there were 247 (17.9%) all‐cause deaths, 89 (6.5%) cardiovascular deaths, 130 (9.4%) hospitalizations for heart failure, and 199 (14.4%) composite events of hospitalization for heart failure and cardiovascular death. The incidence of the composite end point was significantly higher in group 2 (hazard ratio [HR], 1.76; 95% CI, 1.08–2.87 [P=0.024]), group 3 (HR, 2.43; 95% CI, 1.53–3.86 [P<0.001]), and group 4 (HR, 2.89; 95% CI, 1.83–4.57 [P<0.001]) than that in group 1. On adjusted multivariable Cox analysis, Ea/Ees was significantly associated with composite events (HR, 1.47 per 1‐unit increase; 95% CI, 1.08–2.01 [P=0.015]). Conclusions These findings suggest that a higher Ea/Ees at discharge after transcatheter aortic valve replacement is associated with adverse clinical outcomes during midterm follow‐up. Registration URL: https://www.upload.umin.ac.jp/. Unique identifier: UMIN000020423.
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Affiliation(s)
- Hiroaki Yokoyama
- Department of Cardiology Shonan Kamakura General Hospital Kamakura Japan
| | - Futoshi Yamanaka
- Department of Cardiology Shonan Kamakura General Hospital Kamakura Japan.,Department of Cardiovascular Medicine Kokura Memorial Hospital Kitakyushu Japan
| | - Koki Shishido
- Department of Cardiology Shonan Kamakura General Hospital Kamakura Japan
| | - Tomoki Ochiai
- Department of Cardiology Shonan Kamakura General Hospital Kamakura Japan
| | - Shohei Yokota
- Department of Cardiology Shonan Kamakura General Hospital Kamakura Japan
| | - Noriaki Moriyama
- Department of Cardiology Shonan Kamakura General Hospital Kamakura Japan
| | - Yusuke Watanabe
- Department of Cardiology Teikyo University School of Medicine Tokyo Japan
| | - Shinichi Shirai
- Department of Cardiology Sendai Kousei Hospital Sendai Japan
| | - Norio Tada
- Department of Cardiology Saiseikai Yokohama City Eastern Hospital Yokohama Japan
| | - Motoharu Araki
- Department of Cardiology Saiseikai Utsunomiya Hospital Utsunomiya Japan
| | - Fumiaki Yashima
- Department of Cardiovascular Medicine Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Toru Naganuma
- Department of Cardiovascular Medicine Kokura Memorial Hospital Kitakyushu Japan.,Department of Cardiology New Tokyo Hospital Matsudo Japan
| | - Hiroshi Ueno
- Department of Cardiovascular Medicine Toyama University Hospital Toyama Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery Tokyobay Urayasu Ichikawa Medical Center Urayasu Japan
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine Osaka City University Hospital Osaka Japan
| | - Kensuke Takagi
- Department of Cardiology Ogaki Municipal Hospital Ogaki Japan
| | - Masanori Yamamoto
- Department of Cardiology Nagoya Heart Center Nagoya Japan.,Department of Cardiology Toyohashi Heart Center Toyohashi Japan
| | - Shigeru Saito
- Department of Cardiology Shonan Kamakura General Hospital Kamakura Japan
| | - Kentaro Hayashida
- Department of Cardiology Keio University School of Medicine Tokyo Japan
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19
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Taniguchi T, Shirai S, Ando K, Arai Y, Soga Y, Hayashi M, Isotani A, Tada N, Watanabe Y, Naganuma T, Yamanaka F, Yamawaki M, Mizutani K, Tabata M, Ueno H, Kuwabara K, Takagi K, Yashima F, Yamamoto M, Hayashida K. Impact of New York Heart Association functional class on outcomes after transcatheter aortic valve implantation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 38:19-26. [PMID: 34340914 DOI: 10.1016/j.carrev.2021.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND In the current guidelines, indications for transcatheter aortic valve implantation (TAVI) are expanded to include several subgroups of asymptomatic patients with severe aortic stenosis (AS), and there is a paucity of data on the prognostic impact of New York Heart Association (NYHA) functional class in patients with severe AS undergoing TAVI. METHODS Among 2588 patients enrolled in the OCEAN-TAVI registry, patients were divided into 4 groups according to baseline NYHA class (class I in 95 patients, class II in 1172 patients, class III in 1126 patients, and class IV in 195 patients). RESULTS Median follow-up was 729 days. The cumulative 2-year incidence of all-cause death was significantly higher in patients with NYHA class IV and III than in those with NYHA class II and I. (30.0%, 21.3%, 13.4%, and 11.2%, respectively, P < 0.001). After adjusting confounders, NYHA class IV and III, but not NYHA class II were independently associated with higher mortality compared with NYHA class I (reference) (adjusted HR: 3.43, 95%CI: 1.83-7.15, P < 0.001; adjusted HR: 2.07, 95%CI: 1.15-4.19, P = 0.013; and adjusted HR: 1.50, 95%CI: 0.83-3.04, P = 0.19, respectively). With increasing NYHA class, there was an incremental increase of heart failure hospitalization in the effect size relative to the reference (NYHA class I). CONCLUSIONS The long-term outcomes of patients with NYHA class I were better than those with NYHA class IV or III in some selected patients undergoing TAVI.
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Affiliation(s)
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yoshio Arai
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yoshiharu Soga
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Masaomi Hayashi
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Akihiro Isotani
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Norio Tada
- Cardiovascular Center, Sendai Kosei Hospital, Sendai, Japan
| | - Yusuke Watanabe
- Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, Tokyo, Japan
| | - Toru Naganuma
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Futoshi Yamanaka
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Masahiro Yamawaki
- Department of Cardiovascular Medicine, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Hiroshi Ueno
- Department of Cardiovascular Medicine, Toyama University School of Medicine, Toyama, Japan
| | - Kensuke Kuwabara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Japan; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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20
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Enta Y, Miyasaka M, Taguri M, Tada N, Hata M, Watanabe Y, Naganuma T, Yamawaki M, Yamanaka F, Shirai S, Ueno H, Mizutani K, Tabata M, Takagi K, Yamamoto M, Hayashida K. Patients' characteristics and mortality in urgent/emergent/salvage transcatheter aortic valve replacement: insight from the OCEAN-TAVI registry. Open Heart 2021; 7:openhrt-2020-001467. [PMID: 33318151 PMCID: PMC7737081 DOI: 10.1136/openhrt-2020-001467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives Patients’ backgrounds and clinical outcomes in urgent/emergent/salvage transcatheter aortic valve replacement (Em-TAVR) remain unclear. We investigated patient characteristics and the mortality in Em-TAVR and the predictors for the need for Em-TAVR. Methods We consecutively enrolled 1613 patients undergoing TAVR for severe aortic stenosis between October 2013 and July 2016 from the Optimised transCathEter vAlvular interventioN (OCEAN)-transcatheter aortic valve implantation (TAVI) registry. The urgency was based on the European System for Cardiac Operative Risk Evaluation II. Urgent, emergent or salvage were included with the Em-TAVR group and elective with the El-TAVR group. Results Em-TAVR was observed in 87 (5.4%) patients. A higher Clinical Frailty Scale (CFS), peripheral artery disease (PAD), hypoalbuminaemia, reduced left ventricular ejection fraction (LVEF) and preoperative at least moderate mitral regurgitation (MR) predicted the need for the Em-TAVR by the multivariate logistic regression analysis. The Em-TAVR group had the higher Society of Thoracic Surgeons Score (13.7 (IQR 8.2–21.0) vs 6.5 (IQR 4.6–9.2); p<0.001) and higher 30-day mortality (9.2% vs 1.3%; p<0.001) than the El-TAVR group. Accordingly, Kaplan-Meier analysis showed that the cumulative mortality was higher in the Em-TAVR group than that in the El-TAVR group (log-rank; p<0.001). However, Em-TAVR did not predict mortality in the multivariate Cox regression analysis. Conclusions Em-TAVR was performed in 5.4% of patients. Higher CFS, PAD, hypoalbuminaemia, reduced LVEF and preprocedural MR predicted the need for Em-TAVR. Em-TAVR was not a predictor for mortality in the multivariate analysis, suggesting that it is a reasonable treatment option.
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Affiliation(s)
- Yusuke Enta
- Cardiovascular Center, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Masaki Miyasaka
- Cardiovascular Center, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Masataka Taguri
- Cardiovascular Center, Sendai Kousei Hospital, Sendai, Miyagi, Japan.,Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | - Norio Tada
- Cardiovascular Center, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Masaki Hata
- Cardiovascular Center, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Yusuke Watanabe
- Cardiology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Toru Naganuma
- Cardiology, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Masahiro Yamawaki
- Cardiology, Saiseikai Yokohama-City Eastern Hospital, Yokohama, Kanagawa, Japan
| | - Futoshi Yamanaka
- Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Shinichi Shirai
- Cardiology, Kokura Memorial Hospital, Kitakyusyu, Fukuoka, Japan
| | - Hiroshi Ueno
- Cardiology, Toyama University Hospital, Toyama, Toyama, Japan
| | - Kazuki Mizutani
- Cardiovascular Medicine, Osaka City General Hospital, Osaka, Osaka, Japan
| | - Minoru Tabata
- Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Kensuke Takagi
- Cardiology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Masanori Yamamoto
- Cardiology, Toyohashi Heart Center, Toyohashi, Aichi, Japan.,Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Kentaro Hayashida
- Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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21
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Saito S, Hayashida K, Takayama M, Goto T, Ihlberg L, Sawa Y. Clinical Outcomes in Patients Treated With a Repositionable and Fully Retrievable Aortic Valve ― REPRISE Japan Study ―. Circ J 2021; 85:991-1000. [DOI: 10.1253/circj.cj-20-0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital
| | | | | | - Tsuyoshi Goto
- Department of Cardiology, Kurashiki Central Hospital
| | | | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
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22
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Imamura T, Ueno H, Sobajima M, Kinugawa K, Watanabe Y, Yashima F, Tada N, Naganuma T, Araki M, Yamanaka F, Shirai S, Mizutani K, Tabata M, Takagi K, Yamamoto M, Hayashida K. Creatinine Score Can Predict Persistent Renal Dysfunction Following Trans-Catheter Aortic Valve Replacement. Int Heart J 2021; 62:546-551. [PMID: 34053999 DOI: 10.1536/ihj.20-713] [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] [Indexed: 11/18/2022]
Abstract
Severe aortic stenosis (AS) is often accompanied by renal dysfunction, which portends a poor prognosis. Trans-catheter aortic valve replacement (TAVR) is an accepted therapy for patients with severe AS, whereas the prediction of persistent renal dysfunction following TAVR remains challenging. In this study, we aimed to evaluate the pre-procedural score to assess the reversibility of renal dysfunction following TAVR. A total of 2,588 patients with severe AS who received TAVR and were enrolled in the Optimized transCathEter vAlvular iNtervention (OCEAN-TAVI) multicenter registry (UMIN000020423) were retrospectively investigated and those with serum creatinine (Cre) data at baseline and one year following TAVR were included. The Cre score was calculated using the formula: 0.2 × (age [years]) + 3.6 × (baseline serum Cre [mg/dL]). This score was evaluated to assess the risk of persistent renal dysfunction defined as serum Cre level > 1.5 mg/dL at one year following TAVR. Of the 1705 patients (84.3 ± 5.0 years old) included, 246 (14%) had persistent renal dysfunction following TAVR. The Cre score predicted the incidence of persistent renal dysfunction with an adjusted incidence rate ratio of 1.48 (95% confidence interval 1.42-1.56) with a cutoff of 21.4 (43% versus 5%, P < 0.001). The Cre score also predicted 4-year survival following TAVR (70% versus 52%, P < 0.001) with an adjusted hazard ratio of 1.75 (95% confidence interval 1.29-2.37). In conclusion, the Cre score identified those with a high risk of one-year persistent renal dysfunction following TAVR. The implication of Cre score-guided therapeutic strategy is the next concern.
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Affiliation(s)
| | - Hiroshi Ueno
- Second Department of Internal Medicine, University of Toyama
| | - Mitsuo Sobajima
- Second Department of Internal Medicine, University of Toyama
| | | | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital.,Department of Cardiology, Keio University School of Medicine
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital
| | | | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital
| | | | | | | | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center
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23
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Adachi Y, Yamamoto M, Shimura T, Yamaguchi R, Kagase A, Tokuda T, Tsujimoto S, Koyama Y, Otsuka T, Yashima F, Tada N, Naganuma T, Araki M, Yamanaka F, Shirai S, Mizutani K, Tabata M, Ueno H, Takagi K, Watanabe Y, Hayashida K. Late kidney injury after transcatheter aortic valve replacement. Am Heart J 2021; 234:122-130. [PMID: 33454371 DOI: 10.1016/j.ahj.2021.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/12/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Information on early to late-phase kidney damage in patients who underwent transcatheter aortic valve replacement (TAVR) is scarce. We aimed to identify the predictive factors for late kidney injury (LKI) at 1-year and patient prognosis beyond 1-year after TAVR. METHODS We retrospectively reviewed 1,705 patients' data from the Japanese TAVR multicenter registry. Acute kidney injury (AKI) and LKI, defined as an increase of at least 0.3 mg/dL in creatinine level, a relative 50% decrease in kidney function from baseline to 48 hours and 1-year, were evaluated. The patients were categorized into the 4 groups as AKI-/LKI- (n = 1.362), AKI+/LKI- (n = 95), AKI-/LKI+ (n = 199), and AKI+/LKI+ (n = 46). RESULTS The cumulative 3-year mortality rates were significantly increased across the four groups (12.5%, 15.8%, 24.6%, 25.8%, P < .001). Multivariate analysis revealed that chronic kidney disease, coronary artery disease, periprocedural AKI, and heart failure-related re-admission within 1-year were significantly associated with LKI. The Cox regression analysis revealed that AKI-/LKI+ and AKI+/LKI+ were independent predictors of increased late mortality beyond 1-year after TAVR (P = .001 and P = .01). CONCLUSIONS LKI was influenced by adverse cardio-renal events and was associated with increased risks of late mortality beyond 1-year after TAVR.
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24
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Fukuda H, Kiyohara K, Sato D, Kitamura T, Kodera S. A Real-World Comparison of 1-Year Survival and Expenditures for Transcatheter Aortic Valve Replacements: SAPIEN 3 Versus CoreValve Versus Evolut R. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:497-504. [PMID: 33840427 DOI: 10.1016/j.jval.2020.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/30/2020] [Accepted: 10/23/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES New versions of balloon-expandable and self-expandable valves for transcatheter aortic valve replacement (TAVR) have been developed, but few studies have examined the outcomes associated with these devices using national-level data. This study aimed to elucidate the clinical and economic outcomes of TAVR for aortic stenosis in Japan through an analysis of real-world data. METHODS This retrospective cohort study was performed using data from patients with aortic stenosis who had undergone transfemoral TAVR with Edwards SAPIEN 3, Medtronic CoreValve, or Medtronic Evolut R valves throughout Japan from April 2016 to March 2018. Pacemaker implantation, mortality, and health expenditure were examined for each valve type during hospitalization and at 1 month, 3 months, 6 months, and 1 year. Generalized linear regression models and Cox proportional hazards models were used to examine the associations between the valve types and outcomes. RESULTS We analyzed 7244 TAVR cases (SAPIEN 3: 5276, CoreValve: 418, and Evolut R: 1550) across 145 hospitals. The adjusted 1-year expenditures for SAPIEN 3, CoreValve, and Evolut R were $79 402, $76 125, and $75 527, respectively; SAPIEN 3 was significantly more expensive than the other valves (P < .05). The pacemaker implantation hazard ratios (95% confidence intervals) for CoreValve and Evolut R were significantly higher (P < .001) than SAPIEN 3 at 2.61 (2.07-3.27) and 1.80 (1.53-2.12), respectively. The mortality hazard ratios (95% confidence intervals) for CoreValve and Evolut R were not significant at 1.11 (0.84-1.46) and 1.22 (0.97-1.54), respectively. CONCLUSIONS SAPIEN 3 users had generally lower pacemaker implantation and mortality but higher expenditures than CoreValve and Evolut R users.
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Affiliation(s)
- Haruhisa Fukuda
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
| | - Kosuke Kiyohara
- Department of Food Science, Otsuma Women's University, Tokyo, Japan
| | - Daisuke Sato
- Center for Next Generation of Community Health, Chiba University Hospital, Chiba, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Satoshi Kodera
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
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25
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Onohara T, Yoshikawa Y, Watanabe T, Kishimoto Y, Harada S, Horie H, Kumagai K, Nii R, Yamamoto K, Nishimura M. Cost analysis of transcatheter versus surgical aortic valve replacement in octogenarians: analysis from a single Japanese center. Heart Vessels 2021; 36:1558-1565. [PMID: 33710376 DOI: 10.1007/s00380-021-01826-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/05/2021] [Indexed: 11/27/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has revolutionized the prognosis of intermediate- or high-risk patients with severe aortic stenosis, particularly among older adults. However, in possible candidates for surgical aortic valve replacement (SAVR), the implantation of expensive prostheses may be questionable in an era when healthcare costs are becoming a major concern. In this retrospective analysis of a single Japanese center, we focused on patients aged over 80 years; the objectives of this study were: (1) to compare TAVR and SAVR in terms of total hospitalization costs and (2) to describe the itemized cost of TAVR and SAVR to identify patients aged over 80 years in whom TAVR or SAVR would be cost-effective. A total of 146 patients aged over 80 years who underwent TAVR or SAVR for severe aortic stenosis were included. These patients were divided into a high-risk group (Society of Thoracic Surgeons [STS] mortality score > 8%; 36: TAVR and 12: SAVR) with 48 patients and a non-high-risk group (STS mortality score < 8%; 45: TAVR and 53 SAVR) with 98 patients. No 30-day mortality was observed in either group. In both groups, postoperative intensive care unit stay and hospital stay were longer with SAVR than with TAVR. In the non-high-risk group, the total cost was comparable for TAVR and SAVR; however, in the high-risk group, the total cost was significantly higher with SAVR than that with TAVR. A breakdown analysis of the total cost in the high-risk group showed both pre- and postoperative costs to be significantly higher with SAVR than with TAVR; however, operative costs were higher with TAVR. Up to 3 years, the overall survival in both groups did not significantly differ between TAVR and SAVR. Our findings suggest that from the perspective of total medical costs, TAVR is more suitable than SAVR for high-risk older adults.
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Affiliation(s)
- Takeshi Onohara
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Yasushi Yoshikawa
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
| | - Tomomi Watanabe
- Division of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Yuichiro Kishimoto
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Shingo Harada
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Hiromu Horie
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Kunitaka Kumagai
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Rikuto Nii
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Motonobu Nishimura
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
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26
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Shimura T, Yamamoto M, Yamaguchi R, Adachi Y, Sago M, Tsunaki T, Kagase A, Koyama Y, Otsuka T, Yashima F, Tada N, Naganuma T, Yamawaki M, Yamanaka F, Shirai S, Mizutani K, Tabata M, Ueno H, Takagi K, Watanabe Y, Hayashida K. Calculated plasma volume status and outcomes in patients undergoing transcatheter aortic valve replacement. ESC Heart Fail 2021; 8:1990-2001. [PMID: 33666353 PMCID: PMC8120354 DOI: 10.1002/ehf2.13270] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/31/2020] [Accepted: 02/08/2021] [Indexed: 01/23/2023] Open
Abstract
Aims This study investigated the prognostic value of plasma volume status (PVS) in patients who underwent transcatheter aortic valve replacement (TAVR). Methods and results Plasma volume status was calculated in 2588 patients who underwent TAVR using data from the Japanese multicentre registry. All‐cause mortality and heart failure hospitalization (HFH) within 2 years of TAVR were compared among the PVS quartiles (Q1, PVS < 5.5%; Q2, PVS 5.5–13.5%; Q3, PVS 13.5–21.0%; and Q4, PVS ≥ 21.0%). Subgroups were stratified by the PVS cut‐off value combined with the New York Heart Association (NYHA) class as follows: low PVS with NYHA I/II (n = 959), low PVS with NYHA III/IV (n = 845), high PVS with NYHA I/II (n = 308), and high PVS with NYHA III/IV (n = 476). The cumulative all‐cause mortality and HFH within 2 years of TAVR significantly increased with increasing PVS quartiles [8.5%, 16.8%, 19.2%, and 27.0% (P < 0.001) and 5.8%, 8.7%, 10.3%, and 12.9% (P < 0.001), respectively]. The high‐PVS group regardless of the NYHA class had a higher all‐cause mortality and HFH [9.6%, 18.2%, 24.5%, and 30.4% (P < 0.001) and 6.1%, 10.4%, 14.1%, and 11.3% (P < 0.001)]. In a Cox regression multivariate analysis, the PVS values of Q3 and Q4 had independently increased all‐cause mortality [hazard ratio (HR), 1.50 and 1.64 (P = 0.017 and P = 0.008), respectively], and Q4 had independently increased HFH (HR, 1.98, P = 0.005). The low PVS with NYHA III/IV, high PVS with NYHA I/II, and high PVS with NYHA III/IV also had significantly increased all‐cause mortality [HR, 1.45, 1.73, and 1.86 (P = 0.006, P = 0.002, and P < 0.001), respectively] and HFH [HR, 1.52, 2.21, and 1.70 (P = 0.049, P = 0.002, and P = 0.031), respectively]. Conclusions Plasma volume status is useful for predicting all‐cause mortality and HFH after TAVR.
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Affiliation(s)
- Tetsuro Shimura
- Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyamachyo, Toyohashi, Aichi, 441-8530, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyamachyo, Toyohashi, Aichi, 441-8530, Japan.,Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Ryo Yamaguchi
- Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyamachyo, Toyohashi, Aichi, 441-8530, Japan
| | - Yuya Adachi
- Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyamachyo, Toyohashi, Aichi, 441-8530, Japan
| | - Mitsuru Sago
- Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyamachyo, Toyohashi, Aichi, 441-8530, Japan
| | - Tatsuya Tsunaki
- Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyamachyo, Toyohashi, Aichi, 441-8530, Japan
| | - Ai Kagase
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Yutaka Koyama
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan.,Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan.,Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Kazuki Mizutani
- Department of Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Hiroshi Ueno
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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27
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Wang X, Xiong TY, Chen M. PCR Planet: a review of structural transcatheter intervention practice across the continents. EUROINTERVENTION 2020; 16:797-801. [PMID: 33215995 DOI: 10.4244/eijv16i10a149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Xi Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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28
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Izumi C, Eishi K, Ashihara K, Arita T, Otsuji Y, Kunihara T, Komiya T, Shibata T, Seo Y, Daimon M, Takanashi S, Tanaka H, Nakatani S, Ninami H, Nishi H, Hayashida K, Yaku H, Yamaguchi J, Yamamoto K, Watanabe H, Abe Y, Amaki M, Amano M, Obase K, Tabata M, Miura T, Miyake M, Murata M, Watanabe N, Akasaka T, Okita Y, Kimura T, Sawa Y, Yoshida K. JCS/JSCS/JATS/JSVS 2020 Guidelines on the Management of Valvular Heart Disease. Circ J 2020; 84:2037-2119. [DOI: 10.1253/circj.cj-20-0135] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kiyoyuki Eishi
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women’s Medical University Hospital
| | - Takeshi Arita
- Division of Cardiovascular Medicine Heart & Neuro-Vascular Center, Fukuoka Wajiro
| | - Yutaka Otsuji
- Department of Cardiology, Hospital of University of Occupational and Environmental Health
| | - Takashi Kunihara
- Department of Cardiac Surgery, The Jikei University School of Medicine
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Postgraduate of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- Department of Clinical Laboratory/Cardiology, The University of Tokyo Hospital
| | | | | | - Satoshi Nakatani
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Hiroshi Ninami
- Department of Cardiac Surgery, Tokyo Women’s Medical University
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka General Medical Center
| | | | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | | | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | | | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kikuko Obase
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Takashi Miura
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Mitsushige Murata
- Department of Laboratory Medicine, Tokai University Hachioji Hospital
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Takatsuki Hospital
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Kiyoshi Yoshida
- Department of Cardiology, Sakakibara Heart Institute of Okayama
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29
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Adachi Y, Yamamoto M, Shimura T, Yamaguchi R, Kagase A, Tokuda T, Tsujimoto S, Koyama Y, Otsuka T, Yashima F, Tada N, Naganuma T, Araki M, Yamanaka F, Shirai S, Mizutani K, Tabata M, Ueno H, Takagi K, Watanabe Y, Hayashida K. Late Adverse Cardiorenal Events of Catheter Procedure-Related Acute Kidney Injury After Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 133:89-97. [PMID: 32798043 DOI: 10.1016/j.amjcard.2020.07.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/30/2022]
Abstract
Data regarding the longitudinal effect of catheter procedure-related acute kidney injury (AKI) on clinical outcomes are limited. This study aimed to assess the late adverse cardiorenal events of AKI following transcatheter aortic valve implantation (TAVI). A total of 2,518 patients who underwent TAVI, excluding in-hospital deaths, were enrolled from the Japanese multicenter registry. The definition of AKI was determined using the Valve Academic Research Consortium-2 criteria. The incidence, predictors, major adverse renal and cardiac events (MARCE), and all-cause mortality of AKI were evaluated. MARCE included readmission for renal and heart failure (HF), hemodialysis requirement, and cardiovascular-renal death during the follow-up period. The incidence of AKI was 9.7% in the entire cohort. The significant predictive factors of AKI were men, diabetes mellitus, hypertension, chronic kidney disease, low albumin, overdose of contrast media, nontransfemoral approach, transfusion, vascular complications, and new pacemaker implantation. The rates of HF readmission and future hemodialysis were significantly higher in patients with AKI than in those without AKI (19.7% vs 9.0%, p <0.001, 3.3% vs 0.4%, p <0.001, respectively). Cox regression multivariate analysis showed that AKI occurrence was an independent predictive factor for the incremental risk of both MARCE and late mortality up to 4 years (hazard ratio [HR] 1.59, 95% confidence interval [CI] 0.75 to 1.20, p <0.001, HR 2.18, 95% CI 1.70 to 2.79; p <0.001, respectively). In conclusion, AKI occurrence was significantly associated with late adverse cardiorenal events after TAVI. Adequate clinical management can be expected to reduce AKI-related late phase cardiorenal damage even after successful TAVI.
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Affiliation(s)
- Yuya Adachi
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan; Department of Cardiology, Nagoya Heart Center, Nagoya, Japan.
| | - Tetsuro Shimura
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Ryo Yamaguchi
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Ai Kagase
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | | | - Yutaka Koyama
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan; Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Kazuki Mizutani
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Hiroshi Ueno
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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30
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Ninomiya R, Orii M, Fujiwara J, Yoshizawa M, Nakajima Y, Ishikawa Y, Kumagai A, Fusazaki T, Tashiro A, Kin H, Yoshioka K, Morino Y. Sex-Related Differences in Cardiac Remodeling and Reverse Remodeling After Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis in a Japanese Population. Int Heart J 2020; 61:961-969. [PMID: 32921672 DOI: 10.1536/ihj.20-154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Left ventricular (LV) remodeling with aortic stenosis (AS) appears to differ according to sex, but reverse remodeling after transcatheter aortic valve implantation (TAVI) has not been elucidated in a Japanese population. This study aims to determine whether any sex-related differences in LV or reverse remodeling after TAVI exist in the context of severe AS.Of 208 patients who received TAVI for severe AS in our institution, 100 (men, 42; mean age, 83.0 ± 4.9 years) underwent transthoracic echocardiography before and 3 months after TAVI. Despite similar valvular gradients, women with severe AS had lower indexed LV mass (LVMi) than did men (152.3 ± 35.4 versus 173.2 ± 44.6 g/m2, P = 0.005), with smaller indexed LV end-diastolic (LVEDVi) (50.2 ± 13.3 versus 61.4 ± 20.7 mL/m2, P = 0.001) and end-systolic (LVESVi; 17.9 ± 8.7 versus 24.3 ± 13.8 mL/m2, P = 0.006) volumes. After TAVI, women (-6.0% ± 14.4%) had higher reduction in the rate of change of relative wall thickness (RWT) than did men (4.4% ± 19.0%, P = 0.003). Men (-8.9% ± 3.9%) had higher reduction in the rate of change of LVEDVi than did women (1.5% ± 3.3%, P = 0.045). Incidence of LV reverse remodeling defined as a reduction in LVESV of >15% was significantly higher in men (50%) than in women (26%, P = 0.013).In addition to sex differences in the pattern of LV remodeling with AS, reverse LV remodeling after TAVI also differed between sexes.
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Affiliation(s)
- Ryo Ninomiya
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Makoto Orii
- Department of Radiology, Iwate Medical University
| | - Jumpei Fujiwara
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Michiko Yoshizawa
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Yoshifumi Nakajima
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Yu Ishikawa
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Akiko Kumagai
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Tetsuya Fusazaki
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
| | - Atsushi Tashiro
- Department of Laboratory of Medicine, Iwate Medical University
| | - Hajime Kin
- Department of Cardiovascular Surgery, Iwate Medical University
| | | | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
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31
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Hioki H, Watanabe Y, Kozuma K, Kataoka A, Yashima F, Naganuma T, Araki M, Tada N, Shirai S, Yamanaka F, Mizutani K, Tabata M, Takagi K, Ueno H, Yamamoto M, Hayashida K. Short-term dual anti-platelet therapy decreases long-term cardiovascular mortality after transcatheter aortic valve replacement. Heart Vessels 2020; 36:252-259. [PMID: 32880683 DOI: 10.1007/s00380-020-01693-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/28/2020] [Indexed: 01/09/2023]
Abstract
No data are available on extended dual anti-platelet therapy (DAPT) duration which may influence long-term prognosis (later than 1 year) after transcatheter aortic valve replacement (TAVR). Therefore, this study is aimed to evaluate whether discontinuing DAPT within 1 year had an impact on adverse events after TAVR. Using data from the OCEAN-TAVI registry, we assessed 1008 patients who survived the first year after TAVR with DAPT since discharge. Patients were divided into 'DAPT group' (n = 462), comprising patients who took DAPT at both discharge and 1 year, and 'stop-DAPT group' (n = 546), comprising patients who took DAPT at discharge and single anti-platelet therapy (SAPT) at 1 year. We compared the incidence of cardiovascular (CV) death, major and minor bleeding, and ischemic stroke later than 1 year after TAVR between the two groups. A total of 28 CV deaths were observed later than 1 year after TAVR. The stop-DAPT group had a significantly lower incidence of CV death than the DAPT group (1.8% vs. 4.9%, log-rank P = 0.029). Stop DAPT was associated with lower CV death later than 1 year of TAVR in Cox regression analysis (adjusted hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.20-0.99), and in analysis with inverse probability of treatment weighting method using propensity score (adjusted HR, 0.45; 95% CI, 0.20-0.98). Our study demonstrated that switching from DAPT to SAPT within 1 year of TAVR was significantly associated with a lower CV death later than 1 year after TAVR.
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Affiliation(s)
- Hirofumi Hioki
- Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan.
| | - Yusuke Watanabe
- Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Ken Kozuma
- Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Akihisa Kataoka
- Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | | | | | - Motoharu Araki
- Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | | | | | | | - Kazuki Mizutani
- Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Minoru Tabata
- Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | | | | | - Masanori Yamamoto
- Toyohashi Heart Center, Aichi, Japan.,Nagoya Heart Center, Aichi, Japan
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32
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Maeda K, Kuratani T, Pak K, Shimamura K, Mizote I, Miyagawa S, Toda K, Sakata Y, Sawa Y. Development of a new risk model for a prognostic prediction after transcatheter aortic valve replacement. Gen Thorac Cardiovasc Surg 2020; 69:44-50. [PMID: 32656706 DOI: 10.1007/s11748-020-01436-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Current guidelines for transcatheter aortic valve replacement (TAVR) recommend that TAVR should be performed in patients with a life expectancy > 1 year. However, it is challenging to estimate the patients' life expectancy because it is related to various factors, including frailty and nutritional status. HYPOTHESIS A new risk model can estimate the prognosis of patients after TAVR. METHODS We randomly divided 388 patients with aortic stenosis (AS) undergoing TAVR from October 2009 to August 2016 into two groups (2:1 ratio; training cohort, 259; validation cohort, 129). Using 94 baseline factors in the training cohort, we developed possible scoring models by the Cox proportional hazard regression model with the overall survival as the endpoint. Then, cross-validated 5-year C-statistics were calculated to assess the accuracy of the model. RESULTS Of 94 baseline factors, 12 factors were finally identified (5-year C-statistics in the training cohort: 0.709)-age, gender, body mass index, left ventricular ejection fraction, % vital capacity, forced expiratory volume 1.0 (s) %, albumin, hemoglobin, creatine, platelet, creatine kinase, and prothrombin time-international normalized ratio. The cross-validated 1-, 3-, and 5-year C-statistics in the validation cohort were 0.792, 0.758, and 0.778, respectively. Furthermore, calibration plots in the validation cohort revealed that 5-year survival is well predicted (r = 0.962). CONCLUSIONS The new survival prediction model after TAVR could provide appropriate guidance during decision making regarding the TAVR implementation.
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Affiliation(s)
- Koichi Maeda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Kyongsun Pak
- Division of Biostatistics, Center for Clinical Research, National Center for Child Health and Development, Setagaya, Japan
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Isamu Mizote
- Department of Cardiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yasushi Sakata
- Division of Biostatistics, Center for Clinical Research, National Center for Child Health and Development, Setagaya, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
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33
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Hayashida K. Should Transcatheter Aortic Valve Implantation Be the First-Choice Treatment? An Important Step Forward. Circ J 2020; 84:704-705. [PMID: 32224556 DOI: 10.1253/circj.cj-20-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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34
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Abstract
Background:
Transcatheter aortic valve replacement (TAVR) is widely used; however, its appropriateness is unknown. We sought to investigate the appropriateness of TAVR.
Methods and Results:
We assigned appropriateness ratings to patients undergoing TAVR for severe aortic stenosis between October 2013 and May 2017 at 14 Japanese hospitals participating in the optimized transcatheter valvular intervention-transcatheter aortic valve implantation registry according to the US appropriate use criteria for treating severe aortic stenosis. To account for the influence of uncaptured variables on appropriate use criteria ratings, we initially assigned them to a best-case scenario where they were assumed to classify a case to the most appropriate clinical scenario and then to a worst-case scenario where assumed least appropriate. Overall proportion of TAVRs classified as appropriate, maybe appropriate, or rarely appropriate was assessed. In addition, extent of hospital-level variation in rarely appropriate procedures was evaluated. Of 2036 TAVRs (median age [25th, 75th]: 85.0 years [81.0–88.0]; 70.5% female the Society of Thoracic Surgeons Predicted Risk of Mortality score: 6.2% [4.4–8.9]), in the best-case scenario, 177 (8.7%) were not successfully mapped, and 1580 (77.6%) were classified as appropriate, 180 (8.8%) as maybe appropriate, 99 (4.9%) as rarely appropriate, respectively. In the worst-case scenario, the rate of rarely appropriate increased to 6.8%. The majority of rarely appropriate TAVRs was performed in patients with moderate to severe dementia (defined as mini-mental status examination of ≤17), bicuspid aortic valve, or anticipated life expectancy <1 year. There was substantial variation in the proportion of rarely appropriate TAVR across hospitals (median rate of rarely appropriate: 4.9% [3.8–6.6] in the best-case scenario,
P
<0.001; 6.5% [5.6–8.6] in the worst-case scenario,
P
<0.001).
Conclusions:
In clinical practice, the proportion of rarely appropriate TAVRs ranged from 4.9% to 6.8% with substantial institutional variation. Our study elucidates common clinical scenarios deemed rarely appropriate and clarifies the potential targets of quality improvement.
Registration:
URL:
https://www.umin.ac.jp/ctr/index.htm
. Unique identifier: UMIN000020423.
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35
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Fukui S, Kawakami M, Otaka Y, Ishikawa A, Yashima F, Hayashida K, Oguma Y, Fukuda K, Liu M. Preoperative Instrumental Activities of Daily Living Predicts Survival After Transcatheter Aortic Valve Implantation. Circ Rep 2020; 2:83-88. [PMID: 33693212 PMCID: PMC7929760 DOI: 10.1253/circrep.cr-19-0109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background:
This aim of this study was to clarify prognosis after transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis (AS) and to identify baseline factors associated with mortality. Methods and Results:
We prospectively enrolled 257 consecutive elderly persons with AS who were referred to Keio University Hospital and who underwent assessment of cardiac, physical (walking speed), cognitive, and renal functions, nutritional status, activities of daily living (ADL), instrumental ADL (IADL) assessed with the Frenchay activities index (FAI), and comorbidities. The primary outcome was postoperative death. Differences in basic characteristics were compared between a group that survived for a median of 661 days (IQR, 0–1,289 days) after TAVI and a group that did not. Multivariate hazard ratios (HR) were calculated for independent factors selected in Cox proportional hazard models. Thirty-one individuals died during follow-up. Walking speed was significantly faster (0.87±0.25 vs. 0.70±0.24 m/s, P<0.001) and FAI was significantly higher (21.2±8.0 vs. 15.7±8.0, P=0.026) in the survival group compared with those who died. Multivariate HR for mortality according to walking speed was 0.05 (95% CI: 0.028–0.091) in model 1 and 0.04 (95% CI: 0.020–0.081) in model 2, and those for FAI were 0.94 (95% CI: 0.92–0.95) and 0.92 (95% CI: 0.90–0.92), respectively. Conclusions:
Preoperative walking speed and IADL are crucial factors associated with prognosis after TAVI even after adjustment.
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Affiliation(s)
- Shogo Fukui
- Department of Rehabilitation Medicine, Keio University School of Medicine Tokyo Japan.,Graduate School of Health Management, Keio University Tokyo Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine Tokyo Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University Toyoake Japan
| | - Aiko Ishikawa
- Department of Rehabilitation Medicine, Keio University School of Medicine Tokyo Japan
| | - Fumiaki Yashima
- Department of Cardiology, Keio University School of Medicine Tokyo Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine Tokyo Japan
| | - Yuko Oguma
- Graduate School of Health Management, Keio University Tokyo Japan.,Sports Medicine Research Center, Keio University Tokyo Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine Tokyo Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine Tokyo Japan
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Steinberg DH. Disseminating TAVR Across the World - And Optimizing Outcomes While It's Done. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:829-830. [PMID: 31733707 DOI: 10.1016/j.carrev.2019.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 10/25/2022]
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Hayashida K. Left ventricular dysfunction before transcatheter aortic valve implantation. ASIAINTERVENTION 2019; 5:110-111. [PMID: 36483528 PMCID: PMC9706775 DOI: 10.4244/aijv5i2a18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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