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Cafaro A, Spione F, Burattini O, De Feo D, Xhelo A, Palmitessa C, D’Alessandro M, Amendola VP, Rimmaudo F, Guaricci AI, Bortone AS, Pestrichella V, Contegiacomo G, Tesorio T, Colonna G, Iacovelli F. Fluoroscopy Time as a New Predictor of Short-Term Outcomes after Transcatheter Aortic Valve Replacement. J Cardiovasc Dev Dis 2023; 10:459. [PMID: 37998517 PMCID: PMC10671838 DOI: 10.3390/jcdd10110459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is an almost totally cine-fluoroscopic guided procedure. The amount of radiation used during the procedure is strictly related to the fluoroscopy time (FT), that has already been demonstrated to be associated with outcomes and complexity of coronary procedures. The aim of our study is to demonstrate the relationship between FT and the short-term outcomes after TAVR defined by to the Valve Academic Research Consortium (VARC)-2 and -3 consensus documents. METHODS After splitting 1797 consecutive patients into tertiles of FT, the composite endpoint early safety (ES) was adjudicated according to VARC-2 and VARC-3 definitions, whereas the composite endpoints device success (DS) and technical success (TS) according to VARC-3 criteria. RESULTS The absence of all these outcomes (VARC-2 ES amd VARC-3 TS, DS, and ES) was significantly associated with longer FT: this association was independent from both intraprocedural complications and other intraprocedural factors linked to longer FT, and still persisted after propensity score matching analysis. Notwithstanding, after receiver operating characteristic analysis, FT had adequate diagnostic accuracy in identifying the absence of only VARC-3 TS and VARC-2 ES. CONCLUSION Longer FT is related with periprocedural and short-term outcomes after the procedure, especially in those that are more challenging. A FT duration of more than 30 min has an adequate accuracy in identifying VARC-3 technical failure (TS and DS) and absence of VARC-2 ES, selecting patients who are likely to take advantage from more careful in-hospital follow-up.
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Affiliation(s)
| | - Francesco Spione
- Interventional Cardiology Service, “Montevergine” Clinic, GVM Care & Research, 83013 Mercogliano, Italy; (F.S.); (T.T.)
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Osvaldo Burattini
- Division of Cardiology, “SS. Annunziata” Hospital, 74121 Taranto, Italy; (O.B.); (F.I.)
| | - Daniele De Feo
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (D.D.F.); (A.X.); (C.P.); (M.D.); (V.P.A.); (A.I.G.)
| | - Alessandro Xhelo
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (D.D.F.); (A.X.); (C.P.); (M.D.); (V.P.A.); (A.I.G.)
| | - Chiara Palmitessa
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (D.D.F.); (A.X.); (C.P.); (M.D.); (V.P.A.); (A.I.G.)
| | - Maurizio D’Alessandro
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (D.D.F.); (A.X.); (C.P.); (M.D.); (V.P.A.); (A.I.G.)
| | - Vincenzo Pio Amendola
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (D.D.F.); (A.X.); (C.P.); (M.D.); (V.P.A.); (A.I.G.)
| | - Flavio Rimmaudo
- Division of Cardiology, “Vittorio Emanuele” Hospital, 93012 Gela, Italy;
| | - Andrea Igoren Guaricci
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (D.D.F.); (A.X.); (C.P.); (M.D.); (V.P.A.); (A.I.G.)
| | - Alessandro Santo Bortone
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy;
| | | | - Gaetano Contegiacomo
- Interventional Cardiology Service, “Anthea” Clinic, GVM Care & Research, 70124 Bari, Italy;
| | - Tullio Tesorio
- Interventional Cardiology Service, “Montevergine” Clinic, GVM Care & Research, 83013 Mercogliano, Italy; (F.S.); (T.T.)
| | - Giuseppe Colonna
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy;
| | - Fortunato Iacovelli
- Division of Cardiology, “SS. Annunziata” Hospital, 74121 Taranto, Italy; (O.B.); (F.I.)
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (D.D.F.); (A.X.); (C.P.); (M.D.); (V.P.A.); (A.I.G.)
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Iacovelli F, Loizzi F, Cafaro A, Burattini O, Salemme L, Cioppa A, Rizzo F, Palmitessa C, D'Alessandro M, De Feo D, Pucciarelli A, De Cillis E, Pestrichella V, Contegiacomo G, Tesorio T, Bortone AS. Surgical Mortality Risk Scores in Transcatheter Aortic Valve Implantation: Is Their Early Predictive Value Still Strong? J Cardiovasc Dev Dis 2023; 10:244. [PMID: 37367409 DOI: 10.3390/jcdd10060244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Surgical mortality risk scores, even if not properly designed and rarely tested in the transcatheter aortic valve implantation (TAVI) setting, still guide the heart team in managing significant aortic stenosis. METHODS After splitting 1763 consecutive patients retrospectively based on their mortality risk thresholds, the composite endpoint early safety (ES) was adjudicated according to Valve Academic Research Consortium (VARC)-2 and -3 consensus documents. RESULTS ES incidence was higher if VARC-2 rather than VARC-3 defined. Despite only patients showing VARC-2 ES had significantly lower absolute values of all three main risk scores, these last still failed to foresee both VARC-2 and -3 ES in intermediate-risk patients. The receiver operating characteristic analysis also showed a significant correlation, but with poor diagnostic accuracy, among the three scores and only VARC-2 ES; moreover, the absence of VARC-2 ES and low-osmolar contrast media administration were identified as independent predictors of 1-year mortality and absence of VARC-3 ES, respectively. Finally, even a single complication included in the ES definition could significantly affect 1-year mortality. CONCLUSION Currently, the most used mortality risk scores do not have adequate diagnostic accuracy in predicting ES after TAVI. The absence of VARC-2, instead of VARC-3, ES is an independent predictor of 1-year mortality.
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Affiliation(s)
- Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy
- Division of Cardiology, "SS. Annunziata" Hospital, 74121 Taranto, Italy
| | - Francesco Loizzi
- Division of Cardiology, "SS. Annunziata" Hospital, 74121 Taranto, Italy
| | | | - Osvaldo Burattini
- Division of Cardiology, "SS. Annunziata" Hospital, 74121 Taranto, Italy
| | - Luigi Salemme
- Interventional Cardiology Service, "Montevergine" Clinic, GVM Care & Research, 83013 Mercogliano, Italy
| | - Angelo Cioppa
- Interventional Cardiology Service, "Montevergine" Clinic, GVM Care & Research, 83013 Mercogliano, Italy
| | - Francesco Rizzo
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy
| | - Chiara Palmitessa
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy
| | - Maurizio D'Alessandro
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy
| | - Daniele De Feo
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy
| | - Armando Pucciarelli
- Interventional Cardiology Service, "Montevergine" Clinic, GVM Care & Research, 83013 Mercogliano, Italy
| | - Emanuela De Cillis
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy
| | | | - Gaetano Contegiacomo
- Interventional Cardiology Service, "Anthea" Clinic, GVM Care & Research, 70124 Bari, Italy
| | - Tullio Tesorio
- Interventional Cardiology Service, "Montevergine" Clinic, GVM Care & Research, 83013 Mercogliano, Italy
| | - Alessandro Santo Bortone
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy
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Lee DU, Han J, Fan GH, Hastie DJ, Kwon J, Lee KJ, Addonizio EA, Karagozian R. The clinical impact of chronic liver disease in patients undergoing transcatheter and surgical aortic valve replacement: Systematic analysis of the 2011-2017 US hospital database. Catheter Cardiovasc Interv 2021; 98:E1044-E1057. [PMID: 34562288 DOI: 10.1002/ccd.29952] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES In this study, we use a national database to evaluate post-transcatheter (TAVR)/surgical aortic valve replacement (SAVR) outcomes stratified using chronic liver disease (CLD). BACKGROUND In patients undergoing TAVR and SAVR, the surgical risks should be optimized; this includes evaluating hepatic diseases that may pose an operative risk. METHODS 2011-2017 National Inpatient Sample was used to select in-hospital TAVR and SAVR cases, which were stratified according to CLD (cirrhosis, hepatitis B/C, alcoholic/fatty/nonspecific liver disease). The cases-controls were matched using propensity score matching and compared with various endpoints. RESULT After matching for demographics and comorbidities, for TAVR, 606 and 1818 were with or without CLD; for SAVR, 1353 and 4059 were with and without CLD. In TAVR, there was no differences in mortality (2.81% vs. 2.75% OR 1.02 95% CI 0.58-1.78) or length of stay (6.29 vs. 6.44d p = 0.29), and CLD-present patients had marginally increased costs ($228,415 vs. $226,682 p = 0.048). There were no differences in complications. In multivariate, there was no difference in mortality (aOR 1.02 95% CI 0.58-1.79). In SAVR, CLD patients had higher mortality (7.98% vs. 3.23% OR 2.60 95% CI 2.00-3.38), length of stay (13.3 vs. 11.3 days p < 0.001), and costs ($273,487 vs. $238,097 p < 0.001). CLD patients also had increased respiratory failure (9.02% vs. 7.19% OR 1.28 95% CI 1.03-1.59) and bleeding (8.43% vs. 6.33% OR 1.36 95% CI 1.08-1.71). In multivariate, CLD had higher mortality (aOR 2.60 95% CI 2.00-3.38). CONCLUSION CLD is associated with higher mortality and complications in patients undergoing SAVR; however, no correlation was found in patients undergoing TAVR.
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Affiliation(s)
- David Uihwan Lee
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland, USA
| | - John Han
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Gregory Hongyuan Fan
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - David Jeffrey Hastie
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jean Kwon
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ki Jung Lee
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Elyse Ann Addonizio
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Raffi Karagozian
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
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Ando T, Ashraf S, Briasoulis A, Takagi H, Grines CL, Malik AH. Risk of Ischemic Stroke in Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients With Prior Stroke. Am J Cardiol 2021; 157:79-84. [PMID: 34366113 DOI: 10.1016/j.amjcard.2021.06.049] [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: 04/12/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
It has not been well studied whether transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) have lower risk of ischemic stroke (IS) in those with prior history of IS. From the Nationwide Readmission Database from October 2015 to November 2017, TAVI and SAVR above age 50 were identified with the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System codes. Transapical TAVI and SAVR with concomitant bypass, mitral, or tricuspid surgery were excluded. The primary outcome was in-hospital IS. A total of 92,435 TAVI (13,292 with prior stroke) and 68,651 SAVR (5,365 with prior stroke) were identified. In-hospital IS was significantly lower in TAVI compared with SAVR (3.7% vs 8.0%, adjusted odds ratio 0.65, 95% confidence interval 0.47 to 0.89, p <0.01) with prior stroke whereas it was similar between TAVI and SAVR (1.7% vs 2.1%, adjusted odds ratio 0.97, 95% confidence interval 0.78 to 1.19, p = 0.75) in those without prior stroke (P interaction < 0.001). In-hospital mortality, acute kidney injury, and bleeding were lower in TAVI compared with SAVR in patients with and without prior stroke (P interaction > 0.05 for all). This analysis of a national claims database showed that TAVI was associated with a lower risk of in-hospital IS compared with SAVR among patients with prior stroke.
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Zhao PY, Wang YH, Liu RS, Zhu JH, Wu JY, Song B. The noninferiority of transcatheter aortic valve implantation compared to surgical aortic valve replacement for severe aortic disease: Evidence based on 16 randomized controlled trials. Medicine (Baltimore) 2021; 100:e26556. [PMID: 34260533 PMCID: PMC8284753 DOI: 10.1097/md.0000000000026556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Currently, transcatheter aortic valve implantation (TAVI) as an effective and convenient intervention has been adopted extensively for patients with severe aortic disease. However, the efficacy and safety of TAVI have not yet been well evaluated and its noninferiority compared with traditional surgical aortic valve replacement (sAVR) still lack sufficient evidence. This meta-analysis was designed to comprehensively compare the noninferiority of TAVI with sAVR for patients with severe aortic disease. METHODS A systematic search of PubMed, Embase, Cochrane Library, and Web of Science up to October 1, 2020 was conducted for relevant studies that comparing TAVI and sAVR in the treatment of severe aortic disease. The primary outcomes were early, midterm and long term mortality. The secondary outcomes included early complications and other late outcomes. Two reviewers assessed trial quality and extracted the data independently. All statistical analyzes were performed using the standard statistical procedures provided in Review Manager 5.2. RESULTS A total of 16 studies including 14394 patients were identified. There was no difference in 30-day, 1-year, 2-year, and 5-year all-cause or cardiovascular mortality as well as stroke between TAVI and sAVR. Regarding to the 30-day outcomes, compared with sAVR, TAVI experienced a significantly lower incidence of myocardial infarction (risk ratio [RR] 0.62; 95% confidence interval [CI] 0.40-0.97; 5441 pts), cardiogenic shock (RR 0.34; 95% CI 0.19-0.59; 1936 pts), acute kidney injury (AKI) > stage 2 (RR 0.37; 95% CI 0.25-0.54; 5371 pts), and new-onset atrial fibrillation (NOAF) (RR 0.29; 95% CI 0.24-0.35; 5371 pts) respectively, but higher incidence of permanent pacemaker implantation (RR 3.16; 95% CI 1.61-6.21; 5441 pts) and major vascular complications (RR 2.22; 95% CI 1.14-4.32; 5371 pts). Regarding to the 1- and 2-year outcomes, compared with sAVR, TAVI experienced a significantly lower incidence of NOAF, but higher incidence of neurological events, transient ischemic attacks (TIA), permanent pacemaker and major vascular complications respectively. Regarding to the 5-year outcomes, compared with sAVR, TAVI experienced a significantly lower incidence of NOAF, but higher incidence of TIA and reintervention respectively. CONCLUSIONS Our analysis shows that TAVI was equal to sAVR in early, midterm and long term mortality for patients with severe aortic disease. In addition, TAVI may be favorable in reducing the incidence of both early, midterm and long term NOAF. However, pooled results showed superiority of sAVR in reducing permanent pacemaker implantation, neurological events, TIA, major vascular complications and reintervention.
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Affiliation(s)
- Peng-Ying Zhao
- Department of Cardiovascular Surgery, Lanzhou University First Affiliated Hospital, Lanzhou, China
| | - Yong-Hong Wang
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi’ning, China
- Medical College of Qinghai University, Qinghai University, Xi’ning, China
| | - Rui-Sheng Liu
- Department of Cardiovascular Surgery, Lanzhou University First Affiliated Hospital, Lanzhou, China
| | - Ji-Hai Zhu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi’ning, China
- Medical College of Qinghai University, Qinghai University, Xi’ning, China
| | - Jian-Ying Wu
- Department of Cardiovascular Surgery, Qinghai University Affiliated Hospital, Xi’ning, China
- Medical College of Qinghai University, Qinghai University, Xi’ning, China
| | - Bing Song
- Department of Cardiovascular Surgery, Lanzhou University First Affiliated Hospital, Lanzhou, China
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Biancari F, Rosato S, Costa G, Barbanti M, D'Errigo P, Tamburino C, Cerza F, Rosano A, Seccareccia F. A novel, comprehensive tool for predicting 30-day mortality after surgical aortic valve replacement. Eur J Cardiothorac Surg 2021; 59:586-592. [PMID: 33575794 DOI: 10.1093/ejcts/ezaa375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES We sought to develop and validate a novel risk assessment tool for the prediction of 30-day mortality after surgical aortic valve replacement incorporating a patient's frailty. METHODS Overall, 4718 patients from the multicentre study OBSERVANT was divided into derivation (n = 3539) and validation (n = 1179) cohorts. A stepwise logistic regression procedure and a criterion based on Akaike information criteria index were used to select variables associated with 30-day mortality. The performance of the regression model was compared with that of European System for Cardiac Operative Risk Evaluation (EuroSCORE) II. RESULTS At 30 days, 90 (2.54%) and 35 (2.97%) patients died in the development and validation data sets, respectively. Age, chronic obstructive pulmonary disease, concomitant coronary revascularization, frailty stratified according to the Geriatric Status Scale, urgent procedure and estimated glomerular filtration rate were independent predictors of 30-day mortality. The estimated OBS AVR score showed higher discrimination (area under curve 0.76 vs 0.70, P < 0.001) and calibration (Hosmer-Lemeshow P = 0.847 vs P = 0.130) than the EuroSCORE II. The higher performances of the OBS AVR score were confirmed by the decision curve, net reclassification index (0.46, P = 0.011) and integrated discrimination improvement (0.02, P < 0.001) analyses. Five-year mortality increased significantly along increasing deciles of the OBS AVR score (P < 0.001). CONCLUSIONS The OBS AVR risk score showed high discrimination and calibration abilities in predicting 30-day mortality after surgical aortic valve replacement. The addition of a simplified frailty assessment into the model seems to contribute to an improved predictive ability over the EuroSCORE II. The OBS AVR risk score showed a significant association with long-term mortality.
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Affiliation(s)
- Fausto Biancari
- Department of Surgery, University of Oulu, Oulu, Finland.,Department of Surgery, University of Turku, Turku, Finland.,Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Stefano Rosato
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Giuliano Costa
- Division of Cardiology, Policlinico Vittorio Emanuele Hospital, University of Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, Policlinico Vittorio Emanuele Hospital, University of Catania, Italy
| | - Paola D'Errigo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Corrado Tamburino
- Division of Cardiology, Policlinico Vittorio Emanuele Hospital, University of Catania, Italy
| | - Francesco Cerza
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - Aldo Rosano
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
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Costa G, D'Errigo P, Rosato S, Valvo R, Biancari F, Tamburino C, Cerza F, Cicala SD, Seccareccia F, Barbanti M. Long-term outcomes of self-expanding versus balloon-expandable transcatheter aortic valves: Insights from the OBSERVANT study. Catheter Cardiovasc Interv 2021; 98:1167-1176. [PMID: 33847447 DOI: 10.1002/ccd.29701] [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: 02/04/2021] [Accepted: 03/19/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To compare clinical outcomes of balloon-expandable (BE) and self-expanding (SE) transcatheter aortic valves (TAVs) up to 5 years. BACKGROUND To date, no robust, comparative data of BE and SE TAVs at long-term are available. METHODS We considered a total of 1,440 patients enrolled in the multicenter OBSERVANT study and undergoing transfemoral transcatheter aortic valve implantation (TF-TAVI) with either supra-annular SE (n = 830, 57.6%) and intra-annular BE (n = 610, 42.4%) valves. Clinical outcomes of the two groups were compared after adjustment using inverse probability of treatment weighting (IPTW) and confirmed by sensitivity analysis with propensity score matching. RESULTS Patients receiving SE valve showed a higher all-cause mortality at 5 years (Kaplan-Meier estimates 52.3% vs. 47.7%; Hazard ratio [HR] 1.18, 95% confidence interval [CI] 1.01-1.38, p = .04). Landmark analyses showed that there was a not statistically significant reversal of risk excess against the BE group starting from 3 years after TAVI (3-5 years HR 0.97, 95% CI 0.76-1.25, p = .86). Post-procedural, moderate/severe paravalvular regurgitation (PVR)(HR 1.46, 95% CI 1.14-1.87; p < .01) and acute kidney injury (AKI)(HR 3.89, 95% CI 2.47-6.38; p < .01) showed to be independent predictors of 5-year all-cause mortality in multivariable analysis. CONCLUSIONS Considering the intrinsic limitations of the OBSERVANT study, we found that patients undergoing TF-TAVI with a supra-annular SE valve had a higher all-cause mortality compared to those receiving an intra-annular BE valve at 5 years. A late catch up phenomenon of patients receiving the BE valve was observed beyond 3 years. Post-procedural moderate/severe PVR seems to play a crucial role in determining this finding. Comparative studies of new generation devices with longer follow-up are needed to evaluate the benefit of each specific TAV type.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Paola D'Errigo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Valvo
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Fausto Biancari
- Department of Surgery, University of Oulu, Oulu, Finland.,Department of Surgery, University of Turku, Turku, Finland.,Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Francesco Cerza
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | | | - Fulvia Seccareccia
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
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Incidence and Risk Factors of Postoperative Dysphagia in Severe Aortic Stenosis. TOPICS IN GERIATRIC REHABILITATION 2021. [DOI: 10.1097/tgr.0000000000000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hochstadt A, Merdler I, Meridor Y, Schwartz AL, Ingbir M, Ghantous E, Havakuk O, Mazo A, Steinvil A, Finkelstein A, Viskin S, Rosso R. Effect of pacemaker implantation after transcatheter aortic valve replacement on long- and mid-term mortality. Heart Rhythm 2020; 18:199-206. [PMID: 33091603 DOI: 10.1016/j.hrthm.2020.10.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has become quite common. Atrioventricular conduction defects remain a frequent complication resulting with permanent pacemaker (PPM) implantation. Past studies showed conflicting results regarding PPM effect on mortality. OBJECTIVE The purpose of this study was to assess the influence of PPM implantation on mid- and long-term mortality in a large cohort of patients who underwent TAVR. METHODS Patients undergoing TAVR between 2009 and 2019 were categorized into groups: no PPM implanted (no-PPM), PPM implanted before the procedure (pre-PPM), and PPM implanted postprocedure (post-PPM). All-cause mortality up to 6 years was compared. Subanalyses were performed according to pacing burden. Proportion of patients who had decreased left ventricular ejection fraction within 1 year of the procedure after TAVR was also recorded. RESULTS A total of 1489 patients were followed. Unadjusted mortality was similar for patients regardless of PPM status within 12 months (P > .187), yet within 72 months, mortality was similar for the post-PPM (P = .257) and higher for pre-PPM (hazard ratio 1.53; P = .002) groups. Analysis adjusted by clinical characteristics did not show any independent long- or mid-term survival effects of PPM (P > .563). Analysis according to pacing burden showed no significant mortality difference (P > .8). Analysis of post-PPM patients with "high" or "near constant" (>40%) pacing burden vs no-PPM patients showed similar mortality for both mid- and long-term mortality (P = .055 and P = .513). Left ventricular ejection fraction decrease within 1 year was more common in both PPM groups, with a higher proportion with higher pacing burden (P < .001). CONCLUSION This cohort of consecutive patients undergoing TAVR showed that postprocedure PPM was not associated with increased long-term mortality. This conclusion was not altered by ventricular pacing burden.
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Affiliation(s)
- Aviram Hochstadt
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ilan Merdler
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Meridor
- Department of Internal Medicine J, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie L Schwartz
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Ingbir
- Department of Internal Medicine J, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eihab Ghantous
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Havakuk
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anna Mazo
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Steinvil
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Finkelstein
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sami Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raphael Rosso
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Nagai T, Horinouchi H, Ohno Y, Murakami T, Sakai K, Nakazawa G, Yoshioka K, Ikari Y. Predictors for non-delayed discharge after transcatheter aortic valve replacement: utility of echocardiographic parameters. Int J Cardiovasc Imaging 2020; 37:47-58. [PMID: 32712734 DOI: 10.1007/s10554-020-01944-z] [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] [Received: 12/17/2019] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
Considering that transcatheter aortic valve replacement (TAVR) procedures have become less invasive, the duration for monitoring patient care after a successful TAVR can be reduced. Therefore, this study aimed to investigate the prognostic value of baseline echocardiographic parameters for non-delayed discharge in patients after TAVR. The study group included 154 consecutive patients (mean age: 84.4 ± 4.5 years; and 101 women) who underwent a TAVR. Comprehensive echocardiograms including both side indices of myocardial performance (IMP) and blood tests were obtained prior to the TAVR procedure. The median post-TAVR length of stay was 6 days while the mode and first quartile were both 4 days. Receiver operating characteristic curve analysis showed that the optimum cut-off value of the left-sided IMP in patients with a normal left ventricular ejection fraction (LVEF, ≥ 50%) (n = 124) for non-delayed discharge (≤ 4 days) was 0.34 with an area under the curve (AUC) value of 0.71563 and p value of < 0.0001, while the optimum cut-off value in patients with reduced LVEF (< 50%) (n = 30) was 0.47 with an AUC value of 0.77778 and p value of < 0.0120. An adjusted analysis indicated the negative left-sided IMP results as the only predictor for non-delayed discharge (p < 0.0001). Furthermore, the adjusted predictors for survival without early cardiovascular re-hospitalization within 6 months after TAVR were the positive left-sided IMP result, when the cut-off value of 0.52 was used, and the presence of elevated RAP of 8 to 15 mmHg. The early discharge policy should be carefully considered in high-risk populations, but the left-sided IMP may play a significant role in the pre-screening process.
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Affiliation(s)
- Tomoo Nagai
- Division of Cardiovascular Medicine, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan.
| | - Hitomi Horinouchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan
| | - Yohei Ohno
- Division of Cardiovascular Medicine, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan
| | - Tsutomu Murakami
- Division of Cardiovascular Medicine, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan
| | - Katsuaki Sakai
- Division of Cardiovascular Medicine, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan
| | - Gaku Nakazawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan
| | - Koichiro Yoshioka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan
| | - Yuji Ikari
- Division of Cardiovascular Medicine, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan
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11
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Mariscalco G, D’Errigo P, Biancari F, Rosato S, Musumeci F, Barbanti M, Ranucci M, Santoro G, Badoni G, Fusco D, Ventura M, Tamburino C, Seccareccia F. Early and late outcomes after transcatheter versus surgical aortic valve replacement in obese patients. Arch Med Sci 2020; 16:796-801. [PMID: 32542080 PMCID: PMC7286321 DOI: 10.5114/aoms.2019.85253] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 12/12/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Data on the early and late outcome following transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in obese patients are limited. We investigated whether TAVI may be superior to SAVR in obese patients. MATERIAL AND METHODS Obese patients (body mass index ≥ 30 kg/m2) who underwent either SAVR or TAVI were identified from the nationwide OBSERVANT registry, and their in-hospital and long-term outcomes were analysed. Propensity score matching was employed to identify two cohorts with similar baseline characteristics. RESULTS The propensity score matching provided 142 pairs balanced in terms of baseline risk factors. In-hospital and 30-day mortality did not differ between SAVR and TAVI obese patients (4.6% vs. 3.3%, p = 0.56, and 5.2% vs. 3.2%, p = 0.41, respectively). Obese SAVR patients experienced a higher rate of renal failure (12.4% vs. 3.6%, p = 0.0105) and blood transfusion requirement (60.3% vs. 25.7%, p < 0.0001) in comparison with TAVI patients. A higher rate of permanent pacemaker implantation (14.4% vs. 3.6%, p = 0.0018), and major vascular injuries (7.4% vs. 0%, p = 0.0044) occurred in the TAVI group. Five-year survival was higher in the SAVR group compared to the TAVI patient cohort (p = 0.0046), with survival estimates at 1, 3 and 5 years of 88.0%, 80.3%, 71.8% for patients undergoing SAVR, and 85.2%, 69.0%, 52.8% for those subjected to TAVI procedures. CONCLUSIONS In obese patients, both SAVR and TAVI are valid treatment options, although in the long term SAVR exhibited higher survival rates.
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Affiliation(s)
- Giovanni Mariscalco
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- Corresponding author: Prof. Giovanni Mariscalco MD, PhD, Department of Heart and Vessels, Cardiac Surgery Unit, Varese University Hospital, 7 Via Guicciardini St, 21100 Varese, Italy, E-mail:
| | - Paola D’Errigo
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Fausto Biancari
- Heart Center, Turku University Hospital, Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
- Department of Surgery, University of Oulu, Oulu, Finland
| | - Stefano Rosato
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Francesco Musumeci
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Marco Barbanti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Marco Ranucci
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Gabriella Badoni
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Danilo Fusco
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Martina Ventura
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
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12
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Howard C, Jullian L, Joshi M, Noshirwani A, Bashir M, Harky A. TAVI and the future of aortic valve replacement. J Card Surg 2019; 34:1577-1590. [PMID: 31600005 DOI: 10.1111/jocs.14226] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aortic valve stenosis (AS) is the most common valvular pathology and has traditionally been managed using surgical aortic valve replacement (SAVR). A large proportion of affected patient demographics, however, are unfit to undergo major surgery given underlying comorbidities. Since its introduction in 2002, transcatheter aortic valve implantation (TAVI) has gained popularity and transformed the care available to different-risk group patients with severe symptomatic AS. Specific qualifying criteria and refinement of TAVI techniques are fundamental in determining successful outcomes for intervention. Given the successful applicability in high-risk patients, TAVI has been further developed and trialed in intermediate and low-risk patients. Within intermediate-risk patient groups, TAVI was shown to be noninferior to SAVR evaluating 30-d mortality and secondary endpoints such as the risk of bleeding, development of acute kidney injury, and length of admission. The feasibility of expanding TAVI procedures into low-risk patients is still a controversial topic in the literature. A number of trials have recently been published which demonstrate TAVI as noninferior and even superior over SAVR for primary study endpoints.
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Affiliation(s)
- Callum Howard
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Lucas Jullian
- Department of Cardiothoracic Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - Mihika Joshi
- Department of Cardiology, Countess of Chester Hospital, Chester, UK
| | - Arish Noshirwani
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mohamad Bashir
- Department of Aortovascular Surgery, Manchester Royal Infirmary, Manchester, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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13
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Tarantini G, Nai Fovino L, D'Errigo P, Rosato S, Barbanti M, Tamburino C, Ranucci M, Santoro G, Badoni G, Seccareccia F. Factors influencing the choice between transcatheter and surgical treatment of severe aortic stenosis in patients younger than 80 years: Results from the OBSERVANT study. Catheter Cardiovasc Interv 2019; 95:E186-E195. [PMID: 31423704 DOI: 10.1002/ccd.28447] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/01/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We aimed to analyze the baseline features and clinical outcomes of patients younger than 80 years undergoing transfemoral transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) enrolled in the OBservational Study of Effectiveness of SAVR-TAVR procedures for severe Aortic steNosis Treatment (OBSERVANT) real-world study, focusing on variables guiding Heart Team decision toward TAVI. BACKGROUND Patients treated with TAVI, independently of surgical risk score, are mostly older than 80 years. METHODS OBSERVANT is a multicenter, observational, prospective cohort study that enrolled patients with symptomatic severe aortic stenosis (AS) who underwent SAVR or TAVI from December 2010 to June 2012 in 93 Italian participating hospitals. For this analysis, baseline characteristics, therapeutic approach and outcomes up to 5 years of follow-up of 4,801 patients under 80 years of age were collected. Patients were stratified by age classes (<65, 65-74, and 75-79 years). RESULTS Patients <80 years of age with severe symptomatic AS undergoing TAVI (n = 483) had significantly higher Logistic EuroSCORE (10.84% vs. 5.22%, p < .001) and prevalence of comorbidities compared to subjects undergoing SAVR (n = 4,318). The decision to perform TAVI over SAVR was driven by anatomical factors, mainly previous cardiac surgery (odds ratio [OR] 24.73, confidence interval [CI] 12.71-48.10, p < .001) and the presence of porcelain aorta (OR 17.44, CI 6.67-45.55, p < .001), and clinical factors, mainly moderate-severe frailty score (OR 5.49, CI 3.33-9.07, p < .001), oxygen dependency (OR 7.42, CI 2.75-20.04, p < .001) and need for dialytic treatment (OR 5.24, CI 1.54-17.80, p < .008). Among patients undergoing TAVI, those under 65 years had the highest baseline risk profile (despite a low Logistic EuroSCORE) and the highest 5-year mortality compared to those 65-74 and 75-79-year-old (65.22% vs. 48.54% vs. 55.24%, log-rank p = .061). CONCLUSION Among patients under 80 years of age with symptomatic severe AS, only 10% underwent TAVI. These patients were at higher baseline risk compared to those undergoing SAVR. The decision to perform TAVI was driven by the presence of both anatomical and clinical factors beyond surgical risk scores. Patients under 65 years of age, despite the low Logistic EuroSCORE, had the highest preoperative risk profile and carried the worse outcome.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | | | | | - Marco Barbanti
- Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Marco Ranucci
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy
| | - Gennaro Santoro
- Fondazione "G.Monasterio" CNR/Regione Toscana per la Ricerca Medica e la Sanità Pubblica, Florence, Italy
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14
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Chen JF, Mori M, Geirsson A. "Real-World" TAVR Data in Constant Flux. Mayo Clin Proc 2019; 94:1643. [PMID: 31378239 DOI: 10.1016/j.mayocp.2019.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/18/2019] [Indexed: 11/18/2022]
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15
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Tabata N, Sinning JM, Kaikita K, Tsujita K, Nickenig G, Werner N. Current status and future perspective of structural heart disease intervention. J Cardiol 2019; 74:1-12. [DOI: 10.1016/j.jjcc.2019.02.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
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16
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Five-Year Outcomes of Transfemoral Transcatheter Aortic Valve Replacement or Surgical Aortic Valve Replacement in a Real World Population. Circ Cardiovasc Interv 2019; 12:e007825. [DOI: 10.1161/circinterventions.119.007825] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The OBSERVANT study (Observational Study of Effectiveness of SAVR–TAVI Procedures for Severe Aortic Stenosis Treatment) showed that mortality at 1 year is similar after transfemoral transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) for real-world propensity-matched patients with aortic stenosis at low and intermediate risk. We report the 5-year outcomes of the Italian OBSERVANT study.
Methods and Results:
The unadjusted enrolled population (N=7618) between December 2010 and June 2012 included 5707 patients on SAVR and 1911 patients on TAVR. The propensity score method was applied to select 2 groups with similar baseline characteristics. All outcomes were adjudicated through a linkage with administrative databases. The primary end points of this analysis were death from any cause and major adverse cardiac and cerebrovascular events at 5 years. The matched population had a total of 1300 patients (650 per group). The propensity score method generated a low and intermediate-risk population (mean logistic EuroSCORE 2: 5.1±6.2% versus 4.9±5.1%, SAVR versus transfemoral TAVR;
P
=0.485). At 5 years, the rate of 5 death from any cause was 35.8% in the surgical group and 48.3% in the transcatheter group (hazard ratio, 1.38; 95% CI, 1.12–1.69;
P
=0.002). Similarly, TAVR was associated with an increased risk of major adverse cardiac and cerebrovascular events as compared with SAVR (42.5% versus 54.0%; hazard ratio, 1.35; 95% CI, 1.11–1.63;
P
=0.003). The cumulative incidence of cerebrovascular events, myocardial infarction, and coronary revascularization were similar in the study groups at 5 years.
Conclusions:
The present results suggest that at 5 years, in a real-world population with severe aortic stenosis and at low and intermediate risk, suggest that SAVR is associated in with lower mortality and major adverse cardiac and cerebrovascular events rates than transfemoral TAVR performed using first-generation devices. These data need to be confirmed in randomized trials using new-generation TAVR devices.
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17
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Kaier K, von Zur Mühlen C, Zirlik A, Bothe W, Hehn P, Zehender M, Bode C, Stachon P. Estimating the additional costs per life saved due to transcatheter aortic valve replacement: a secondary data analysis of electronic health records in Germany. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:625-632. [PMID: 30600467 DOI: 10.1007/s10198-018-1023-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/11/2018] [Indexed: 06/09/2023]
Abstract
Aortic stenosis (AS) is the most common valvular heart disease, with a dismal prognosis when untreated. Recommended therapy is surgical (SAVR) or transcatheter (TAVR) aortic valve replacement. Based on a retrospective cohort of isolated SAVR and TAVR procedures performed in Germany in 2015 (N = 17,826), we examine the impact of treatment selection on in-hospital mortality and total in-hospital costs for a variety of at-risk populations. Since patients were not randomized to the two treatment options, the two endpoints in-hospital mortality and reimbursement are analyzed using logistic and linear regression models with 20 predefined patient characteristics as potential confounders. Incremental cost-effectiveness ratios were calculated as a ratio of the risk-adjusted reimbursement and mortality differences with 95% confidence intervals obtained by Fieller's theorem. Our study shows that TF-TAVR is more costly that SAVR and that cost differences between the procedures vary little between patient groups. Results regarding in-hospital mortality are mixed. SAVR is the predominant procedure among younger patients. For patients older than 85 years or at intermediate and higher pre-operative risk TF-TAVR seems to be the treatment of choice. Incremental cost-effectiveness ratios (ICER) are most favorable for patients older than 85 years (ICER €154,839, 95% CI €89,163-€302,862), followed by patients at higher pre-operative risk (ICER €413,745, 95% CI €258,027-€952,273). A hypothetical shift from SAVR towards TF-TAVR among patients at intermediate pre-operative risk is associated with a less favorable ICER (€1,486,118, 95% CI €764,732-€23,692,323), as the risk-adjusted mortality benefit is relatively small (- 0.97% point), while the additional reimbursement is still eminent (+€14,464). From a German healthcare system payer's perspective, the additional costs per life saved due to TAVR are most favorable for patients older than 85 and/or at higher pre-operative risk.
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Affiliation(s)
- Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79104, Freiburg, Germany
| | - Constantin von Zur Mühlen
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79104, Freiburg, Germany
| | - Andreas Zirlik
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79104, Freiburg, Germany
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Wolfgang Bothe
- Department of Cardiac and Vascular Surgery, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philip Hehn
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Manfred Zehender
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79104, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79104, Freiburg, Germany
| | - Peter Stachon
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79104, Freiburg, Germany.
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18
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Tarantini G, Lefèvre T, Terkelsen CJ, Frerker C, Ohlmann P, Mojoli M, Eltchaninoff H, Pinaud F, Redwood S, Windecker S. One-Year Outcomes of a European Transcatheter Aortic Valve Implantation Cohort According to Surgical Risk. Circ Cardiovasc Interv 2019; 12:e006724. [DOI: 10.1161/circinterventions.118.006724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology, University of Padova, Italy (G.T., M.M.)
| | - Thierry Lefèvre
- Department of Interventional Cardiology, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France (T.L.)
| | | | - Christian Frerker
- Department of Interventional Vascular Therapy, Asklepios Klinik St Georg, Hamburg, Germany (C.F.)
| | - Patrick Ohlmann
- Department of Cardiovascular Surgery, Les Hôpitaux Universitaires de Strasbourg, France (P.O.)
| | - Marco Mojoli
- Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology, University of Padova, Italy (G.T., M.M.)
| | - Hélène Eltchaninoff
- Department of Cardiology, Hôpital Charles Nicolle, University of Rouen, France (H.E.)
| | - Frédéric Pinaud
- Department of Cardiovascular and Cardiothoracic Surgery, Angers University Hospital, France (F.P.)
| | - Simon Redwood
- Department of Cardiology, King’s Health Partners, London, United Kingdom (S.R.)
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center Bern, Switzerland (S.W.)
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19
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Indolfi C, Bartorelli AL, Berti S, Golino P, Esposito G, Musumeci G, Petronio S, Tamburino C, Tarantini G, Ussia G, Vassanelli C, Spaccarotella C, Violini R, Mercuro G, Romeo F. Updated clinical indications for transcatheter aortic valve implantation in patients with severe aortic stenosis: expert opinion of the Italian Society of Cardiology and GISE. J Cardiovasc Med (Hagerstown) 2018; 19:197-210. [PMID: 29578921 DOI: 10.2459/jcm.0000000000000636] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: The introduction of percutaneous treatment of severe aortic stenosis with transcatheter aortic valve implantation (TAVI) remains one of the greatest achievements of interventional cardiology. In fact, TAVI emerged as a better option than either medical therapy or balloon aortic valvuloplasty for patients who cannot undergo surgical aortic valve replacement (SAVR) or are at high surgical risk. Recently, increased operator experience and improved device systems have led to a worldwide trend toward the extension of TAVI to low-risk or intermediate-risk patients. In this expert opinion paper, we first discuss the basic pathophysiology of aortic stenosis in different settings then the key results of recent clinical investigations on TAVI in intermediate-risk aortic stenosis patients are summarized. Particular emphasis is placed on the results of the nordic aortic valve intervention, placement of aortic transcatheter valves (PARTNER) 2 and Surgical Replacement and Transcatheter Aortic Valve Implantation Randomized trials. The PARTNER 2 was the first large randomized trial that evaluated the outcome of TAVI in patients at intermediate risk. The PARTNER 2 data demonstrated that TAVI is a feasible and reasonable alternative to surgery in intermediate-risk patients (Society of Thoracic Surgeons 4-8%), especially if they are elderly or frail. There was a significant interaction between TAVI approach and mortality, with transfemoral TAVI showing superiority over SAVR. Moreover, we examine the complementary results of the recently concluded Surgical Replacement and Transcatheter Aortic Valve Implantation trial. This prospective randomized trial demonstrated that TAVI is comparable with surgery (primary end point 12.6% in the TAVI group vs. 14.0% in the SAVR group) in severe aortic stenosis patients deemed to be at intermediate risk. We review the most relevant clinical evidence deriving from nonrandomized studies and meta-analyses. Altogether, clinical outcome available data suggest that TAVI with a newer generation device might be the preferred treatment option in this patient subgroup. Finally, the differences between the latest European and American Guidelines on TAVI were reported and discussed. The conclusion of this expert opinion article is that TAVI, if feasible, is the treatment of choice in patients with prohibitive or high surgical risk and may lead to similar or lower early and midterm mortality rates compared with SAVR in intermediate-risk patients with severe aortic stenosis.
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Affiliation(s)
- Ciro Indolfi
- Cattedra di Cardiologia, Università degli Studi Magna Graecia, Catanzaro, Italy
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20
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Schymik G, Herzberger V, Bergmann J, Bramlage P, Conzelmann LO, Würth A, Luik A, Schröfel H, Tzamalis P. Evolution of transcatheter aortic valve implantation over 7 years: results of a prospective single-centre registry of 2000 patients in a large municipal hospital (TAVIK Registry). BMJ Open 2018; 8:e022574. [PMID: 30366914 PMCID: PMC6224754 DOI: 10.1136/bmjopen-2018-022574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Use of transcatheter aortic valve implantation (TAVI) to treat severe aortic stenosis (AS) has gained popularity, accompanied by an evolution of patient and clinical factors. We aimed to characterise changes and evaluate their impact on outcomes. SETTING In this single-centre, German TAVIK registry patients undergoing TAVI between 2008 and 2015 were documented prospectively. PARTICIPANTS/INTERVENTIONS 2000 consecutive patients with AS undergoing TAVI were divided in four cohorts. 500 patients underwent TAVI in each of the following time bins: April 2008 to July 2010 (cohort I), July 2010 to April 2013 (cohort II), April 2012 to October 2013 (cohort III) and October 2013 to March 2015 (cohort IV). RESULTS The mean age was 81.8 years, without significant variation across cohorts. Compared with cohort I, prior MI (5.4%vs11.0%; p<0.001) and New York Heart Association class IV (10.0%vs3.6%; p<0.001) were less common in cohort IV. Across cohorts, there was a fall in EuroSCORE (24.3%-18.7%), frailty (48.4%-17.0%) and use of transapical access (43.6%-29.0%), while transfemoral access increased (56.4%-71.0%; p<0.001 for each). Periprocedurally, there was a fall in moderate/severe aortic regurgitation (3.2%-0.0%) and rate of unplanned cardiopulmonary bypass (4.0%-1.0%; both p<0.001). A similar trend applied to 30-day rate of major vascular complications (5.2%-1.8%; p=0.006), life-threatening bleeding (7.0%-3.0%; p<0.001) and cardiovascular mortality (4.4%-1.8%; p=0.020). One-year post-TAVI, mortality and stroke rates did not differ. CONCLUSIONS Evolution of TAVI between 2008 and 2015 saw a trend towards its usage in lower risk patients and rapid progression towards improved safety. Evaluation and refinement should now continue to further lessen stroke and pacemaker rates.
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Affiliation(s)
- Gerhard Schymik
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Valentin Herzberger
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Jens Bergmann
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | | | - Alexander Würth
- Department of Cardiology, Medical Clinic III, Vicentius Hospital Karlsruhe, Karlsruhe, Germany
| | - Armin Luik
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Holger Schröfel
- Department Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Panagiotis Tzamalis
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
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Serruys PW, Modolo R, Reardon M, Miyazaki Y, Windecker S, Popma J, Chang Y, Kleiman NS, Lilly S, Amrane H, Boonstra PW, Kappetein AP, Onuma Y, Søndergaard L, van Mieghem N. One-year outcomes of patients with severe aortic stenosis and an STS PROM of less than three percent in the SURTAVI trial. EUROINTERVENTION 2018; 14:877-883. [DOI: 10.4244/eij-d-18-00460] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Transcatheter aortic valve implantation in patients younger than 75 years: Guidelines-based patients selection and clinical outcome. Int J Cardiol 2018; 272:273-278. [PMID: 30104032 DOI: 10.1016/j.ijcard.2018.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/11/2018] [Accepted: 08/08/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients treated by transcatheter aortic valve implantation (TAVI) in all major recent trials are still mostly octogenarians. Aim of this study is to analyze the risk profile and outcome of TAVI patients <75 years. METHODS AND RESULTS We retrospectively analyzed 172 patients <75 years with symptomatic severe native AS or degeneration of surgical aortic bioprosthesis treated with TAVI. The level of surgical risk was reassessed according to multiparametric ACC classification (prohibitive in 68 patients, high in 34, intermediate in 70). Mean age was 69.02 ± 6.18 years, mean STS score 5.56 ± 5.21. The majority of them presented one or more clinical or anatomical characteristics favoring TAVI according to ECS guidelines, despite the young age. Vascular access was transfemoral in 76%. According to the VARC-2 definitions, device success was high (90%) in all groups. The early safety was 89%, clinical recovery was slower in prohibitive risk patients. Bleeding events were more frequent in prohibitive and high surgical risk classes. Clinical efficacy at 1 year was overall 83%, and significantly better in intermediate risk patients (p = 0.004). The functional status remained stable over time as well as prostheses performance. CONCLUSION About 40% of patients <75 years were treated by TAVI due to the presence of a prohibitive risk, mainly related to technical impediments. The remaining was referred to TAVI due to an estimated high or intermediate surgical risk driven by STS score, frailty and/or major organ system compromise. Early and mid-term clinical and hemodynamic outcomes were good, in particular in intermediate risk patients.
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Thiagarajan K, Jeevanantham V, Van Ham R, Gleason TG, Badhwar V, Chang Y, Thirumala PD. Perioperative Stroke and Mortality After Surgical Aortic Valve Replacement: A Meta-Analysis. Neurologist 2018; 22:227-233. [PMID: 29095324 DOI: 10.1097/nrl.0000000000000151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Perioperative stroke rate after surgical aortic valve replacement (SAVR) varies between 1.3% and 6.2%, whereas the operative mortality ranges between 1% and 16.4%. The aim of this study was to determine whether perioperative stroke is a risk factor for operative mortality after SAVR by performing a meta-analysis of relevant studies. MATERIALS AND METHODS PubMed, EMBASE, and Web of Science databases were searched to retrieve relevant literature. Screening of the articles was done independently on the basis of predetermined criteria. Data from the relevant studies were extracted and a random effects model was used to calculate the odds of mortality among patients with perioperative strokes after aortic valve replacement compared with those without such strokes. Subgroup analyses of patients (1) aged above and below 70 years and (2) undergoing isolated valve replacement procedure were performed. Metaregression to check for association of effect estimate and (1) sex, (2) mechanical valve replacement, (3) New York Heart Association class III/IV, (4) left ventricle ejection fraction <30%, and (5) preoperative atrial fibrillation was performed. RESULTS Statistical analyses using a random effects model showed that patients with perioperative strokes had 4.74 times greater odds for operative mortality after SAVR, independent of the following covariates: (1) sex, (2) mechanical valve replacement, (3) New York Heart Association class III/IV, (4) left ventricle ejection fraction <30%, and (5) preoperative atrial fibrillation. CONCLUSIONS Patients with perioperative strokes after SAVR have nearly 5 times greater odds of experiencing operative mortality compared with those without. Thus, perioperative strokes are associated with increased risk of early mortality and require further examination of preventive strategies.
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Affiliation(s)
- Karthy Thiagarajan
- Departments of *Neurological Surgery §Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh Medical Center ‡University of Pittsburgh School of Medicine, Pittsburgh, PA †Saint Anthony Hospital, Oklahoma City, OK ∥Division of Cardiothoracic Surgery, West Virginia University, Morgantown, WV
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Schymik G, Varsami C, Bramlage P, Conzelmann LO, Würth A, Luik A, Schröfel H, Tzamalis P. Two-Year Outcomes of Transcatheter Compared With Surgical Aortic Valve Replacement in "Minimal-Risk" Patients Lacking EuroSCORE Co-morbidities (from the TAVIK Registry). Am J Cardiol 2018; 122:149-155. [PMID: 29861048 DOI: 10.1016/j.amjcard.2018.02.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/16/2018] [Accepted: 02/26/2018] [Indexed: 12/20/2022]
Abstract
We aimed to compare the outcomes of transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) in an elderly but nonfrail, minimally co-morbid population. Although data comparing these 2 procedures in intermediate- and low-risk patients are mounting, no distinction has been made between co-morbidity and age/gender as driving forces for surgical risk. Patients undergoing isolated TAVI or SAVR between May 2008 and March 2015 were documented. Data for 225 patients (TAVI 132, SAVR 93) aged ≥75 and <86 years and fulfilling minimal-risk criteria were analyzed. Patients who underwent TAVI were older (80.7 vs 77.4 years, p <0.0001) and had a higher mean Society of Thoracic Surgeons score (2.16% vs 1.72%, p <0.0001). Mild prosthetic valve regurgitation (odds ratio [OR] 4.9, 95% confidence interval [CI] 3.34 to 7.20) was more likely after TAVI, as were renal complications (predominantly stage I acute kidney injury; OR 2.86, 95% CI 1.79 to 4.55) and new pacemaker implantation (OR 3.33, 95% CI 1.76 to 6.26) at 30 days; however, life-threatening bleeding (OR 0.58, 95% CI 0.36 to 0.93) and reintervention for bleeding (OR 0.03, 95% CI 0.01 to 0.13) were less likely. Survival was comparable between groups at 30 days (99.2% vs 100%, p = 1.0) and 1 year (96.2% vs 96.8%, OR 0.85, 95% CI 0.20 to 3.63, p = 0.823), but it was poorer for patients who underwent TAVI at 2 years (OR 0.31, 95% CI 0.16 to 0.61). In conclusion, the short-term outcomes of TAVI in elderly, low-risk, minimally co-morbid patients appear to be similar to those of SAVR, with access-specific complications. Although these results point toward the potential for more liberal use of TAVI in minimal-risk patients, poorer midterm survival remains a concern, requiring further exploration.
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Barbanti M, Buccheri S, Capodanno D, D'Errigo P, Ranucci M, Rosato S, Santoro G, Fusco D, Tamburino C, Biancari F, Seccareccia F. Transcatheter or surgical treatment of severe aortic stenosis and coronary artery disease: A comparative analysis from the Italian OBSERVANT study. Int J Cardiol 2018; 270:102-106. [PMID: 29903519 DOI: 10.1016/j.ijcard.2018.06.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/14/2018] [Accepted: 06/04/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND To assess clinical outcomes of patients with concomitant severe aortic stenosis (AS) and coronary artery disease (CAD) who underwent transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) or surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG). METHODS Data were extracted from the multicenter OBSERVANT study. For the purposes of the present analysis, we included only patients with established stable CAD meeting any of the following inclusion criteria: 1) TAVI patients with CAD undergoing staged PCI or TAVI and PCI in the same session; 2) SAVR patients undergoing combined SAVR and CABG in the same session. RESULTS After propensity-score matching, a total of 472 patients (236 per group) were identified. Among TAVI patients, PCI was performed prior to the procedure in 217 patients (92.0%), whereas concomitant TAVI and PCI were performed in 19 patients (8.0%). At 3-year, there was no difference in survival between the two groups (KM estimate of freedom from death for SAVR and TAVI patients of 0.742 and 0.650, respectively; log-rank p-value of 0.105). The rate of MACCE was comparable between the two groups (KM estimate of freedom from MACCE for SAVR and TAVI patients of 0.683 and 0.582, respectively; log-rank p-value of 0.115). CONCLUSIONS In patients with associated severe AS and CAD, percutaneous treatment (TAVR and staged or concomitant PCI) was comparable to surgical treatment (SAVR and concomitant CABG) with respect to the early and mid-term risk of death from any cause, myocardial infarction, stroke and unplanned revascularization.
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Affiliation(s)
- Marco Barbanti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy.
| | - Sergio Buccheri
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy
| | - Paola D'Errigo
- National Centre for Global Health - Istituto Superiore di Sanità, Rome, Italy
| | - Marco Ranucci
- Department of Cardiothoracic and Vascular Anesthesia and ICU - IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Stefano Rosato
- National Centre for Global Health - Istituto Superiore di Sanità, Rome, Italy
| | | | - Danilo Fusco
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy
| | - Fausto Biancari
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Fulvia Seccareccia
- National Centre for Global Health - Istituto Superiore di Sanità, Rome, Italy
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Alatawi FO, Abuelatta RA, AlAhmedi AB, Alharbi IH, Alghamdi SS, Sakrana AA, Alamodi OA, Naeim HA. Clinical outcomes with transcatheter aortic valve implantation at a single cardiac center in Saudi Arabia. Ann Saudi Med 2018; 38:167-173. [PMID: 29848933 PMCID: PMC6074303 DOI: 10.5144/0256-4947.2018.167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has been recognized as a valid alternative to surgery for severe aortic valve stenosis (AS) in high-risk surgical patients. OBJECTIVE Determine first-year clinical outcomes for TAVI at Madinah Cardiac Center (MMC) in Saudi Arabia. DESIGN Retrospective, analytical cross-sectional. SETTING Tertiary cardiac care center. PATIENTS AND METHODS All patients who underwent TAVI for severe AS between February 2013 and December 2016 were included. Clinical, imaging, and laboratory information at baseline and at one year follow-up were analyzed. MAIN OUTCOME MEASURES Clinical and echocardiography out.comes at discharge, at 1-month, and at end of follow-up; one-year mortality, complications and clinical response to TAVI procedure. SAMPLE SIZE AND CHARACTERISTICS N=80, mean (SD) age 79.5 (10.6) years, with severe AS and high-surgical risk. RESULTS Fifty-five (69.2%) patients received Core valves, and 25 (30.8%) received Edward valves. Peri-procedure mortality was 3.8% and 1-year post-operative mortality was 13.8%. Ten patients (12.5%) had life-threatening or major bleeding. Nineteen (23.8%) patients had vascular complications, which were mostly minor. Fourteen patients (17.5%) developed acute kidney injury and 86% of these patients recovered. Five patients (6.25%) had pericardial effusion. Two patients (2.5%) developed endocarditis and another 2 patients (2.5%) had cerebrovascular accidents. Five patients (6.25%) received pacemakers. Mean aortic valve gradient significantly reduced from a mean (SD) 47.6 (19) mm Hg to 10.7 (6.0) mm Hg (P less than .001). New York Heart Association functional class was significantly reduced (P less than .001). CONCLUSION The TAVI experience at MCC is encouraging and comparable to international outcomes in terms of success, morbidity, and mortality rate. LIMITATIONS Retrospective, relatively small sample size. Rate of minor bleeding was overestimated. CONFLICT OF INTEREST None.
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Affiliation(s)
- Faisal Owdah Alatawi
- Dr. Faisal Owdah Alatawi, Department of Medicine, Taibah University, PO Box 30001, Madinah, Saudi Arabia, T: + 966.562-579286, faisalawdahalatawi@ hotmail.com, ORCID: http://orcid. org/0000-0003-1022-9688
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Singh K, Carson K, Rashid MK, Jayasinghe R, AlQahtani A, Dick A, Glover C, Labinaz M. Transcatheter Aortic Valve Implantation in Intermediate Surgical Risk Patients With Severe Aortic Stenosis: A Systematic Review and Meta-Analysis. Heart Lung Circ 2018; 27:227-234. [DOI: 10.1016/j.hlc.2017.02.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 11/15/2016] [Accepted: 02/28/2017] [Indexed: 11/27/2022]
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Clinical trials in valvular surgery: a 2018 update. Curr Opin Cardiol 2017; 33:178-183. [PMID: 29232249 DOI: 10.1097/hco.0000000000000495] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW There is a growing emphasis on the conduct of large-scale, multicenter randomized controlled trials (RCTs) to guide decision-making in cardiac surgery. Here we review recent landmark RCTs in cardiac valvular surgery. RECENT FINDINGS RCTs are the gold-standard level of data in medicine. However, there are unique challenges of conducting large-scale surgical trials including funding, blinding, generalizability, nonstandardization of the surgical technique, crossover, among others. Thus, the vast majority of clinical outcomes data in cardiac surgery are mainly from observational studies and most prospective data are small, single-center trials. The Cardiothoracic Surgery Network is the largest platform focused on the conduct of high-quality, multicenter cardiac surgical trials, which has already produced several seminal guideline-changing and practice-changing contributions to the surgical approach to functional mitral regurgitation, aortic stenosis, atrial fibrillation, and neuroprotective surgical adjuncts. SUMMARY There continues to be great interest in the conduct of high-quality, RCTs to help guide surgical management of patients with valvular heart disease.
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Søndergaard L, Steinbrüchel DA, Ihlemann N, Nissen H, Kjeldsen BJ, Petursson P, Ngo AT, Olsen NT, Chang Y, Franzen OW, Engstrøm T, Clemmensen P, Olsen PS, Thyregod HGH. Two-Year Outcomes in Patients With Severe Aortic Valve Stenosis Randomized to Transcatheter Versus Surgical Aortic Valve Replacement: The All-Comers Nordic Aortic Valve Intervention Randomized Clinical Trial. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003665. [PMID: 27296202 DOI: 10.1161/circinterventions.115.003665] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 04/27/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Nordic Aortic Valve Intervention (NOTION) trial was the first to randomize all-comers with severe native aortic valve stenosis to either transcatheter aortic valve replacement (TAVR) with the CoreValve self-expanding bioprosthesis or surgical aortic valve replacement (SAVR), including a lower-risk patient population than previous trials. This article reports 2-year clinical and echocardiographic outcomes from the NOTION trial. METHODS AND RESULTS Two-hundred eighty patients from 3 centers in Denmark and Sweden were randomized to either TAVR (n=145) or SAVR (n=135) with follow-up planned for 5 years. There was no difference in all-cause mortality at 2 years between TAVR and SAVR (8.0% versus 9.8%, respectively; P=0.54) or cardiovascular mortality (6.5% versus 9.1%; P=0.40). The composite outcome of all-cause mortality, stroke, or myocardial infarction was also similar (15.8% versus 18.8%, P=0.43). Forward-flow hemodynamics were improved following both procedures, with effective orifice area significantly more improved after TAVR than SAVR (effective orifice area, 1.7 versus 1.4 cm(2) at 3 months). Mean valve gradients were similar after TAVR and SAVR. When patients were categorized according to Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) (<4% versus ≥4%), there was no statistically significant difference for TAVR and SAVR groups in the composite outcome for low-risk (14.7%, 95% confidence interval, 8.3-21.2 versus 16.8%; 95% confidence interval, 9.7-23.8; P=0.58) or intermediate-risk patients (21.1% versus 27.1%; P=0.59). CONCLUSIONS Two-year results from the NOTION trial demonstrate the continuing safety and effectiveness of TAVR in lower-risk patients. Longer-term data are needed to verify the durability of this procedure in this patient population. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01057173.
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Affiliation(s)
- Lars Søndergaard
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.).
| | - Daniel Andreas Steinbrüchel
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Nikolaj Ihlemann
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Henrik Nissen
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Bo Juel Kjeldsen
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Petur Petursson
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Anh Thuc Ngo
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Niels Thue Olsen
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Yanping Chang
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Olaf Walter Franzen
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Thomas Engstrøm
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Peter Clemmensen
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Peter Skov Olsen
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Hans Gustav Hørsted Thyregod
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
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Mendez-Bailon M, Lorenzo-Villalba N, Muñoz-Rivas N, de Miguel-Yanes JM, De Miguel-Diez J, Comín-Colet J, Hernandez-Barrera V, Jimenez-Garcia R, Lopez-de-Andres A. Transcatheter aortic valve implantation and surgical aortic valve replacement among hospitalized patients with and without type 2 diabetes mellitus in Spain (2014-2015). Cardiovasc Diabetol 2017; 16:144. [PMID: 29121921 PMCID: PMC5679322 DOI: 10.1186/s12933-017-0631-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/02/2017] [Indexed: 11/23/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is strongly related to the in-hospital and short-term prognosis in patients with cardiovascular diseases needing surgical or invasive interventions. How T2DM might influence the treatment of aortic stenosis (AS) has not been completely elucidated for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). The aims of this study were: (1) to describe the use of aortic valve replacement procedures (TAVI and SAVR) among hospitalized patients with and without T2DM; and (2) to identify factors associated with in hospital mortality (IHM) among patients undergoing these procedures. Methods We analyzed data from the Spanish National Hospital Discharge Database between January 1, 2014 and December 31, 2015 for patients aged ≥ 40 years. We selected patients whose medical procedures included TAVI (ICD-9-CM codes 35.05, 35.06) and SAVR (ICD-9-CM codes 35.21, 35.22). We stratified each cohort by diabetes status: T2DM (ICD-9-CM codes 250.x0, 250.x2) and no diabetes. We retrieved data about specific comorbidities, risk factors, procedures, and specific in-hospital postoperative complications. Hospital outcome variables included IHM, and length of hospital stay (LOHS). Results We identified a total of 2141 and 16,013 patients who underwent TAVI (n = 715; 33.39% with T2DM) and SAVR (n = 4057; 25.33% with T2DM). In patients who underwent TAVI we found no differences in IHM (3.64% in T2DM vs. 5.12% in non-T2DM, p = 0.603). In the cohort of SAVR, mean LOHS was significantly lower in patients with T2DM than in non-diabetic patients (13.77 vs. 17.27 days). IHM was lower in patients with T2DM (4.36% vs. 6.31%, p < 0.01). After multivariable adjustment for both procedures, patients with T2DM had significantly lower IHM than patients without diabetes (adjusted OR 0.60; IC 95% 0.37–0.99 for TAVI and adjusted OR 0.80; IC 95% 0.66-0-96 for SAVR). Conclusions T2DM diabetic patients with AS undergoing a valvular replacement procedure through SAVR or TAVI did not have a worse prognosis compared to non-diabetic patients during hospitalization, showing lower IHM after multivariable adjustment. However, given the limitations of administrative data more prospective studies and clinical trials aimed at evaluating the influence of these procedures in diabetic patients with AS are needed. Electronic supplementary material The online version of this article (10.1186/s12933-017-0631-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Manuel Mendez-Bailon
- Internal Medicine Department, Instituto de Investigación Cardiovascular, Hospital Clínico San Carlos, Complutense University, Madrid, Spain
| | - Noel Lorenzo-Villalba
- Service de Médicine Interne et Cancerlogie, Centre Hospitalier Saint Cyr, Lyon, France
| | - Nuria Muñoz-Rivas
- Internal Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Javier De Miguel-Diez
- Pneumology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Josep Comín-Colet
- Department of Cardiology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Valentin Hernandez-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcón, Madrid, Spain.
| | - Ana Lopez-de-Andres
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcón, Madrid, Spain
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Young MN, Inglessis I. Transcatheter Aortic Valve Replacement: Outcomes, Indications, Complications, and Innovations. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:81. [DOI: 10.1007/s11936-017-0580-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Barker CM, Reardon MJ. Should TAVR Replace Surgery for Aortic Stenosis in Low- to Intermediate-Risk Patients? Can J Cardiol 2017; 33:1124-1128. [DOI: 10.1016/j.cjca.2017.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/23/2017] [Accepted: 06/23/2017] [Indexed: 11/16/2022] Open
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Abstract
Heart failure (HF) remains the leading cause of hospitalization in older adults and is associated with increased morbidity and mortality despite the use of guideline-directed medical therapy. There has been tremendous progress in the development of novel transcatheter and interventional therapies for HF over the past decade. The evolution of structural heart disease interventions and interventional HF has led to a multidisciplinary heart team approach in the management of HF patients. Careful selection of the appropriate patient population and end points in future randomized controlled trials will be crucial to demonstrate the potential efficacy of the novel interventional HF therapies.
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Affiliation(s)
- Dhaval Kolte
- Division of Cardiovascular Medicine, Brown University, 593 Eddy Street, Providence, RI 02903, USA
| | - Jinnette Dawn Abbott
- Division of Cardiovascular Medicine, Brown University, 593 Eddy Street, Providence, RI 02903, USA
| | - Herbert D Aronow
- Division of Cardiovascular Medicine, The Warren Alpert Medical School of Brown University, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA.
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Elmaraezy A, Ismail A, Abushouk AI, Eltoomy M, Saad S, Negida A, Abdelaty OM, Abdallah AR, Aboelfotoh AM, Hassan HM, Elmaraezy AG, Morsi M, Althaher F, Althaher M, AlSafadi AM. Efficacy and safety of transcatheter aortic valve replacement in aortic stenosis patients at low to moderate surgical risk: a comprehensive meta-analysis. BMC Cardiovasc Disord 2017; 17:234. [PMID: 28836953 PMCID: PMC5571502 DOI: 10.1186/s12872-017-0668-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 08/17/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Recently, transcatheter aortic valve replacement (TAVR) has become the procedure of choice in high surgical risk patients with aortic stenosis (AS). However, its value is still debated in operable AS cases. We performed this meta-analysis to compare the safety and efficacy of TAVR to surgical aortic valve replacement (SAVR) in low-to-moderate surgical risk patients with AS. METHODS A systematic search of five authentic databases retrieved 11 eligible studies (20,056 patients). Relevant Data were pooled as risk ratios (RRs) or standardized mean differences (SMD), with their 95% confidence interval, using Comprehensive Meta-Analysis and RevMan software for windows. RESULTS At one-year of follow-up, the pooled effect-estimates showed no significant difference between TAVR and SAVR groups in terms of all-cause mortality (RR 1.02, 95% CI [0.83, 1.26], stroke (RR 0.83, 95%CI [0.56, 1.21]), myocardial infarction (RR 0.82, 95% CI [0.57, 1.19]), and length of hospital stay (SMD -0.04, 95% CI [-0.34, 0.26]). The incidence of major bleeding (RR 0.45, 95% CI [0.24, 0.86]) and acute kidney injury (RR 0.52, 95% CI [0.30, 0.88]) was significantly lower in the TAVR group, compared to the SAVR group. However, TAVR was associated with a higher risk of permanent pacemaker implantation (RR 2.57, 95% CI [1.36, 4.86]), vascular-access complications at 1 year (RR 1.99, 95%CI [1.04, 3.80]), and paravalvular aortic regurgitation at 30 days (RR 3.90, 95% CI [1.25, 12.12]), compared to SAVR. CONCLUSIONS Due to the comparable mortality rates in SAVR and TAVR groups and the lower risk of life-threatening complications in the TAVR group, TAVR can be an acceptable alternative to SAVR in low-to-moderate risk patients with AS. However, larger trials with longer follow-up periods are required to compare the long-term outcomes of both techniques.
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Affiliation(s)
- Ahmed Elmaraezy
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- NovaMed Medical Research Association, Cairo, Egypt
| | - Ammar Ismail
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- NovaMed Medical Research Association, Cairo, Egypt
| | | | - Moutaz Eltoomy
- Genetic Engineering & Biotechnology Research Institute (GEBRI), University of Sadat City, Sadat City, Egypt
| | - Soha Saad
- Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Negida
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | | | | | | | | | - Mahmoud Morsi
- Faculty of Medicine, Minoufia University, Shebin El-Kom, Egypt
| | - Farah Althaher
- Faculty of Medicine, Misr University for science and technology (MUST), 6th of October City, Giza, Egypt
| | - Moath Althaher
- Faculty of Medicine, Misr University for science and technology (MUST), 6th of October City, Giza, Egypt
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Tarantini G, Nai Fovino L, Gersh BJ. Transcatheter aortic valve implantation in lower-risk patients: what is the perspective? Eur Heart J 2017; 39:658-666. [DOI: 10.1093/eurheartj/ehx489] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/02/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, Padova University Hospital, Via Giustiniani 2, 35128 Padova, Italy
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic and Vascular Science, Padova University Hospital, Via Giustiniani 2, 35128 Padova, Italy
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Levi A, Landes U, Assali AR, Orvin K, Sharony R, Vaknin-Assa H, Hamdan A, Shapira Y, Schwartzenberg S, Codner P, Shaul AA, Vaturi M, Gutstein A, Sagie A, Kornowski R. Long-Term Outcomes of 560 Consecutive Patients Treated With Transcatheter Aortic Valve Implantation and Propensity Score-Matched Analysis of Early- Versus New-Generation Valves. Am J Cardiol 2017; 119:1821-1831. [PMID: 28388992 DOI: 10.1016/j.amjcard.2017.02.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/22/2017] [Accepted: 02/22/2017] [Indexed: 12/30/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis in patients at high or prohibitive surgical risk. Nevertheless, long-term clinical and echocardiographic data are still lacking. We carried out an analysis of 560 consecutive patients who underwent TAVI at our institution from 2008 to 2016 to evaluate temporal changes in TAVI characteristics, predictors of 1-year and long-term outcomes, and to compare the performance of the early- and new-generation valve systems. With time, we have adopted lower risk threshold for patient selection and have been using conscious sedation and transfemoral access preferentially (p <0.001 for all). The incidence of greater than mild PVL decreased from 16% to 7.6%, p = 0.029. Within 5 years, 47% of the patients died, the majority (78%) due to noncardiac causes. Independent predictors of 1-year death included periprocedural aspects (i.e., vascular complications, stroke, and PVL), whereas death occurring later than 1 year was solely related to baseline co-morbidities. Transvalvular gradients and residual regurgitation remained nonclinically significant for up to 5 years of follow-up. New-generation valves were associated with less PVL compared with propensity score-matched early-generation valves (p <0.001). In conclusion, TAVI utilization at our institution has progressed to include lower risk patients with transfemoral access becoming applicable in the great majority. Poor long-term survival is attributable to population factors rather than to procedural factors. Intermediate- and long-term hemodynamics are excellent. PVL has diminished significantly with the new-generation valves. Efforts to improve long- and short-term outcomes remain a therapeutic challenge.
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Affiliation(s)
- Amos Levi
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Landes
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abid R Assali
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Katia Orvin
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ram Sharony
- "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiothoracic Surgery, "Rabin Medical Center," Petah Tikva, Israel
| | - Hanna Vaknin-Assa
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ashraf Hamdan
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Shapira
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Schwartzenberg
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pablo Codner
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; Department of Cardiothoracic Surgery, "Rabin Medical Center," Petah Tikva, Israel
| | - Aviv A Shaul
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Vaturi
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Gutstein
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Sagie
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Ak A, Porokhovnikov I, Kuethe F, Schulze PC, Noutsias M, Schlattmann P. Transcatheter vs. surgical aortic valve replacement and medical treatment : Systematic review and meta-analysis of randomized and non-randomized trials. Herz 2017; 43:325-337. [PMID: 28451702 DOI: 10.1007/s00059-017-4562-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has emerged as the procedure of choice for patients with severe aortic stenosis (AS) and high perioperative risk. We performed a meta-analysis to compare the mortality related to TAVR with medical therapy (MT) and surgical aortic valve replacement (SAVR). METHODS A systematic literature search was conducted by two independent investigators from the database inception to 30 December 2014. Relative risk (RR) and odds ratio (OR) were calculated and graphically displayed in forest plots. We used I 2 for heterogeneity (meta-regression) and Egger's regression test of asymmetry (funnel plots). RESULTS We included 24 studies (n = 19 observational studies; n = 5 randomized controlled trials), with a total of 7356 patients in this meta-analysis. Mean age had a substantial negative impact on the long-term survival of AS patients (OR = 1.544; 95% CI: 1.25-1.90). Compared with MT, TAVR showed a statistically significant benefit for all-cause mortality at 12 months (OR = 0.68; 95% CI: 0.49-0.95). Both TAVR and SAVR were associated with better outcomes compared with MT. TAVR showed lower all-cause mortality over SAVR at 12 months (OR = 0.81; 95% CI: 0.68-0.97). The comparison between SAVR and TAVR at 2 years revealed no significant difference (OR = 1.09; 95% CI: 1.01-1.17). CONCLUSION In AS, both TAVR and SAVR provide a superior prognosis to MT and, therefore, MT is not the preferred treatment option for AS. Furthermore, our data show that TAVR is associated with lower mortality at 12 months compared with SAVR. Further studies are warranted to compare the long-term outcome of TAVR versus SAVR beyond a 2-year follow-up period.
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Affiliation(s)
- A Ak
- Institute of Medical Statistics, Informatics and Documentation (IMSID), Friedrich-Schiller University and University Hospital Jena, Bachstraße 18, 07743, Jena, Germany
| | - I Porokhovnikov
- Institute of Medical Statistics, Informatics and Documentation (IMSID), Friedrich-Schiller University and University Hospital Jena, Bachstraße 18, 07743, Jena, Germany
| | - F Kuethe
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - P C Schulze
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - M Noutsias
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - P Schlattmann
- Institute of Medical Statistics, Informatics and Documentation (IMSID), Friedrich-Schiller University and University Hospital Jena, Bachstraße 18, 07743, Jena, Germany.
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Sardar P, Kundu A, Chatterjee S, Feldman DN, Owan T, Kakouros N, Nairooz R, Pape LA, Feldman T, Dawn Abbott J, Elmariah S. Transcatheter versus surgical aortic valve replacement in intermediate-risk patients: Evidence from a meta-analysis. Catheter Cardiovasc Interv 2017; 90:504-515. [DOI: 10.1002/ccd.27041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/26/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Partha Sardar
- Division of Cardiovascular Medicine; University of Utah; Salt Lake City Utah
| | - Amartya Kundu
- Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
| | - Saurav Chatterjee
- Division of Cardiology; Temple University School of Medicine; Philadelphia Pennsylvania
| | - Dmitriy N. Feldman
- Division of Cardiology; Weill Cornell Medical College, New York Presbyterian Hospital; New York New York
| | - Theophilus Owan
- Division of Cardiovascular Medicine; University of Utah; Salt Lake City Utah
| | - Nikolaos Kakouros
- Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
| | - Ramez Nairooz
- University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Linda A. Pape
- Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
| | - Ted Feldman
- Department of Medicine; Division of Cardiology, Evanston Hospital; Evanston Illinois
| | - J. Dawn Abbott
- Division of Cardiology; Brown Medical School, Rhode Island Hospital; Providence Rhode Island
| | - Sammy Elmariah
- Cardiology Division; Department of Medicine, Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts
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Landes U, Barsheshet A, Finkelstein A, Guetta V, Assali A, Halkin A, Vaknin‐Assa H, Segev A, Bental T, Ben‐Shoshan J, Barbash IM, Kornowski R. Temporal trends in transcatheter aortic valve implantation, 2008-2014: patient characteristics, procedural issues, and clinical outcome. Clin Cardiol 2017; 40:82-88. [PMID: 27783882 PMCID: PMC6490360 DOI: 10.1002/clc.22632] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND About a decade past the first transcatheter aortic valve implantation (TAVI), data are limited regarding temporal trends accompanying its evolution from novel technology to mainstream therapy. We evaluated these trends in a large multicenter TAVI registry. HYPOTHESIS TAVI is changing and improving with time. METHODS Patients who underwent TAVI between January 2008 and December 2014 at 3 high-volume Israeli centers were divided into 5 time quintiles according to procedure date. Outcomes were analyzed and reported according to Valve Academic Research Consortium-2. RESULTS A total of 1285 patients were studied (43% male; mean age, 83 ± 3 years; mean Society of Thoracic Surgeons [STS] score, 5.5 ± 3.6). Over time, there was a shift toward treating patients at lower STS score, increased use of conscious sedation and transfemoral approach, and decreased use of balloon predilatation. The balloon-expandable to self-expandable valve utilization ratio decreased, the valve-in-valve experience increased from 4% to 17% of all TAVI volume, and length of hospital stay was halved (P = 0.006). Kaplan-Meier survival curves showed gradual decrease in mortality risk (P = 0.031), but there was no significant 1-year mortality decrease by multivariable analysis. Each year increment was associated with an adjusted 20%, 15%, and 12% decrease in new pacemaker obligation (P = 0.004), new pacemaker obligation or left bundle branch block (P = 0.008), and in-hospital infections (P = 0.082), respectively. CONCLUSIONS Temporal trends accompanying TAVI evolution include its utilization in lower-risk patients, procedural simplification, improved overall survival, decreased pacemaker obligation, and shorter hospital stay.
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Affiliation(s)
- Uri Landes
- Department of Cardiology, Beilinson HospitalRabin Medical CenterPetah TikvaIsrael
| | - Alon Barsheshet
- Department of Cardiology, Beilinson HospitalRabin Medical CenterPetah TikvaIsrael
| | | | - Victor Guetta
- Leviev Heart Center, Sheba Medical CenterRamat GanIsrael
- Sackler Faculty of Medicine, Tel Aviv UniversityIsrael
| | - Abid Assali
- Department of Cardiology, Beilinson HospitalRabin Medical CenterPetah TikvaIsrael
| | - Amir Halkin
- Department of CardiologyTel Aviv Medical CenterIsrael
| | - Hanna Vaknin‐Assa
- Department of Cardiology, Beilinson HospitalRabin Medical CenterPetah TikvaIsrael
| | - Amit Segev
- Leviev Heart Center, Sheba Medical CenterRamat GanIsrael
- Sackler Faculty of Medicine, Tel Aviv UniversityIsrael
| | - Tamir Bental
- Department of Cardiology, Beilinson HospitalRabin Medical CenterPetah TikvaIsrael
| | | | - Israel M. Barbash
- Leviev Heart Center, Sheba Medical CenterRamat GanIsrael
- Sackler Faculty of Medicine, Tel Aviv UniversityIsrael
| | - Ran Kornowski
- Department of Cardiology, Beilinson HospitalRabin Medical CenterPetah TikvaIsrael
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Ngo A, Hassager C, Thyregod HGH, Søndergaard L, Olsen PS, Steinbrüchel D, Hansen PB, Kjærgaard J, Winther-Jensen M, Ihlemann N. Differences in left ventricular remodelling in patients with aortic stenosis treated with transcatheter aortic valve replacement with corevalve prostheses compared to surgery with porcine or bovine biological prostheses. Eur Heart J Cardiovasc Imaging 2017; 19:39-46. [DOI: 10.1093/ehjci/jew321] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 12/19/2016] [Indexed: 12/17/2022] Open
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Bautista-Hernandez V, Cal-Purriños N, Arribas-Leal JM, Carnero-Alcazar M, Gutierrez-Diez JF, Cuenca-Castillo JJ. Rapid Deployment Aortic Replacement (RADAR) Registry in Spain: a protocol. BMJ Open 2017; 7:e011437. [PMID: 28073791 PMCID: PMC5253533 DOI: 10.1136/bmjopen-2016-011437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Rapid deployment valves (RDV) represent a newly introduced approach to aortic valve replacement which facilitates surgical implantation and minimally invasive techniques, shortens surgical times and shows excellent haemodynamic performance. However, evidence on their safety, efficacy and potential complications is mostly fitted with small-volume and retrospective studies. Moreover, no current guidelines exist. To improve our knowledge on this technology, The Rapid Deployment Aortic Replacement (RADAR) Registry will be established across Spain with the aim of assessing RDV outcomes in the real-world setting. METHODS AND ANALYSIS The RADAR Registry is designed as a product registry that would provide information on its use and outcomes in clinical practice. This multicentre, prospective, national effort will initially involve 4 centres in Spain. Any patient undergoing cardiac surgery for aortic valve replacement and receiving an RDV as an isolated operation or in combination with other cardiac procedures may be included. Participation is voluntary. Data collection is equal to information obtained during standard care and is prospectively entered by the participating physicians perioperatively and during subsequent follow-up visits. The primary outcome assessed is in-hospital and up to 5 years of follow-up, prosthetic valve functioning and clinical status. Secondary outcomes are to perform subgroup analysis, to compare outcomes with other existing approaches and to develop future clinical guidelines. The follow-up assessments are timed with routine clinical appointments. Dissociated data will be extracted and collectively analysed. Initial target sample size for the registry is 500 participants entered with complete follow-up information. Different substudies will be implemented within the registry to investigate specific populations undergoing aortic valve replacement. ETHICS AND DISSEMINATION The protocol is approved by all local institutional ethics committees. Findings will be shared by the participant hospitals, policymakers and the academic community to promote quality monitoring and efficient use of this technology.
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Affiliation(s)
- Victor Bautista-Hernandez
- Department of Cardiovascular Surgery, Xerencia de Xestión Integrada A Coruña (XXIAC), A Coruña, Spain
- Congenital and Structural Heart Disease, Instituto de Investigación Biomédica A Coruña (INIBIC), A Coruña, Spain
| | - Natalia Cal-Purriños
- Fundación Profesor Novoa Santos, Xerencia de Xestión Integrada A Coruña (XXIAC), A Coruña, Spain
| | - Jose M Arribas-Leal
- Department of Cardiovascular Surgery, Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | - Jose F Gutierrez-Diez
- Department of Cardiovascular Surgery, Hospital Marqués de Valdecilla, Santander, Spain
| | - Jose J Cuenca-Castillo
- Department of Cardiovascular Surgery, Xerencia de Xestión Integrada A Coruña (XXIAC), A Coruña, Spain
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Hannan EL, Samadashvili Z, Stamato NJ, Lahey SJ, Wechsler A, Jordan D, Sundt TM, Gold JP, Ruiz CE, Ashraf MH, Smith CR. Utilization and 1-Year Mortality for Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement in New York Patients With Aortic Stenosis: 2011 to 2012. JACC Cardiovasc Interv 2017; 9:578-85. [PMID: 27013157 DOI: 10.1016/j.jcin.2015.12.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/12/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate changes in the use of transcatheter aortic valve replacement (TAVR) relative to surgical aortic valve replacement (SAVR) and to examine relative 1-year TAVR and SAVR outcomes in 2011 to 2012 in a population-based setting. BACKGROUND TAVR has become a popular option for patients with severe aortic stenosis, particularly for higher-risk patients. METHODS New York's Cardiac Surgery Reporting System was used to identify TAVR and SAVR volumes and to propensity match TAVR and SAVR patients using numerous patient risk factors contained in the registry to compare 1-year mortality rates. Mortality rates were also compared for different levels of patient risk. RESULTS The total number of aortic valve replacement patients increased from 2,291 in 2011 to 2,899 in 2012, an increase of 27%. The volume of SAVR patients increased by 7.1% from 1,994 to 2,135 and the volume of TAVR patients increased 157% from 297 to 764. The percentage of SAVR patients that were at higher risk (≥3% New York State [NYS] score, equivalent to a Society of Thoracic Surgeons score of about 8%) decreased from 27% to 23%, and the percentage of TAVR patients that were at higher risk decreased from 83% to 76%. There was no significant difference in 1-year mortality between TAVR and SAVR patients (15.6% vs. 13.1%; hazard ratio [HR]: 1.30 [95% confidence interval (CI): 0.89 to 1.92]). There were no differences among patients with NYS score <3% (12.5% vs. 10.2%; HR: 1.42 [95% CI: 0.68 to 2.97]) or among patients with NYS score ≥3% (17.1% vs. 14.5%; HR: 1.27 [95% CI: 0.81 to 1.98]). CONCLUSIONS TAVR has assumed a much larger share of all aortic valve replacements for severe aortic stenosis, and the average level of pre-procedural risk has decreased substantially. There are no differences between 1-year mortality rates for TAVR and SAVR patients.
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Affiliation(s)
- Edward L Hannan
- School of Public Health, University at Albany, State University of New York, Albany, New York.
| | - Zaza Samadashvili
- School of Public Health, University at Albany, State University of New York, Albany, New York
| | - Nicholas J Stamato
- Department of Cardiology, Campbell County Memorial Hospital, Gillette, Wyoming
| | - Stephen J Lahey
- Division of Cardiothoracic Surgery, University of Connecticut, Storrs, Connecticut
| | - Andrew Wechsler
- Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Desmond Jordan
- Department of Surgery, Columbia-Presbyterian Medical Center, New York, New York
| | - Thoralf M Sundt
- Cardiac Surgical Division, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Carlos E Ruiz
- Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, New York
| | - Mohammed H Ashraf
- Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, New York
| | - Craig R Smith
- Department of Surgery, Columbia-Presbyterian Medical Center, New York, New York
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O'Sullivan CJ, Wenaweser P. A Glimpse into the Future: In 2020, Which Patients will Undergo TAVI or SAVR? Interv Cardiol 2017; 12:44-50. [PMID: 29588730 DOI: 10.15420/icr.2016:24:2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has evolved into a safe and effective procedure to treat symptomatic patients with severe aortic stenosis (AS), with predictable and reproducible results. Rates of important complications such as vascular complications, strokes and paravalvular leaks are lower than ever, because of improved patient selection, systematic use of multidector computer tomography, increasing operator experience and device iteration. Accumulating data suggest that transfemoral TAVI with newer generation transcatheter heart valves and delivery systems is superior to conventional surgical aortic valve replacement among intermediate- and high-risk patients with severe symptomatic AS with regard to all-cause mortality and stroke. One can anticipate that by 2020, the majority of patients with severe symptomatic AS will undergo TAVI as first line therapy, regardless of surgical risk.
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Affiliation(s)
| | - Peter Wenaweser
- Department of Cardiology, University Hospital Bern, Inselspital, Switzerland.,Cardiovascular Center Zurich, Hirslanden Clinic im Park, Zurich, Switzerland
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D’Errigo P, Ranucci M, Covello RD, Biancari F, Rosato S, Barbanti M, Onorati F, Tamburino C, Santoro G, Grossi C, Santini F, Bontempi K, Fusco D, Seccareccia F. Outcome After General Anesthesia Versus Monitored Anesthesia Care in Transfemoral Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2016; 30:1238-43. [DOI: 10.1053/j.jvca.2016.05.034] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Indexed: 11/11/2022]
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Transcatheter Aortic Valve Replacement 2016: A Modern-Day "Through the Looking-Glass" Adventure. J Am Coll Cardiol 2016; 67:1472-1487. [PMID: 27012409 DOI: 10.1016/j.jacc.2015.12.059] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/09/2015] [Accepted: 12/15/2015] [Indexed: 11/23/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has become a safe and effective therapy for patients with severe aortic stenosis (AS). In recent trials, the hemodynamic performance and clinical outcomes of the latest generation of TAVR devices demonstrated at least parity with surgical outcomes in patients of similar risk. Many initial obstacles with TAVR have largely been overcome, including frequent access site complications and concerns about strokes and paravalvular leaks. Using a multidisciplinary heart team approach, patient selection, procedural planning, and device implantation have been refined and optimized such that clinical outcomes are generally predictable and reproducible. Future research will focus on the durability of TAVR devices, further enhancements in clinical outcomes, and adjunctive therapies. On the basis of initial results from ongoing clinical trials, the indication for TAVR will likely expand to lower-risk patients. This review provides an overview of recent progress in this field, and highlights future opportunities and directions.
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Lunardi M, Pesarini G, Zivelonghi C, Piccoli A, Geremia G, Ariotti S, Rossi A, Gambaro A, Gottin L, Faggian G, Vassanelli C, Ribichini F. Clinical outcomes of transcatheter aortic valve implantation: from learning curve to proficiency. Open Heart 2016; 3:e000420. [PMID: 27621826 PMCID: PMC5013502 DOI: 10.1136/openhrt-2016-000420] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/02/2016] [Accepted: 05/03/2016] [Indexed: 11/14/2022] Open
Abstract
Objective The use of transcatheter aortic valve implantation (TAVI) is growing rapidly in countries with a predominantly elderly population, posing a huge challenge to healthcare systems worldwide. The increment of human and economic resource consumption imposes a careful monitoring of clinical outcomes and cost-benefit balance, and this article is aimed at analysing clinical outcomes related to the TAVI learning curve. Methods Outcomes of 177 consecutive transfemoral TAVI procedures performed in 5 years by a single team were analysed by the Cumulative Sum of failures method (CUSUM) according to the clinical events comprised in the Valve Academic Research Consortium (VARC-2) safety end point and the VARC-2 definition of device success. Margins for events acceptance were extrapolated from landmark trials that tested both balloon or self-expandable percutaneous valves. Results 30-day and 1-year survival rates were 97.2% and 89.9%, respectively. Achievement of the primary end point (number of cases needed to provide the acceptable margin of the composite end point of any death, stroke, myocardial infarction, life-threatening bleeding, major vascular complications, stage 2–3 acute kidney injury and valve-related dysfunction requiring a repeat procedure) required the performance of 54 cases, while the learning curve to achieve ‘device success’ identified 32 cases to reach the expected proficiency. In this experience, the baseline clinical risk as assessed by the Society of Thoracic Surgeons (STS) score determined the long-term survival rather than the adverse events related to the learning curve. Conclusions A relatively large number of cases are required to achieve clinical outcomes comparable to those reported in high-volume centres and controlled trials. According to our national workload standards, this represents more than 2 years of continuous activity.
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Affiliation(s)
- Mattia Lunardi
- Division of Cardiology, Department of Medicine , University of Verona , Verona , Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine , University of Verona , Verona , Italy
| | - Carlo Zivelonghi
- Division of Cardiology, Department of Medicine , University of Verona , Verona , Italy
| | - Anna Piccoli
- Division of Cardiology, Department of Medicine , University of Verona , Verona , Italy
| | - Giulia Geremia
- Division of Cardiology, Department of Medicine , University of Verona , Verona , Italy
| | - Sara Ariotti
- Division of Cardiology, Department of Medicine , University of Verona , Verona , Italy
| | - Andrea Rossi
- Division of Cardiology, Department of Medicine , University of Verona , Verona , Italy
| | - Alessia Gambaro
- Division of Cardiology, Department of Medicine , University of Verona , Verona , Italy
| | - Leonardo Gottin
- Division of Cardiac Surgery, Department of Surgery , University of Verona , Verona , Italy
| | - Giuseppe Faggian
- Division of Cardiac Surgery, Department of Surgery , University of Verona , Verona , Italy
| | - Corrado Vassanelli
- Division of Cardiology, Department of Medicine , University of Verona , Verona , Italy
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine , University of Verona , Verona , Italy
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The rise of new technologies for aortic valve stenosis: A comparison of sutureless and transcatheter aortic valve implantation. J Thorac Cardiovasc Surg 2016; 152:99-109.e2. [DOI: 10.1016/j.jtcvs.2015.11.041] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 10/16/2015] [Accepted: 11/17/2015] [Indexed: 11/20/2022]
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Vahanian A, Urena M, Walther T, Treede H, Wendler O, Lefèvre T, Spence MS, Redwood S, Kahlert P, Rodes-Cabau J, Leipsic J, Webb J. Thirty-day outcomes in patients at intermediate risk for surgery from the SAPIEN 3 European approval trial. EUROINTERVENTION 2016; 12:e235-43. [DOI: 10.4244/eijv12i2a37] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hannan EL, Samadashvili Z, Jordan D, Sundt TM, Stamato NJ, Lahey SJ, Gold JP, Wechsler A, Ashraf MH, Ruiz C, Wilson S, Smith CR. Thirty-Day Readmissions After Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis in New York State. Circ Cardiovasc Interv 2016; 8:e002744. [PMID: 26227347 DOI: 10.1161/circinterventions.115.002744] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several studies have compared short-term and medium-term mortality rates for patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR), but no studies have compared short-term readmission rates for the 2 procedures. METHODS AND RESULTS New York's Cardiac Surgery Reporting System was used to propensity match 617 TAVI and 1981 SAVR patients using numerous patient risk factors contained in the registry. The 389 propensity-matched pairs were then used to analyze differences in readmission rates between the 2 groups. TAVI and SAVR readmission rates were also compared for patients with a history of congestive heart failure and for patients aged ≥80. Also, reasons for readmission for TAVI and SAVR patients were examined and compared. Readmission rates were not statistically different for all propensity-matched TAVI and SAVR patients (respective rates, 18.8% and 19.3%; P=0.86). After further adjustment using a logistic regression model, there was still no significant difference (adjusted odds ratio, 0.97; 95% confidence interval [0.68-1.39]). For patients aged ≥80, the 30-day readmission rates were 19.9% and 22.0% (P=0.59), and when further adjusted using the logistic regression model, adjusted odds ratio=0.89 (0.55-1.45). For patients with a history of congestive heart failure, the respective rates were 22.8% and 20.4% (P=0.56), and with further adjustment, adjusted odds ratio became 1.15 (0.72-1.82). CONCLUSIONS There are no statistically significant differences between TAVI and SAVR patients in short-term readmission rates.
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Affiliation(s)
- Edward L Hannan
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.).
| | - Zaza Samadashvili
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Desmond Jordan
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Thoralf M Sundt
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Nicholas J Stamato
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Stephen J Lahey
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Jeffrey P Gold
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Andrew Wechsler
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Mohammed H Ashraf
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Carlos Ruiz
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Sean Wilson
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Craig R Smith
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
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Young MN, Elmariah S. Transcatheter Aortic Valve Replacement in Low-Risk Patients Within the Observational Study of Effectiveness of SAVR–TAVI Procedures for Severe Aortic Stenosis Treatment Study. Circ Cardiovasc Interv 2016; 9:e003830. [DOI: 10.1161/circinterventions.116.003830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael N. Young
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Sammy Elmariah
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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