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De Felice F, Paolucci L, Musto C, Nazzaro MS, Chin D, Stio R, Pennacchi M, Adamo M, Chizzola G, Massussi M, Giannini C, Angelillis M, De Carlo M, Gorla R, Bedogni F, Bellini B, Montorfano M, Bruschi G, Merlanti B, Ferrara E, Poli A, Regazzoli D, Palmerini T, Iadanza A, Nicolini E, Toselli M, De Marco F, Gabrielli D. Eight-Year Outcomes of Patients With Reduced Left Ventricular Ejection Fraction Who Underwent Transcatheter Aortic Valve Replacement With a Self-Expanding Bioprosthesis. Am J Cardiol 2024; 232:57-64. [PMID: 39307331 DOI: 10.1016/j.amjcard.2024.09.015] [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: 09/02/2024] [Revised: 09/08/2024] [Accepted: 09/10/2024] [Indexed: 10/06/2024]
Abstract
Data deriving from patients who underwent TAVR between 2007 and 2017 in 13 Italian centers were prospectively collected. Patients were stratified in those with normal LVEF and reduced LVEF. The latter was further classified according to ischemic or nonischemic etiology. The primary end point was a composite of all-cause death and rehospitalizations; the secondary end points were the isolated composers of the primary end point and cardiac death. Overall, 2,626 patients were included in the analysis: 68.1% with normal LVEF and 31.9% with reduced LVEF. At 8 years, reduced LVEF was significantly associated with the primary end point (adjusted hazard ratio 1.17, 95% confidence interval 1.06 to 1.29). Consistent findings were evident for the composite end point. No differences in these trends were found at the 30-day landmark analyses. Compared with nonischemic etiology, ischemic reduced LVEF was associated with an increased risk of cardiac death (adjusted hazard ratio 1.43, 95% confidence interval 1.02 to 2.02). In conclusion, patients with reduced LVEF who underwent TAVR are exposed to a progressively increased risk of death and rehospitalizations, even at very long-term follow-up.
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Affiliation(s)
- Francesco De Felice
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy.
| | - Luca Paolucci
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Carmine Musto
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Marco Stefano Nazzaro
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Diana Chin
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Rocco Stio
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Mauro Pennacchi
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Giuliano Chizzola
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Mauro Massussi
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Cristina Giannini
- Interventional Cardiology Section, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marco Angelillis
- Interventional Cardiology Section, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marco De Carlo
- Interventional Cardiology Section, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Riccardo Gorla
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Barbara Bellini
- Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Bruschi
- Cardiac Surgery, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Bruno Merlanti
- Cardiac Surgery, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Erica Ferrara
- Interventional Cardiology Unit, Legnano Civil Hospital, Legnano, Italy
| | - Arnaldo Poli
- Interventional Cardiology Unit, Legnano Civil Hospital, Legnano, Italy
| | | | - Tullio Palmerini
- Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Alessandro Iadanza
- UOSA Cardiologia Interventistica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Elisa Nicolini
- Interventional Cardiology, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Marco Toselli
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Federico De Marco
- Interventional Cardiology Department, IRCSS Centro Cardiologico Monzino, Milan, Italy
| | - Domenico Gabrielli
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
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Zhang W, Jadidi M, Razian SA, Holzapfel GA, Kamenskiy A, Nordsletten DA. A viscoelastic constitutive framework for aging muscular and elastic arteries. Acta Biomater 2024:S1742-7061(24)00534-8. [PMID: 39303831 DOI: 10.1016/j.actbio.2024.09.021] [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: 05/10/2024] [Revised: 09/11/2024] [Accepted: 09/12/2024] [Indexed: 09/22/2024]
Abstract
The evolution of arterial biomechanics and microstructure with age and disease plays a critical role in understanding the health and function of the cardiovascular system. Accurately capturing these adaptative processes and their effects on the mechanical environment is critical for predicting arterial responses. This challenge is exacerbated by the significant differences between elastic and muscular arteries, which have different structural organizations and functional demands. In this study, we aim to shed light to these adaptive processes by comparing the viscoelastic mechanics of autologous thoracic aortas (TA) and femoropopliteal arteries (FPA) in different age groups. We have extended our fractional viscoelastic framework, originally developed for FPA, to both types of arteries. To evaluate this framework, we analyzed experimental mechanical data from TA and FPA specimens from 21 individuals aged 13 to 73 years. Each specimen was subjected to a multi-ratio biaxial mechanical extension and relaxation test complemented by bidirectional histology to quantify the structural density and microstructural orientations. Our new constitutive model accurately captured the mechanical responses and microstructural differences of the tissues and closely matched the experimentally measured densities. It was found that the viscoelastic properties of collagen and smooth muscle cells (SMCs) in both the FPA and TA remained consistent with age, but the viscoelasticity of the SMCs in the FPA was twice that of the TA. Additionally, changes in collagen nonlinearity with age were similar in both TA and FPA. This model provides valuable insights into arterial mechanophysiology and the effects of pathological conditions on vascular biomechanics. STATEMENT OF SIGNIFICANCE: Developing durable treatments for arterial diseases necessitates a deeper understanding of how mechanical properties evolve with age in response to mechanical environments. In this work, we developed a generalized viscoelastic constitutive model for both elastic and muscular arteries and analyzed both the thoracic aorta (TA) and the femoropopliteal artery (FPA) from 21 donors aged 13 to 73. The derived parameters correlate well with histology, allowing further examination of how viscoelasticity evolves with age. Correlation between the TA and FPA of the same donors suggest that the viscoelasticity of the FPA may be influenced by the TA, necessitating more detailed analysis. In summary, our new model proves to be a valuable tool for studying arterial mechanophysiology and exploring pathological impacts.
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Affiliation(s)
- Will Zhang
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
| | - Majid Jadidi
- Department of Biomechanics, University of Nebraska at Omaha, NE, USA.
| | | | - Gerhard A Holzapfel
- Institute of Biomechanics, Graz University of Technology, Austria; Department of Structural Engineering, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Alexey Kamenskiy
- Department of Biomechanics, University of Nebraska at Omaha, NE, USA.
| | - David A Nordsletten
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Division of Biomedical Engineering and Imaging Sciences, Department of Biomedical Engineering, King's College London, UK.
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3
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Alvarez-Covarrubias HA, Joner M, Cassese S, Warmbrunn M, Lutz J, Trenkwalder T, Seguchi M, Aytekin A, Presch A, Pellegrini C, Rheude T, Patrick Mayr N, Kufner S, Schunkert H, Kastrati A, Xhepa E. Iliofemoral artery predilation prior to transfemoral transcatheter aortic valve implantation in patients with aortic valve stenosis and advanced peripheral artery disease. Catheter Cardiovasc Interv 2023; 101:628-638. [PMID: 36709496 DOI: 10.1002/ccd.30576] [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: 05/31/2022] [Revised: 10/23/2022] [Accepted: 01/15/2023] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To investigate the feasibility and safety of percutaneous transluminal angioplasty (PTA) of the iliofemoral arteries (IFA) before transfemoral transcatheter aortic valve implantation (Tf-TAVI) in patients with advanced peripheral artery disease (PAD). BACKGROUND Although Tf-TAVI represents the access of choice, alternative vascular access routes are preferred for patients displaying advanced PAD. PTA of the IFA represents a less invasive option, broadening the spectrum of patients eligible for Tf-TAVI. METHODS All patients requiring PTA of the IFA before Tf-TAVI, between 2012 and 2021, were included. Primary efficacy endpoint was the rate of successful transcatheter heart valve (THV) delivery and implantation. Primary safety endpoint was the rate of PTA and access-site-related vascular complications, procedural- and in-hospital complications. RESULTS Among 2726 Tf-TAVI procedures, 59 patients required IFA predilation. Successful THV delivery and implantation was achieved in 57 (96.6%) patients, respectively. Sheath placement was achieved in 59 (100%) patients with only one minor dissection and no major vascular complications following iliofemoral PTA. Regarding access site complications, two (3.4%) vessel perforations and one (1.7%) vessel rupture were observed, with eight (13.5%) patients requiring unplanned endovascular interventions. There was one intraprocedural death due to THV-induced vessel laceration, while in-hospital all-cause mortality was 8.5% in the present high-risk patient cohort. CONCLUSIONS Predilation of IFA is safe and effective in patients with advanced PAD. Careful preprocedural planning is paramount in improving procedural safety and efficacy. This strategy has the potential to broaden the spectrum of patients eligible for Tf-TAVI.
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Affiliation(s)
- Hector A Alvarez-Covarrubias
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, Cd. de México, Mexico City, México
| | - Michael Joner
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Salvatore Cassese
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mairead Warmbrunn
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Jannik Lutz
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Teresa Trenkwalder
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Masaru Seguchi
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Alp Aytekin
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Antonia Presch
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Constanza Pellegrini
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Tobias Rheude
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - N Patrick Mayr
- Institut für Anästhesiologie, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Sebastian Kufner
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Erion Xhepa
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Trends and Outcomes of Transcatheter Aortic Valve Implantation in Patients With Peripheral Arterial Disease: Insights From the National Readmissions Database. Curr Probl Cardiol 2023; 48:101605. [PMID: 36690314 DOI: 10.1016/j.cpcardiol.2023.101605] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
Due to shared risk factors, many patients with severe aortic stenosis (AS) also have concomitant peripheral arterial disease (PAD). The readmission rates and long term clinical outcomes of these patients following transcatheter aortic valve implantation (TAVI) in a large sample has not been well defined. The National Readmissions Database (NRD) (2015-2019) was used to identify patients undergoing TAVI. TAVI in patients with PAD was compared with those without PAD using a propensity score matched (PSM) analysis to obtain adjusted odds ratios (aOR) with 95% confidence intervals (CI) of net adverse clinical events (NACE), and its components. A total of 189,216 patients were identified, of which 14,925 patients (7386 with PAD, 7539 without PAD) were selected for adjusted analysis. Using PSM, patients with PAD undergoing TAVI had significantly higher in-hospital adjusted odds of NACE (aOR 1.60, 95% CI 1.36-1.88), and mortality (aOR 4.10, 95% CI 2.88-5.83). However, rates of other in-hospital peri procedural complications (stroke, major bleeding, paravalvular leak, cardiogenic shock) were not significantly different. There was no significant difference in the incidence of NACE, mortality, or other complications between the 2 groups at 30- and 180 days follow-up. Patients with PAD undergoing TAVI have an increased risk of mortality and NACE during the periprocedural period. However, following discharge, there was no statistically significant difference in 30 days and 6 month outcomes of TAVI in this population compared to those without significant PAD.
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Ohya M, Kohsaka S, Kumamaru H, Ikuta A, Nakano J, Shimamoto T, Watanabe Y, Shimamura K, Maeda K, Komiya T, Fuku Y, Kadota K. Modified percutaneous coronary intervention-derived risk models (PARIS and CREDO-Kyoto integer scoring systems) applied to Japanese transcatheter aortic valve replacement patients. Open Heart 2023; 10:openhrt-2022-002172. [PMID: 36657943 PMCID: PMC9853247 DOI: 10.1136/openhrt-2022-002172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Postprocedural ischaemic and bleeding risks after transcatheter aortic valve replacement (TAVR) remain a major concern. Nevertheless, no reliable risk models incorporating both possibilities are currently available. We aimed to assess the accuracy of percutaneous coronary intervention (PCI)-derived models and the performance of a recalibrated model that included variables more applicable to TAVR. METHODS This study included 26 869 patients who had been enrolled in a national registry. Ischaemic events were defined as myocardial infarction, stroke, transient ischaemic attack or peripheral embolism at 1 year. Bleeding events were defined as any bleeding based on the Valve Academic Research Consortium-2 consensus document at 1 year. Patterns of Non-adherence to Anti-Platelet Regimen in Stented Patients (PARIS) and Coronary Revascularisation Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) integer scoring systems were tested. The models were recalibrated by applying new variables using the Fine and Gray method. RESULTS The 1-year cumulative incidences for ischaemic and bleeding events were 2.7% and 3.1%. Patients with high PARIS and CREDO-Kyoto risk scores had higher incidences of both ischaemic (3.3% vs 2.4% vs 2.4%, p<0.001 and 2.8% vs 2.0% vs 0.8%, p<0.001) and bleeding events (3.3% vs 2.5% vs 0.8%, p<0.001 and 3.7% vs 3.0% vs 2.4%, p<0.001) when compared with intermediate and low-risk patients. The receiver operating characteristic area under the curves for these models were 0.53, 0.58, 0.56 and 0.55, respectively. After the models were recalibrated to incorporate variables more applicable to TAVR, the performance of ischaemic and bleeding models modestly improved (0.58 and 0.61, respectively). CONCLUSIONS The PCI-derived models demonstrated modest accuracy but was inadequate for risk stratification of TAVR patients at 1-year follow-up. TRIAL REGISTRATION NUMBER 3395.
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Affiliation(s)
- Masanobu Ohya
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University, Tokyo, Japan
| | - Hiraku Kumamaru
- Department of Clinical Epidermiology, Tokyo University, Tokyo, Japan
| | - Akihiro Ikuta
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Jota Nakano
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takeshi Shimamoto
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Shizuoka, Japan
| | | | | | - Koichi Maeda
- Department of Cardiology, Osaka University, Osaka, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yasushi Fuku
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
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Wong CK, Chiu ACHO, Chan KYE, Sze SY, Tam FCC, Un KC, Lam SCC, Tse HF. Advances in technology and techniques for transcatheter aortic valve replacement with concomitant peripheral arterial disease. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:959249. [PMID: 36062263 PMCID: PMC9433652 DOI: 10.3389/fmedt.2022.959249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022] Open
Abstract
Aortic stenosis (AS) is a prevalent disease affecting 3.7% of the adult population aged 65 or above. In the past, surgical aortic valve replacement (SAVR) was the only definitive therapy available for the treatment of severe AS. Owing to the invasive nature of open-heart surgery, patients with advanced age and frailty could not benefit from SAVR. The advent of transcatheter aortic valve replacement (TAVR) in the past decade has offered an alternative treatment option for patients with severe AS, particularly those who are deemed to have high surgical risks. Nevertheless, a large proportion of patients also have concomitant peripheral arterial disease (PAD), which increases the risk of peri-procedural vascular complication, and precludes the possibility of transfemoral TAVR owing to inadequate luminal size for delivery system deployment. In this review, the prevalence and outcome of TAVR patients with PAD will be discussed. Furthermore, novel technologies and techniques that enable TAVR to be safely performed using transfemoral or alternative access in patients with severe PAD will be reviewed.
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Kattih B, Carstens DC, Boeckling F, Rasper T, Pergola G, Dimmeler S, Vasa-Nicotera M, Zeiher AM, Mas-Peiro S. Low Circulating Musclin is Associated With Adverse Prognosis in Patients Undergoing Transcatheter Aortic Valve Implantation at Low-Intermediate Risk. J Am Heart Assoc 2022; 11:e022792. [PMID: 35229655 PMCID: PMC9075297 DOI: 10.1161/jaha.121.022792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Musclin is an activity‐stimulated and cardioprotective myokine that attenuates pathological cardiac remodeling. Musclin deficiency, in turn, results in reduced physical endurance. The aim of this study was to assess the prognostic value of circulating musclin as a novel, putative biomarker to identify patients undergoing transcatheter aortic valve implantation (TAVI) who are at a higher risk of death. Methods and Results In this study, we measured systemic musclin levels in 368 patients undergoing TAVI who were at low to intermediate clinical risk (median EuroSCORE [European System for Cardiac Operative Risk Evaluation] II: 3.5; quartile 1–quartile, 2.2%–5.3%), whereby 209 (56.8%) patients were at low and 159 (43.2%) were at intermediate risk. Median preprocedural musclin levels were 2.7 ng/mL (quartile 1–quartile 3, 1.5–4.6 ng/mL). Musclin levels were dichotomized in low (<2.862 ng/mL, n=199 [54.1%]) or high (≥ 2.862 ng/mL, n=169 [45.9%]) groups using cutoff values determined by classification and regression tree analysis. The primary end point was 1‐year overall survival. Patients with low circulating musclin levels exhibited a significantly higher prevalence of frailty, low albumin values, hypertension, and history of stroke as well as higher N‐terminal pro‐B‐type natriuretic peptide. Low musclin levels significantly predicted risk of death in univariable (hazard ratio, 1.81; 95% CI, 1.00–3.53 [P=0.049]) and multivariable (adjusted hazard ratio, 2.45; 95% CI, 1.06–5.69 [P=0.037]) Cox regression analyses. Additionally, low musclin levels in combination with conventional EuroSCORE II suggested improved risk stratification in patients undergoing TAVI who were at low to intermediate clinical risk into subgroups with reduced 1‐year survival rates by log‐rank test (P for trend=0.003). Conclusions Circulating musclin is an independent predictor of 1‐year overall survival in patients undergoing TAVI. Combined with EuroSCORE II, circulating musclin might help to improve prediction of mortality in patients undergoing TAVI who are at low to intermediate clinical risk.
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Affiliation(s)
- Badder Kattih
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany.,German Centre for Cardiovascular ResearchPartner Site Frankfurt Rhine-Main Berlin Germany.,Institute for Cardiovascular Regeneration Goethe University Frankfurt am Main Germany
| | - Daniel C Carstens
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany.,Institute for Cardiovascular Regeneration Goethe University Frankfurt am Main Germany
| | - Felicitas Boeckling
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany.,German Centre for Cardiovascular ResearchPartner Site Frankfurt Rhine-Main Berlin Germany.,Institute for Cardiovascular Regeneration Goethe University Frankfurt am Main Germany
| | - Tina Rasper
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany
| | - Graziella Pergola
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany.,German Centre for Cardiovascular ResearchPartner Site Frankfurt Rhine-Main Berlin Germany
| | - Stefanie Dimmeler
- German Centre for Cardiovascular ResearchPartner Site Frankfurt Rhine-Main Berlin Germany.,Institute for Cardiovascular Regeneration Goethe University Frankfurt am Main Germany
| | - Mariuca Vasa-Nicotera
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany.,German Centre for Cardiovascular ResearchPartner Site Frankfurt Rhine-Main Berlin Germany
| | - Andreas M Zeiher
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany.,German Centre for Cardiovascular ResearchPartner Site Frankfurt Rhine-Main Berlin Germany
| | - Silvia Mas-Peiro
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany.,German Centre for Cardiovascular ResearchPartner Site Frankfurt Rhine-Main Berlin Germany
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Zisiopoulou M, Berkowitsch A, Neuber R, Gouveris H, Fichtlscherer S, Walther T, Vasa-Nicotera M, Seppelt P. Personalized Preoperative Prediction of the Length of Hospital Stay after TAVI Using a Dedicated Decision Tree Algorithm. J Pers Med 2022; 12:jpm12030346. [PMID: 35330346 PMCID: PMC8950279 DOI: 10.3390/jpm12030346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of this study was to identify pre-operative parameters able to predict length of stay (LoS) based on clinical data and patient-reported outcome measures (PROMs) from a scorecard database in patients with significant aortic stenosis who underwent TAVI (transfemoral aortic valve implantation). Methods: 302 participants (51.7% males, age range 78.2−84.2 years.) were prospectively recruited. After computing the median LoS value (=6 days, range = 5−8 days), we implemented a decision tree algorithm by setting dichotomized values at median LoS as the dependent variable and assessed baseline clinical variables and PROMs (Clinical Frailty Scale (CFS), EuroQol-5 Dimension-5 Levels (EQ-5D) and Kansas City Cardiomyopathy Questionnaire (KCCQ)) as potential predictors. Results: Among clinical parameters, only peripheral arterial disease (p = 0.029, HR = 1.826) and glomerular filtration rate (GFR, cut-off < 33 mL/min/1.73 m2, p = 0.003, HR = 2.252) were predictive of LoS. Additionally, two PROMs (CFS; cut-off = 3, p < 0.001, HR = 1.324 and KCCQ; cut-off = 30, p = 0.003, HR = 2.274) were strong predictors. Further, a risk score for LoS (RS_LoS) was calculated based on these predictors. Patients with RS_LoS = 0 had a median LoS of 5 days; patients RS_LoS ≥ 3 had a median LoS of 8 days. Conclusions: based on the pre-operative values of the above four predictors, a personalized prediction of LoS after TAVI can be achieved.
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Affiliation(s)
- Maria Zisiopoulou
- Department of Cardiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany; (A.B.); (R.N.); (S.F.); (M.V.-N.); (P.S.)
- Correspondence: ; Tel.: +49-69-6301-832-90
| | - Alexander Berkowitsch
- Department of Cardiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany; (A.B.); (R.N.); (S.F.); (M.V.-N.); (P.S.)
| | - Ralf Neuber
- Department of Cardiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany; (A.B.); (R.N.); (S.F.); (M.V.-N.); (P.S.)
| | - Haralampos Gouveris
- Quality Management, Department of Otorhinolaryngology, University Medical Center Mainz, 55131 Mainz, Germany;
| | - Stephan Fichtlscherer
- Department of Cardiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany; (A.B.); (R.N.); (S.F.); (M.V.-N.); (P.S.)
| | - Thomas Walther
- Department of Cardiothoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany;
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany; (A.B.); (R.N.); (S.F.); (M.V.-N.); (P.S.)
| | - Philipp Seppelt
- Department of Cardiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60590 Frankfurt am Main, Germany; (A.B.); (R.N.); (S.F.); (M.V.-N.); (P.S.)
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9
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Ashikaga K, Doi S, Yoneyama K, Watanabe M, Suzuki N, Kuwata S, Kaihara T, Koga M, Okuyama K, Kamijima R, Tanabe Y, Takeichi N, Watanabe S, Izumo M, Kida K, Akashi YJ. Impact of perioperative change in physical function on midterm outcomes after transcatheter aortic valve implantation. Heart Vessels 2021; 36:1072-1079. [PMID: 33484292 DOI: 10.1007/s00380-021-01776-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/08/2021] [Indexed: 11/26/2022]
Abstract
Preoperative frailty diminishes the potential for functional recovery after transcatheter aortic valve implantation (TAVI). However, perioperative changes in physical status and their impact on prognosis after TAVI have not previously been reported. Therefore, this study aimed to investigate whether perioperative changes in physical function affect prognosis in patients undergoing TAVI. We retrospectively reviewed 257 patients who underwent TAVI. The Short Physical Performance Battery (SPPB), an objective physical status assessment tool, was evaluated pre- and post-TAVI. Patients were divided into two groups: (i) patients whose SPPB score declined in the perioperative period (the decline group) and (ii) patients whose SPPB score did not decline in the perioperative period (the non-decline group). The primary endpoint was unplanned hospitalization owing to heart failure or cardiovascular death following TAVI. The mean follow-up period was 385 ± 151 days, mean age was 83.2 ± 5.8 years, and 67% of the patients were women. Sixteen patients required readmission owing to heart failure, and seven experienced cardiovascular-related death. Kaplan-Meier analysis revealed that the event-free rate was significantly lower in the decline group (log-rank, p = 0.006). A stepwise multivariate logistic regression analysis showed that a perioperative change in SPPB was significantly associated with primary endpoints (odds ratio, 1.51; 95% confidence interval, 1.12-2.04). Perioperative change in physical function was an independent risk factor for heart failure, hospitalization, or cardiovascular death following TAVI.
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Affiliation(s)
- Kohei Ashikaga
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Shunichi Doi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kihei Yoneyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Mika Watanabe
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Norio Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Shingo Kuwata
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Toshiki Kaihara
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Masashi Koga
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kazuaki Okuyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Ryo Kamijima
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yasuhiro Tanabe
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Naoya Takeichi
- Rehabilitation Center, St. Marianna University School of Medicine Hospital, Kawasaki, Japan
| | - Satoshi Watanabe
- Rehabilitation Center, St. Marianna University School of Medicine Hospital, Kawasaki, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Keisuke Kida
- Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
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10
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Yamauchi T, Yamamoto H, Miyata H, Kobayashi J, Masai T, Motomura N. Surgical Aortic Valve Replacement for Aortic Stenosis in Dialysis Patients ― Analysis of Japan Cardiovascular Surgery Database ―. Circ J 2020; 84:1271-1276. [DOI: 10.1253/circj.cj-20-0042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takashi Yamauchi
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Toho University, Sakura Medical Center
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11
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Kalyoncuoglu M, Ozturk S. Is the Newly Defined R2CHA2DS2-Vasc Score a Predictor for Late Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement? Braz J Cardiovasc Surg 2020; 35:145-154. [PMID: 32369293 PMCID: PMC7199995 DOI: 10.21470/1678-9741-2019-0221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To assess the performance of the modified R2CHA2DS2-VASc score for predicting mid-to-long-term mortality (> 30 days) in patients undergoing transcatheter aortic valve replacement (TAVR). Methods Data of 78 patients who underwent TAVR were retrospectively reviewed. R2CHA2DS2-VASc score was compared with the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II or ES II) and the transcatheter valve therapytranscatheter aortic valve replacement (TVT-TAVR) risk score. Results The mean follow-up period was 17.4±9.9 months (maximum 37 months). Early mortality (first 30 days) was observed in 10 (12.8%) patients, whereas mid-to-long-term mortality (> 30 days) was observed in 26 (33.3%) patients. Non-survivors had higher values of R2CHA2DS2-VASc, ES II, and TAVR scores than survivors (P<0.001, P<0.001, and P=0.001, respectively). Analysis of Pearson’s correlation revealed that R2CHA2DS2-VASc score was moderately correlated with ES II and TAVR scores (r=0.51, P<0.001; r=0.44, P=0.001, respectively). Pairwise comparisons of R2CHA2DS2-VASc (area under the curve [AUC]: 0.870, 95% confidence interval [CI]: 0.776-0.964; P<0.001), ES II (AUC: 0.801, 95% CI: 0.703-0.899; P<0.001), and TAVR scores (AUC: 0.730, 95% CI: 0.610-852; P=0.002) showed similar accuracy for predicting mortality. R2CHA2DS2-VASc score is an independent predictor of mortality in multivariable Cox regression analysis. A cutoff value of six for R2CHA2DS2-VASc score showed a sensitivity of 74% and a specificity of 89% for predicting mid-to-long-term mortality. Conclusion R2CHA2DS2-VASc score, easily calculated from clinical parameters, is associated with prediction of mid-to-longterm mortality in patients undergoing TAVR.
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Affiliation(s)
- Muhsin Kalyoncuoglu
- University of Health Sciences Haseki Training and Reseach Hospital Department of Cardiology Istanbul Turkey Department of Cardiology, Haseki Training and Reseach Hospital, University of Health Sciences, Istanbul, Turkey
| | - Semi Ozturk
- University of Health Sciences Haseki Training and Reseach Hospital Department of Cardiology Istanbul Turkey Department of Cardiology, Haseki Training and Reseach Hospital, University of Health Sciences, Istanbul, Turkey
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12
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Mota RI, Morgan SE, Bahnson EM. Diabetic vasculopathy: macro and microvascular injury. CURRENT PATHOBIOLOGY REPORTS 2020; 8:1-14. [PMID: 32655983 PMCID: PMC7351096 DOI: 10.1007/s40139-020-00205-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Diabetes is a common and prevalent medical condition as it affects many lives around the globe. Specifically, type-2 Diabetes (T2D) is characterized by chronic systemic inflammation alongside hyperglycemia and insulin resistance in the body, which can result in atherosclerotic legion formation in the arteries and thus progression of related conditions called diabetic vasculopathies. T2D patients are especially at risk for vascular injury; adjunct in many of these patients heir cholesterol and triglyceride levels reach dangerously high levels and accumulate in the lumen of their vascular system. RECENT FINDINGS Microvascular and macrovascular vasculopathies as complications of diabetes can accentuate the onset of organ illnesses, thus it is imperative that research efforts help identify more effective methods for prevention and diagnosis of early vascular injuries. Current research into vasculopathy identification/treatment will aid in the amelioration of diabetes-related symptoms and thus reduce the large number of deaths that this disease accounts annually. SUMMARY This review aims to showcase the evolution and effects of diabetic vasculopathy from development to clinical disease as macrovascular and microvascular complications with a concerted reference to sex-specific disease progression as well.
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Affiliation(s)
- Roberto I. Mota
- Department of Surgery, Division of Vascular Surgery; University of North Carolina at Chapel Hill, NC 27599
- Center for Nanotechnology in Drug Delivery; University of North Carolina at Chapel Hill, NC 27599
- McAllister Heart Institute, University of North Carolina at Chapel Hill, NC 27599
| | - Samuel E. Morgan
- Department of Surgery, Division of Vascular Surgery; University of North Carolina at Chapel Hill, NC 27599
- Center for Nanotechnology in Drug Delivery; University of North Carolina at Chapel Hill, NC 27599
| | - Edward M. Bahnson
- Department of Surgery, Division of Vascular Surgery; University of North Carolina at Chapel Hill, NC 27599
- Center for Nanotechnology in Drug Delivery; University of North Carolina at Chapel Hill, NC 27599
- McAllister Heart Institute, University of North Carolina at Chapel Hill, NC 27599
- Department of Cell Biology and Physiology. University of North Carolina at Chapel Hill, NC 27599
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13
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Takagi H, Hari Y, Nakashima K, Kuno T, Ando T. Meta-analysis of prognostic impact of peripheral arterial disease on mortality after transcatheter aortic valve implantation. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 60:723-732. [PMID: 31302953 DOI: 10.23736/s0021-9509.19.10863-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The aim of this study was to determine whether peripheral arterial disease (PAD) is an independent predictor of mortality in patients who undergo transcatheter aortic valve implantation (TAVI) and we performed meta-analysis of currently available studies. EVIDENCE ACQUISITION MEDLINE and EMBASE were searched through June 2018 using Web-based search engines (PubMed and OVID). We included comparative studies of patients with PAD versus those without PAD and cohort studies which investigated PAD as one of prognostic factors of mortality, which used the multivariable analysis and reported an adjusted odds and hazard ratio (OR/HR) for early (30-day or in-hospital) and late (including early) mortality after TAVI. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic ORs/HRs in the random-effects model. EVIDENCE SYNTHESIS The primary meta-analysis which pooled all the ORs/HRs demonstrated that PAD was associated with a statistically significant increase in both early (OR, 1.21; P=0.02) and midterm (1-year to 7-year) mortality (HR, 1.31; P<0.00001). The secondary meta-analysis which exclusively pooled approach-adjusted/stratified ORs/HRs demonstrated that PAD was associated with a strong trend toward (though statistically non-significant) an increase in early mortality (OR, 1.18; P=0.07) and a still statistically significant increase in midterm mortality (OR, 1.24; P=0.0001). Meta-regression coefficients for the proportion of patients who underwent transfemoral TAVI were not statistically significant (P for early/midterm mortality =0.24/0.52). CONCLUSIONS The present meta-analysis clearly highlighted that PAD was an independent predictor of both early and midterm mortality in patients who underwent TAVI.
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Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan - .,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan -
| | - Yosuke Hari
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kouki Nakashima
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Toshiki Kuno
- Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - Tomo Ando
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
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14
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Ueshima D, Barioli A, Nai Fovino L, D'Amico G, Fabris T, Brener SJ, Tarantini G. The impact of pre‐existing peripheral artery disease on transcatheter aortic valve implantation outcomes: A systematic review and meta‐analysis. Catheter Cardiovasc Interv 2019; 95:993-1000. [DOI: 10.1002/ccd.28335] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Daisuke Ueshima
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Alberto Barioli
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Luca Nai Fovino
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Gianpiero D'Amico
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Tommaso Fabris
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Sorin J. Brener
- Department of Medicine, Cardiac Catheterization LaboratoryNew York‐Presbyterian Brooklyn Methodist Hospital Brooklyn New York
| | - Giuseppe Tarantini
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
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15
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Kim C, Hong MK. Aortic Stenosis and Transcatheter Aortic Valve Implantation: Current Status and Future Directions in Korea. Korean Circ J 2019; 49:283-297. [PMID: 30895756 PMCID: PMC6428950 DOI: 10.4070/kcj.2019.0044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/11/2019] [Indexed: 01/11/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has been accepted as one of primary options for treatment of symptomatic severe aortic stenosis. Although TAVI has been predominantly used for patients at high risk or with old age who were not considered optimal candidates for surgical aortic valve replacement (SAVR), its indication is now expanding toward low risk profile and younger age. Many clinical trials are now ongoing to test the possibility of TAVI for use in patients even with uncharted indications who are not eligible for SAVR in current guidelines but may benefit from valve replacement. Current issues including periprocedural safety, long-term adverse events, hemodynamics and durability associated with TAVI should be also solved for expanding use of TAVI. The review presents current status and future directions of TAVI and discusses perspectives in Korea.
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Affiliation(s)
- Choongki Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Myeong Ki Hong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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16
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Peripheral artery disease and transcatheter aortic valve implantation: The tip of the atherosclerotic iceberg. Int J Cardiol 2018; 255:213-214. [DOI: 10.1016/j.ijcard.2017.12.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 12/21/2017] [Indexed: 11/20/2022]
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