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Khalil S, Tabowei G, Kaur M, Dadzie SK, Kansakar S, Moqattash M, Komminni PK, Palleti SK. Effect of Pulmonary Hypertension on Survival Outcomes in Patients With Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e58540. [PMID: 38957831 PMCID: PMC11218420 DOI: 10.7759/cureus.58540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 07/04/2024] Open
Abstract
The aim of this meta-analysis was to determine the effect of pulmonary hypertension (PH) on survival in patients undergoing transcatheter aortic valve replacement (TAVR). The present study was conducted according to the guidelines of Preferred Reporting of Systematic Review and Meta-Analysis (PRISMA). We conducted a comprehensive search of electronic databases including PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science from January 1, 2015, to March 10, 2024. Outcomes assessed in this meta-analysis included early and late all-cause mortality and cardiovascular mortality. Total 15 studies were integrated into the pooled analysis to assess the impact of PH on outcomes among patients undergoing TAVR, comprising a total sample size of 35,732 individuals. The pooled prevalence of PH stood at 52.57% (n=18,767). Predominantly, the studies were conducted in the United States (n=6), followed by Germany (n=3), with one study each from Japan, Italy, Switzerland, Brazil, Poland, and Australia. Pooled analysis showed that risk of short-term mortality was greater in patients with PH compared to patients without PH (risk ratio (RR): 1.46, 95% CI: 1.19 to 1.80). Risk of long-term mortality was greater in patients with PH (RR: 1.42, 95% CI: 1.29 to 1.55). Risk of cardiovascular mortality was also greater in patients with PH compared to patients without PH (RR: 1.66, 95% CI: 1.36 to 2.02). We advocate for further research to address gaps in understanding different types of PH and their impacts on mortality and cardiovascular outcomes.
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Affiliation(s)
| | - Godfrey Tabowei
- Internal Medicine, Texas Tech University Health Sciences Center, Odessa, USA
| | - Mandeep Kaur
- Internal Medicine, HCA Capital Hospital, Tallahassee, USA
| | - Samuel K Dadzie
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
| | - Sajog Kansakar
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | | | | | - Sujith K Palleti
- Nephrology, Louisiana State University Health Sciences Center, Shreveport, USA
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2
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Niebauer J, Bäck C, Bischoff-Ferrari HA, Dehbi HM, Szekely A, Völler H, Sündermann SH. Preinterventional frailty assessment in patients scheduled for cardiac surgery or transcatheter aortic valve implantation: a consensus statement of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC). Eur J Prev Cardiol 2024; 31:146-181. [PMID: 37804173 DOI: 10.1093/eurjpc/zwad304] [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: 10/10/2022] [Revised: 03/22/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Josef Niebauer
- Paracelsus Medical University Salzburg, Institute of Sports Medicine, Prevention and Rehabilitation, Salzburg, Austria
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- REHA-Zentrum Salzburg, University Hospital Salzburg, Austria
| | - Caroline Bäck
- Department of Cardiothoracic Surgery, RT, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Heike A Bischoff-Ferrari
- Center on Ageing and Mobility, University Hospital and University of Zurich, Zurich, Switzerland
| | - Hakim-Moulay Dehbi
- University College London, Comprehensive Clinical Trials Unit, London, Great Britain
| | - Andrea Szekely
- Semmelweis University, Department of Anesthesiology and Intensive Therapy, Budapest, Hungary
| | - Heinz Völler
- Faculty of Health Sciences Brandenburg, University of Potsdam, Department of Rehabilitation Medicine, Potsdam, Germany
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| | - Simon H Sündermann
- Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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3
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Zheng JY, Lodhi SH, Anstead M, Misumida N, Ahmed T. Severe Bicuspid Aortic Valve Disease in an Adult Cystic Fibrosis Patient. Cureus 2023; 15:e50401. [PMID: 38213378 PMCID: PMC10782187 DOI: 10.7759/cureus.50401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
Bicuspid aortic valve is the most common congenital heart disease. Bicuspid aortic valves are prone to accelerated degenerative changes and aortopathies. These changes often manifest in adulthood as severe aortic stenosis or mixed aortic valve disease. Cystic fibrosis patients are at high risk of adverse surgical outcomes. As survival in cystic fibrosis continues to increase, managing comorbidities including severe aortic stenosis requires consideration. The relatively non-invasive transcatheter aortic valve replacement has been posed as an intervention for high-risk patients with severe symptomatic aortic stenosis. However, traditional randomized trials have excluded patients with bicuspid aortic valves. Herein we present an extremely rare association of severe bicuspid aortic valve stenosis in an adult cystic fibrosis patient. Furthermore, we discuss the clinical course and a multi-disciplinary approach for the management of this rare scenario.
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Affiliation(s)
- Jason Y Zheng
- Medicine, University of Kentucky College of Medicine, Lexington, USA
| | - Samra Haroon Lodhi
- Internal Medicine, University of Kentucky College of Medicine, Lexington, USA
| | - Michael Anstead
- Pulmonology, University of Kentucky College of Medicine, Lexington, USA
| | - Naoki Misumida
- Cardiology, University of Kentucky College of Medicine, Lexington, USA
| | - Taha Ahmed
- Internal Medicine, University of Kentucky College of Medicine, Lexington, USA
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4
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Yeom R, Gorgone M, Malinovic M, Panzica P, Maslow A, Augoustides JG, Marchant BE, Fernando RJ, Nampi RG, Pospishil L, Neuburger PJ. Surgical Aortic Valve Replacement in a Patient with Very Severe Chronic Obstructive Pulmonary Disease. J Cardiothorac Vasc Anesth 2023; 37:2335-2349. [PMID: 37657996 DOI: 10.1053/j.jvca.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 09/03/2023]
Affiliation(s)
- Richard Yeom
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY
| | - Michelle Gorgone
- Department of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - Matea Malinovic
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY
| | - Peter Panzica
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY
| | - Andrew Maslow
- Department of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Bryan E Marchant
- Department of Anesthesiology, Cardiothoracic and Critical Care Sections, Wake Forest University School of Medicine, Winston Salem, NC
| | - Rohesh J Fernando
- Department of Anesthesiology, Cardiothoracic Section, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC.
| | - Robert G Nampi
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Liliya Pospishil
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
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Sündermann SH, Bäck C, Bischoff-Ferrari HA, Dehbi HM, Szekely A, Völler H, Niebauer J. Preinterventional frailty assessment in patients scheduled for cardiac surgery or transcatheter aortic valve implantation: a consensus statement of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC). Eur J Cardiothorac Surg 2023; 64:ezad181. [PMID: 37804175 DOI: 10.1093/ejcts/ezad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/22/2023] [Indexed: 10/09/2023] Open
Affiliation(s)
- Simon H Sündermann
- Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Caroline Bäck
- Department of Cardiothoracic Surgery, RT, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Heike A Bischoff-Ferrari
- Center on Ageing and Mobility, University Hospital and University of Zurich, Zurich, Switzerland
| | - Hakim-Moulay Dehbi
- University College London, Comprehensive Clinical Trials Unit, London, Great Britain
| | - Andrea Szekely
- Semmelweis University, Department of Anesthesiology and Intensive Therapy, Budapest, Hungary
| | - Heinz Völler
- Faculty of Health Sciences Brandenburg, University of Potsdam, Department of Rehabilitation Medicine, Potsdam, Germany
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| | - Josef Niebauer
- Paracelsus Medical University Salzburg, Institute of Sports Medicine, Prevention and Rehabilitation, Salzburg, Austria
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- REHA-Zentrum Salzburg, University Hospital Salzburg, Austria
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Koga M, Izumo M, Yoneyama K, Akashi YJ, Yashima F, Tada N, Yamawaki M, Shirai S, Naganuma T, Yamanaka F, Ueno H, Tabata M, Mizutani K, Takagi K, Watanabe Y, Yamamoto M, Hayashida K. Prognostic Value of Electrocardiographic Left Ventricular Hypertrophy After Transcatheter Aortic Valve Implantation: Insights from the OCEAN-TAVI Registry. Am J Cardiol 2023; 204:130-139. [PMID: 37541149 DOI: 10.1016/j.amjcard.2023.07.101] [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: 04/20/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/06/2023]
Abstract
Electrocardiogram (ECG) left ventricular hypertrophy (LVH) is associated with the prognosis of patients with aortic stenosis. However, the impact of the presence or absence of ECG-LVH on the clinical outcomes after transcatheter aortic valve implantation (TAVI) is limited. This study aimed to assess the prognostic value of ECG-LVH among patients with aortic stenosis treated by TAVI. A total of 1,667 patients who underwent TAVI were prospectively enrolled into the OCEAN-TAVI (Optimized CathEter vAlvular iNtervention-Transcatheter Aortic Valve Implantation) registry. A total of 1,446 patients (mean age 84 years; 29.9% men) were analyzed. The Sokolow-Lyon index was used to determine the presence of ECG-LVH. LVH was also assessed using transthoracic echocardiography (TTE). We investigated the association between ECG-LVH and all-cause and cardiovascular mortality. This study identified ECG-LVH and TTE-LVH in 743 (51.5%) and 1,242 patients (86.0%), respectively. The Kaplan-Meier analysis revealed that all-cause mortality was significantly higher among patients without ECG-LVH than among those with ECG-LVH (log-rank p <0.001). In the multivariable analysis, the absence of ECG-LVH was independently associated with all-cause mortality (hazard ratio 1.98, 95% confidence interval 1.39 to 2.82, p <0.001), regardless of the presence or absence of TTE-LVH. Furthermore, the presence of TTE-LVH with the absence of ECG-LVH was observed in 575 patients (40%), which was associated with cardiovascular mortality (hazard ratio 2.84, 95% confidence interval 1.56 to 5.17, p <0.001). In conclusion, the absence of ECG-LVH was independently associated with an increased risk of all-cause mortality after TAVI. Risk stratification using both ECG-LVH and TTE-LVH is a useful predictor of adverse clinical outcomes after TAVI.
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Affiliation(s)
- Masashi Koga
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masaki Izumo
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan.
| | - Kihei Yoneyama
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Shinichi Shirai
- Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hiroshi Ueno
- Department of Cardiovascular Medicine, Toyama University Hospital, Toyama, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Kazuki Mizutani
- Department of Cardiology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan; Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Shekhar S, Kaw R, Ramu SK, Pampori A, Isogai T, Krishnaswamy A, Puri R, Reed G, Harb SC, Yun J, Kapadia SR. Outcomes After Isolated Aortic Valve Replacements in Patients With Chronic Obstructive Pulmonary Disease. Am J Cardiol 2023; 200:72-74. [PMID: 37302283 DOI: 10.1016/j.amjcard.2023.04.044] [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: 02/22/2023] [Revised: 04/16/2023] [Accepted: 04/30/2023] [Indexed: 06/13/2023]
Affiliation(s)
| | - Roop Kaw
- Departments of Hospital Medicine; Departments of Anesthesiology Outcomes Research
| | | | | | | | | | | | | | | | - James Yun
- Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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8
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Patail H, Kompella R, Hoover NE, Reis W, Masih R, Mather JF, Sutton TS, McKay RG. In-Hospital and One-Year Outcomes of Transcatheter Aortic Valve Replacement in Patients Requiring Supplemental Home Oxygen Use. Cardiol Res 2023; 14:228-236. [PMID: 37304920 PMCID: PMC10257506 DOI: 10.14740/cr1497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
Background There have been limited reports with inconsistent results on the impact of long-term use of oxygen therapry (LTOT) in patients treated with transcatheter aortic valve replacement (TAVR). Methods We compared in-hospital and intermediate TAVR outcomes in 150 patients requiring LTOT (home O2 cohort) with 2,313 non-home O2 patients. Results Home O2 patients were younger, and had more comorbidities including chronic obstructive pulmonary disease (COPD), diabetes, carotid artery disease, lower forced expiratory volume (FEV1) (50.3±21.1% vs. 75.0±24.7%, P < 0.001), and lower diffusion capacity (DLCO, 48.6±19.2% vs. 74.6±22.4%, P < 0.001). These differences represented higher baseline Society of Thoracic Surgeons (STS) risk score (15.5±10.2% vs. 9.3±7.0%, P < 0.001) and lower pre-procedure Kansas City Cardiomyopathy Questionnaire (KCCQ-12) scores (32.5 ± 22.2 vs. 49.1 ± 25.4, P < 0.001). The home O2 cohort required higher use of alternative TAVR vascular access (24.0% vs. 12.8%, P = 0.002) and general anesthesia (51.3% vs. 36.0%, P < 0.001). Compared to non-home O2 patients, home O2 patients showed increased in-hospital mortality (5.3% vs. 1.6%, P = 0.001), procedural cardiac arrest (4.7% vs. 1.0%, P < 0.001), and postoperative atrial fibrillation (4.0% vs. 1.5%, P = 0.013). At 1-year follow-up, the home O2 cohort had a higher all-cause mortality (17.3% vs. 7.5%, P < 0.001) and lower KCCQ-12 scores (69.5 ± 23.8 vs. 82.1 ± 19.4, P < 0.001). Kaplan-Meir analysis revealed a lower survival rate in the home O2 cohort with an overall mean (95% confidence interval (CI)) survival time of 6.2 (5.9 - 6.5) years (P < 0.001). Conclusion Home O2 patients represent a high-risk TAVR cohort with increased in-hospital morbidity and mortality, less improvement in 1-year KCCQ-12, and increased mortality at intermediate follow-up.
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Affiliation(s)
- Haris Patail
- Department of Internal Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Ritika Kompella
- Department of Internal Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | | | - Wyona Reis
- Department of Cardiology, Hartford Hospital, Hartford, CT, USA
| | - Rohit Masih
- Department of Internal Medicine, Hartford Hospital, Hartford, CT, USA
| | - Jeff F. Mather
- Department of Research Administration, Hartford Hospital, Hartford, CT, USA
| | - Trevor S. Sutton
- Integrated Anesthesia Associates, Hartford Hospital, Hartford, CT, USA
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Lauridsen MD, Valentin JB, Strange JE, Jacobsen PA, Køber L, Weinreich U, Johnsen SP, Fosbøl E. Mortality in patients with chronic obstructive pulmonary disorder undergoing transcatheter aortic valve replacement: The importance of chronic obstructive pulmonary disease exacerbation. Am Heart J 2023; 262:100-109. [PMID: 37116603 DOI: 10.1016/j.ahj.2023.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Severe chronic obstructive pulmonary disease (COPD) has been associated with futile outcome after transcatheter aortic valve replacement (TAVR). Data on outcomes according to COPD severity are warranted to aid identification of patients who may not benefit from TAVR. We aimed to examine the association between risk of COPD exacerbation and 1-year mortality after TAVR. METHODS Using Danish nationwide registries we identified patients undergoing first-time TAVR during 2008-2021 by COPD status. COPD severity levels were defined as low or high risk of acute exacerbation of COPD (AE-COPD) and treatment intensity levels (none or short-term, mono/dual, triple therapy, or home oxygen). Kaplan-Meier functions and adjusted Cox regression models were used to assess 1-year mortality comparing COPD severity groups with patients without COPD. RESULTS We identified 7,047 patients with TAVR of whom 644 had a history of COPD (low risk of AE-COPD: 439, high risk of AE-COPD: 205). The median age of the TAVR cohort was 81.4 years (IQR: 76.8-85.1) and 55.8% were males. One-year mortality for TAVR patients without COPD was 8.5% (95% CI: 7.8-9.2) and 15.4% (95% CI: 12.5-18.2) for those with COPD (adjusted HR: 1.63 [95% CI: 1.28-2.07]). Patients with low or high risk of AE-COPD had 1-year mortality of 13.1% (95% CI: 9.8-16.3) and 20.2% (95% CI: 14.6-25.8) corresponding to adjusted HRs of 1.31 (95% CI: 0.97-1.78) and 2.44 (95% CI: 1.70-3.50) compared with patients without COPD. Patients with high risk of AE-COPD and no/short term therapy or use of home oxygen represented the subgroups of patients with the highest 1-year mortality (31.6% [95% CI: 14.5-48.7] and 30.9% [95% CI: 10.3-51.6]). CONCLUSION Among patients undergoing TAVR, increasing risk of exacerbation with COPD was associated with increasing 1-year mortality compared with non-COPD patients. Patients with a high risk of exacerbation with COPD not using any guideline recommended COPD medication and those using home oxygen had the highest 1-year mortality.
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Affiliation(s)
- Marie Dam Lauridsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Danish Center for Clinical Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; The Clinical Institute, Aalborg University, Aalborg, Denmark; Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.
| | - Jan Brink Valentin
- Danish Center for Clinical Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Jarl Emanuel Strange
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Peter A Jacobsen
- The Clinical Institute, Aalborg University, Aalborg, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulla Weinreich
- The Clinical Institute, Aalborg University, Aalborg, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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10
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Myagmardorj R, Nabeta T, Hirasawa K, Singh GK, van der Kley F, de Weger A, Ajmone Marsan N, Bax JJ, Delgado V. Association Between Chronic Obstructive Pulmonary Disease and All-Cause Mortality After Aortic Valve Replacement for Aortic Stenosis. Am J Cardiol 2023; 190:41-47. [PMID: 36549069 DOI: 10.1016/j.amjcard.2022.11.007] [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: 06/16/2022] [Revised: 10/07/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) and aortic stenosis (AS) are the most common diseases in which age plays a major role in the increase of their prevalence and when they co-exist, the outcomes prognosis worsens significantly. The aim of the present study was to evaluate the association between pulmonary functional parameters and all-cause mortality after aortic valve replacement (transcatheter or surgical). A total of 400 patients with severe AS and preoperative pulmonary functional test were retrospectively analyzed. Echocardiography and pulmonary functional parameters before aortic valve replacement were collected. COPD severity was defined according to criteria from the Society of Thoracic Surgeons. COPD was present in 128 patients (32%) with severe AS. Patients without COPD had smaller left ventricular (LV) mass and LV end-systolic volume and better LV function than the group with COPD. During a median follow-up of 32 months, 92 patients (23%) died. The survival rates were significantly lower in patients with moderate and severe COPD (log-rank p = 0.003). In the multivariable Cox regression analysis, any grade of COPD was associated with an approximately 2-fold increased risk of all-cause mortality (hazard ratio 1.933; 95% confidence interval 1.166 to 3.204; p = 0.011 for mild COPD and hazard ratio 2.028; 95% confidence interval 1.154 to 3.564; p = 0.014 for moderate or severe COPD). In addition to other clinical factors, any grade of COPD was associated with 2-fold increased risk of all-cause mortality.
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Affiliation(s)
| | | | | | | | | | - Arend de Weger
- Department of Cardio-Thoracic Surgery, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Victoria Delgado
- Department of Cardiology; Department of Cardiovascular Imaging, University Hospital Germans Trias i Pujol, Barcelona, Spain
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11
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Delijani D, Li L, Rutkin B, Wilson S, Kennedy KF, Hartman AR, Yu PJ. Impact of age on outcomes after transcatheter aortic valve implantation. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:135-141. [PMID: 35533405 DOI: 10.1093/ehjqcco/qcac021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/20/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022]
Abstract
AIMS Usage of transcatheter aortic valve implantation (TAVI) for treatment of severe aortic stenosis is increasing across age groups. However, literature on age-specific TAVI outcomes is lacking. The purpose of this study is to assess the risks of procedural complications, mortality, and readmission in patients undergoing TAVI across different age groups. METHODS AND RESULTS The Nationwide Readmissions Database was used to identify 84 017 patients undergoing TAVI from 2016 to 2018. Patients were stratified into four age groups: younger than 70, 70-79, 80-89, and older than 90. Complications, mortality, and readmission rates were compared between groups in a proportional hazards regression model. Risk of post-procedural stroke, acute kidney injury, and pacemaker or implantable cardioverter defibrillator implantation increased with incremental age grouping. Compared with patients younger than 70, patients aged 70-79 had no significant difference in mortality, whereas patients aged 80-89 and older than 90 had an increased mortality risk [odds ratio (OR) 1.39, confidence interval (CI) 1.14-1.70, P = 0.001 and OR 1.68, CI 1.33-2.12, P < 0.001, respectively]. Patients aged 80-89 and older than 90 had increased overall readmission compared with patients younger than 70 (HR 1.09, CI 1.03-1.14, P = 0.001 and HR 1.33, CI 1.25-1.41, P < 0.001, respectively). Cardiac readmissions followed the same trend. CONCLUSION Patients aged 80-89 and older than 90 undergoing TAVI have increased risk of readmission, complications, and mortality compared with patients younger than 70.
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Affiliation(s)
- David Delijani
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Leo Li
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Bruce Rutkin
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Sean Wilson
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Kevin F Kennedy
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64111, USA
| | - Alan R Hartman
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
| | - Pey-Jen Yu
- Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY 11030, USA
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12
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Aslan S, Güner A, Demir AR, Yılmaz E, Aslan AF, Çelik Ö, Uzun F, Ertürk M. Conscious sedation versus general anesthesia for transcatheter aortic valve implantation in patients with severe chronic obstructive pulmonary disease. Perfusion 2023; 38:186-192. [PMID: 34590527 DOI: 10.1177/02676591211045801] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is considered a major risk factor for postoperative complications after transcatheter aortic valve implantation (TAVI). To date, there is no clear consensus on the best anesthesia management for these patients. We aimed to investigate the effects of types of anesthesia on clinical outcomes in patients with severe COPD undergoing TAVI. METHODS This is a single-center, retrospective study comparing conscious sedation (CS) versus general anesthesia (GA) in 72 patients with severe COPD who underwent TAVI. The primary endpoints were 30-day all-cause mortality and postoperative pulmonary complications. RESULTS The main outcome of interest of this study was that the frequency of pulmonary complications was statistically higher in the GA group (21.4% vs 3.3%, p = 0.038). These differences are most likely attributed to the GA because of prolonged mechanical ventilation, and longer ICU stay (2 (1.2-3) vs 2.5 (2-4) days, p = 0.029) associated with an increased risk of nosocomial infections. There were no significant differences in procedure complications and 30-day mortality between the two groups (GA; 19% vs CS; 13.3%, p = 0.521). One-year survival rates, compared by Kaplan-Meier analysis, were similar between groups (log-rank p = 0.733). CONCLUSION In aortic stenosis patients with severe COPD undergoing TAVI, the use of GA compared with CS was associated with higher incidences of respiratory-related complications, and longer ICU length of stay. CS is a safe and viable option for these patients and should be considered the favored approach.
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Affiliation(s)
- Serkan Aslan
- Department of Cardiology, University Of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Güner
- Department of Cardiology, University Of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Rıza Demir
- Department of Cardiology, University Of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Emre Yılmaz
- Department of Cardiology, University Of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ayşe Feyza Aslan
- Department of Chest Diseases, University Of Health Sciences Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ömer Çelik
- Department of Cardiology, University Of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Fatih Uzun
- Department of Cardiology, University Of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Ertürk
- Department of Cardiology, University Of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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13
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Yang R, Grober AF, Riojas R, Ponna V, Shunk KA, Zimmet JM, Gustafson J, Ge L, Tseng EE. Midterm Durability and Structural Valve Degeneration of Transcatheter Aortic Valve Replacement in a Federal Facility. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:382-391. [PMID: 36217736 PMCID: PMC9761483 DOI: 10.1177/15569845221123259] [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: 11/17/2022]
Abstract
OBJECTIVE Transcatheter aortic valve replacement (TAVR), previously reserved for patients of intermediate to prohibitive surgical risk, has now been expanded to patients of any surgical risk with severe aortic stenosis. Bioprostheses are prone to structural valve degeneration (SVD), a progressive and multifactorial process that limits valve durability. As the population undergoing TAVR shifts toward a lower-risk and younger profile, long-term durability is a crucial determinant for patient outcomes. Our objective was to determine the incidence and risk factors of SVD at midterm follow-up in a veteran TAVR population. METHODS Patients undergoing TAVR at our federal facility were retrospectively evaluated for SVD and other endpoints with standardized consensus criteria. Multivariable Cox proportional hazards analysis was performed to evaluate risk factors for mortality and SVD. RESULTS From 2013 to 2020, 344 patients (median age, 78 years) underwent TAVR. Survival from all-cause mortality was 91.3% at 1 year, 75.1% at 3 years, and 61.7% at 5 years. Cumulative freedom from SVD was 98.2% at 1 year, 96.5% at 3 years, and 93.7% at 5 years. All 13 patients with SVD met hemodynamic criteria, and 1 required intervention. Median time to hemodynamic SVD was 1.04 years. Independent risk factors for SVD included age (hazard ratio [HR] = 0.92, 95% confidence interval [CI]: 0.86 to 0.99) and valve size (HR = 0.19, 95% CI: 0.04 to 0.89). CONCLUSIONS SVD was evident at a low but detectable rate at 5-year follow-up. Further understanding of TAVR biomechanics as well as continued longer-term follow-up will be essential for informing patient-specific risk of SVD.
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Affiliation(s)
- Rachel Yang
- Division of Cardiothoracic Surgery,
University of California San Francisco and San Francisco VA Medical Center, CA,
USA
| | - Aaron F. Grober
- Division of Cardiology, University of
California San Francisco and San Francisco VA Medical Center, CA, USA
| | - Ramon Riojas
- Division of Cardiothoracic Surgery,
University of California San Francisco and San Francisco VA Medical Center, CA,
USA
| | - Vimala Ponna
- Division of Cardiothoracic Surgery,
University of California San Francisco and San Francisco VA Medical Center, CA,
USA
| | - Kendrick A. Shunk
- Division of Cardiology, University of
California San Francisco and San Francisco VA Medical Center, CA, USA
| | - Jeffrey M. Zimmet
- Division of Cardiology, University of
California San Francisco and San Francisco VA Medical Center, CA, USA
| | - Joshua Gustafson
- Division of Cardiothoracic Surgery,
University of California San Francisco and San Francisco VA Medical Center, CA,
USA,Uniformed Services University of the
Health Sciences, Bethesda, MD, USA
| | - Liang Ge
- Division of Cardiothoracic Surgery,
University of California San Francisco and San Francisco VA Medical Center, CA,
USA
| | - Elaine E. Tseng
- Division of Cardiothoracic Surgery,
University of California San Francisco and San Francisco VA Medical Center, CA,
USA,Elaine E. Tseng, MD, Division of
Cardiothoracic Surgery, University of California San Francisco and San Francisco
VA Medical Center, 500 Parnassus Ave, Ste 405W, Box 0118, San Francisco, CA
94143, USA.
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14
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Kumar K, Morris CC, Samhan A, Herman T, Chau T, Lantz G, Chadderdon SM, Song HK, Zahr FE, Golwala H. Intermediate-Term Outcomes Following Transcatheter Aortic Valve Implantation in Patients With a History of Supplemental Home Oxygen Use. Am J Cardiol 2022; 167:159-160. [PMID: 34986989 DOI: 10.1016/j.amjcard.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 11/01/2022]
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15
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Yang Y, Ahn JM, Kang DY, Ko E, Kim S, Kim TO, Kim JH, Lee J, Lee SA, Kim DH, Kim HJ, Kim JB, Choo SJ, Park SJ, Park DW. Implication of Different ECG Left Ventricular Hypertrophy in Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2022; 11:e023647. [PMID: 35112886 PMCID: PMC9245797 DOI: 10.1161/jaha.121.023647] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Various ECG criteria for left ventricular hypertrophy (LVH) have been proposed, but their association with clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement is unknown. We investigated the prevalence of ECG LVH according to different criteria and its prognostic impact on clinical outcomes after transcatheter aortic valve replacement. Methods and Results In this prospective observational cohort, we evaluated 700 patients who underwent transcatheter aortic valve replacement between March 2010 and December 2019. Baseline preprocedural LVH was defined by 3 ECG criteria—Sokolow‐Lyon, Romhilt‐Estes, and Cornell voltage criteria. The primary outcome was major adverse cardiac or cerebrovascular event (MACCE; composite of death, myocardial infarction, stroke, or rehospitalization from cardiovascular cause); the key secondary outcome was all‐cause and cardiovascular mortality. Among 596 eligible patients, the prevalence of LVH was determined as 56.3% by Sokolow‐Lyon, 31.1% by Romhilt‐Estes, and 48.1% by Cornell criteria. Regardless of the criteria, patients with ECG LVH had more severe aortic stenosis hemodynamics and higher left ventricular mass index. After multivariate adjustment, the presence of LVH by the Cornell criteria was significantly associated with lower risks of MACCE (adjusted hazard ratio [HR], 0.68; 95% CI, 0.51–0.91; P=0.009), all‐cause mortality (adjusted HR, 0.55; 95% CI, 0.34–0.90 [P=0.017]), and cardiovascular mortality (adjusted HR, 0.40; 95% CI, 0.20–0.79 [P=0.008]). However, this association was absent with the Sokolow‐Lyon and Romhilt‐Estes criteria. Conclusions ECG LVH by Cornell criteria only was significantly associated with lower risks of MACCE and all‐cause or cardiovascular mortality. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03298178.
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Affiliation(s)
- Yujin Yang
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Jung-Min Ahn
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Do-Yoon Kang
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Euihong Ko
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Seonok Kim
- Department of Clinical Epidemiology and Biostatistics University of Ulsan College of Medicine Seoul Republic of Korea
| | - Tae Oh Kim
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Ju Hyeon Kim
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Junghoon Lee
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Seung-Ah Lee
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Duk-Woo Park
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
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16
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Kjønås D, Schirmer H, Aakhus S, Eidet J, Malm S, Aaberge L, Busund R, Rösner A. Clinical and Echocardiographic Parameters Predicting 1- and 2-Year Mortality After Transcatheter Aortic Valve Implantation. Front Cardiovasc Med 2021; 8:739710. [PMID: 34938779 PMCID: PMC8685271 DOI: 10.3389/fcvm.2021.739710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 11/02/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has become a standard treatment option for patients with symptomatic aortic stenosis. Elderly high-risk patients treated with TAVI have a high residual mortality due to preexisting comorbidities. Knowledge of factors predicting futility after TAVI is sparse and clinical tools to aid the preoperative evaluation are lacking. The aim of this study was to evaluate if echocardiographic measures, including speckle-tracking analysis, in addition to clinical parameters, could aid in the prediction of mortality beyond 30 days after TAVI. Methods: This prospective observational cohort study included 227 patients treated with TAVI at the University Hospital of North Norway, Tromsø and Oslo University Hospital, Rikshospitalet from February 2010 to June 2013. All the patients underwent preoperative echocardiographic evaluation with retrospective speckle-tracking analysis. Primary endpoints were 1- and 2-year mortality beyond 30 days after TAVI. Results: All-cause 1- and 2-year mortality beyond 30 days after TAVI was 12.1 and 19.5%, respectively. Predictors of 1-year mortality beyond 30 days were body mass index [hazard ratio (HR): 0.88, 95% CI: 0.80-0.98, p = 0.018], previous myocardial infarction (HR: 2.69, 95% CI: 1.14-6.32, p = 0.023), and systolic pulmonary artery pressure ≥ 60 mm Hg (HR: 5.93, 95% CI: 1.67-21.1, p = 0.006). Moderate-to-severe mitral regurgitation (HR: 2.93, 95% CI: 1.53-5.63, p = 0.001), estimated glomerular filtration rate (HR: 0.98, 95% CI: 0.96-0.99, p = 0.002), and chronic obstructive pulmonary disease (HR: 1.9, 95% CI: 1.01-3.58, p = 0.046) were predictors of 2-year mortality. Conclusion: Both the clinical and echocardiographic parameters should be considered when evaluating high-risk patients for TAVI, as both are predictive of 1-and 2-year mortality. Our results support the importance of individual risk assessment using a multidisciplinary, multimodal, and individual approach.
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Affiliation(s)
- Didrik Kjønås
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Henrik Schirmer
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Svend Aakhus
- Department of Circulation and Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Jo Eidet
- Department of Anesthesiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Siri Malm
- Department of Cardiology, University Hospital of North Norway, Harstad, Norway
| | - Lars Aaberge
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Rolf Busund
- Institute of Clinical Medicine, The Arctic University of Norway (UiT), Tromsø, Norway
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Assami Rösner
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
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17
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Baritello O, Salzwedel A, Sündermann SH, Niebauer J, Völler H. The Pandora's Box of Frailty Assessments: Which Is the Best for Clinical Purposes in TAVI Patients? A Critical Review. J Clin Med 2021; 10:jcm10194506. [PMID: 34640525 PMCID: PMC8509314 DOI: 10.3390/jcm10194506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/15/2021] [Accepted: 09/24/2021] [Indexed: 02/07/2023] Open
Abstract
Frailty assessment is recommended before elective transcatheter aortic valve implantation (TAVI) to determine post-interventional prognosis. Several studies have investigated frailty in TAVI-patients using numerous assessments; however, it remains unclear which is the most appropriate tool for clinical practice. Therefore, we evaluate which frailty assessment is mainly used and meaningful for ≤30-day and ≥1-year prognosis in TAVI patients. Randomized controlled or observational studies (prospective/retrospective) investigating all-cause mortality in older (≥70 years) TAVI patients were identified (PubMed; May 2020). In total, 79 studies investigating frailty with 49 different assessments were included. As single markers of frailty, mostly gait speed (23 studies) and serum albumin (16 studies) were used. Higher risk of 1-year mortality was predicted by slower gait speed (highest Hazard Ratios (HR): 14.71; 95% confidence interval (CI) 6.50–33.30) and lower serum albumin level (highest HR: 3.12; 95% CI 1.80–5.42). Composite indices (five items; seven studies) were associated with 30-day (highest Odds Ratio (OR): 15.30; 95% CI 2.71–86.10) and 1-year mortality (highest OR: 2.75; 95% CI 1.55–4.87). In conclusion, single markers of frailty, in particular gait speed, were widely used to predict 1-year mortality. Composite indices were appropriate, as well as a comprehensive assessment of frailty.
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Affiliation(s)
- Omar Baritello
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, 14469 Brandenburg, Germany;
- Research Group Molecular and Clinical Life Science of Metabolic Diseases, Faculty of Health Sciences Brandenburg, University of Potsdam, 14476 Potsdam, Germany;
| | - Annett Salzwedel
- Research Group Molecular and Clinical Life Science of Metabolic Diseases, Faculty of Health Sciences Brandenburg, University of Potsdam, 14476 Potsdam, Germany;
| | - Simon H. Sündermann
- Department of Cardiovascular Surgery, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany;
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, 13353 Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, 13353 Berlin, Germany
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, A-5020 Salzburg, Austria;
| | - Heinz Völler
- Research Group Molecular and Clinical Life Science of Metabolic Diseases, Faculty of Health Sciences Brandenburg, University of Potsdam, 14476 Potsdam, Germany;
- Correspondence: ; Tel.: +49-(03)-319774061
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18
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Huckaby LV, Aranda-Michel E, Sultan I, Chu D, Chen S, Thoma F, Kilic A. Outcomes in Patients With Severe Chronic Lung Disease Undergoing Index Cardiac Operations. Ann Thorac Surg 2021; 112:481-486. [PMID: 33275933 PMCID: PMC9098253 DOI: 10.1016/j.athoracsur.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/28/2020] [Accepted: 11/10/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study evaluated the impact of severe chronic lung disease on outcomes of index adult cardiac operations. METHODS A single-center, retrospective study of adult patients with severe chronic lung disease (as defined by The Society of Thoracic Surgeons) undergoing index cardiac operations between 2010 and 2018 was performed. Multivariable Cox regression and Kaplan-Meier analyses were used to evaluate survival. RESULTS Three hundred fifty-four patients (median age, 69 years; 32.77% women) were identified. Current smokers comprised 42.66% of the population, and 34.65% of patients required home oxygen. Median preoperative forced expiratory volume in 1 second was 48% of predicted (interquartile range, 41%-56%), and median diffusing capacity of the lungs for carbon monoxide was 78% of predicted (interquartile range, 55%-101%). Most patients underwent isolated coronary artery bypass (57.06%) or isolated aortic valve replacement (19.49%). Overall, 33 patients (9.07%) required a tracheostomy (median of 10 days from surgery) for a median of 49 days (interquartile range, 25-114) until decannulation. Preoperative home oxygen use was an independent predictor of 30-day (hazard ratio, 2.91; P = .030) and 1-year (hazard ratio, 2.12; P = .009) mortality. One-year and 5-year postoperative survival were 83.62% and 58.34%, respectively. CONCLUSIONS Although severe chronic lung disease is a predictor of mortality and morbidity after index cardiac operations, only 9% of patients required a tracheostomy, and most were alive at 5 years after surgery. Home oxygen use may serve as a further stratification tool in this higher risk subset; however the presence of severe chronic lung disease alone should not deter from surgery in otherwise reasonable surgical candidates.
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Affiliation(s)
- Lauren V Huckaby
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Edgar Aranda-Michel
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Danny Chu
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Shangzhen Chen
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd Thoma
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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19
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Feldman DR, Romashko MD, Koethe B, Patel S, Rastegar H, Zhan Y, Resor CD, Connors AC, Kimmelstiel C, Allen D, Weintraub AR, Wessler BS. Comorbidity Burden and Adverse Outcomes After Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2021; 10:e018978. [PMID: 33960198 PMCID: PMC8200712 DOI: 10.1161/jaha.120.018978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for symptomatic patients with aortic stenosis and elevated procedural risk. Many deaths following TAVR are because of noncardiac causes and comorbid disease burden may be a major determinant of postprocedure outcomes. The prevalence of comorbid conditions and associations with outcomes after TAVR has not been studied. Methods and Results This was a retrospective single‐center study of patients treated with TAVR from January 2015 to October 2018. The association between 21 chronic conditions and short‐ and medium‐term outcomes was assessed. A total of 341 patients underwent TAVR and had 1‐year follow‐up. The mean age was 81.4 (SD 8.0) years with a mean Society of Thoracic Surgeons predicted risk of mortality score of 6.7% (SD 4.8). Two hundred twenty (65%) patients had ≥4 chronic conditions present at the time of TAVR. There was modest correlation between Society of Thoracic Surgeons predicted risk of mortality and comorbid disease burden (r=0.32, P<0.001). After adjusting for Society of Thoracic Surgeons predicted risk of mortality, age, and vascular access, each additional comorbid condition was associated with increased rates of 30‐day rehospitalizations (odds ratio, 1.21; 95% CI, 1.02–1.44), a composite of 30‐day rehospitalization and 30‐day mortality (odds ratio, 1.20; 95% CI, 1.02–1.42), and 1‐year mortality (odds ratio, 1.29; 95% CI, 1.05–1.59). Conclusions Comorbid disease burden is associated with worse clinical outcomes in high‐risk patients treated with TAVR. The risks associated with comorbid disease burden are not adequately captured by standard risk assessment. A systematic assessment of comorbid conditions may improve risk stratification efforts.
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Affiliation(s)
| | | | - Benjamin Koethe
- Institute for Clinical Research and Health Policy Studies Biostatistics, Epidemiology, and Research Design (BERD) Center Tufts Medical Center Boston MA
| | - Sonika Patel
- Department of Internal Medicine University of Maryland Baltimore MD
| | - Hassan Rastegar
- Division of Cardiothoracic Surgery Tufts Medical Center Boston MA
| | - Yong Zhan
- Division of Cardiothoracic Surgery Tufts Medical Center Boston MA
| | | | | | | | - David Allen
- Department of Interventional Radiology Tufts Medical Center Boston MA
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20
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Asgar AW, Jamart L. Out-of-Hospital Mortality Following TAVR: Decrypting the Enigma. JACC Cardiovasc Interv 2021; 14:275-277. [PMID: 33541538 DOI: 10.1016/j.jcin.2020.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Anita W Asgar
- Division of Cardiology, Montreal Heart Institute, Université de Montreal, Montreal, Quebec, Canada.
| | - Laurent Jamart
- Division of Cardiology, Montreal Heart Institute, Université de Montreal, Montreal, Quebec, Canada
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21
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Martha JW, Pranata R, Yonas E, Wibowo A, Akbar MR. Absence of electrocardiographic left ventricular hypertrophy and poor outcome in patients undergoing transcatheter aortic valve replacement-A systematic review and meta-analysis. J Card Surg 2021; 36:2233-2239. [PMID: 33768590 DOI: 10.1111/jocs.15515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/13/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to evaluate whether the absence of electrocardiographic (ECG) left ventricular hypertrophy (LVH) was associated with poor outcome in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS We performed systematic review search on PubMed, Embase, and Scopus up until January 22, 2021. The key exposure was the absence of ECG LVH, defined as the absence of LVH by electrocardiographic criteria. The outcome of interest was composite poor outcome, which is a composite of mortality and/or rehospitalization after TAVR. The effect estimate was reported as hazard ratio (HR). In addition, we generate sensitivity and specificity, positive and negative likelihood ratio (PLR and NLR), diagnostic odds ratio (DOR), and area under curve (AUC). RESULTS There are four studies comprising of 827 patients included in this systematic review and meta-analysis. The prevalence of poor outcome in this pooled analysis was 30%. The absence of ECG LVH was associated with increased poor outcome in patients undergoing TAVR (HR: 1.86, [1.34, 2.57], p < .001; I2 : 0%). Absence of ECG LVH was associated with a sensitivity of 0.75 [0.64, 0.83], specificity of 0.42 [0.30, 0.55], PLR of 1.3 [1.1, 1.5], NLR of 0.60 [0.45, 0.80], DOR 2 [1, 5], and AUC of 0.66 [0.62, 0.70]. Fagan's nomogram indicates in a 22% prevalence of poor outcome in the included studies, the absence of ECG LVH and ECG LVH was associated with 27% and 15% posttest probability for poor outcome, respectively. CONCLUSION Absence of ECG LVH was associated with poor outcome in patients undergoing TAVR.
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Affiliation(s)
- Januar W Martha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia
| | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.,Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Emir Yonas
- Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
| | - Arief Wibowo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia
| | - Mohammad R Akbar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia
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22
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Imamura T. Chronic lung disease and quality of life following transcatheter aortic valve replacement. J Card Surg 2021; 36:800. [PMID: 33512734 DOI: 10.1111/jocs.15386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, Japan
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23
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Catalano MA, Lin D, Mullan CW, Cassiere H, Rutkin B, Maurer G, Berg J, Hartman A, Yu PJ. Impact of chronic lung disease on quality-of-life outcomes in patients undergoing transcatheter aortic valve replacement. J Card Surg 2021; 36:672-677. [PMID: 33403744 DOI: 10.1111/jocs.15248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND As the symptoms for both chronic lung disease (CLD) and aortic stenosis (AS) frequently overlap, it may be challenging to determine the degree of symptomatic improvement expected for a patient with CLD after correction of AS. Our aim was to determine if patients with CLD have the same degree of quality-of-life improvement following transcatheter aortic valve replacement (TAVR) as patients without CLD. METHODS A retrospective review of 238 TAVR patients from January 2017 to November 2018 who underwent preoperative pulmonary function tests and completed 30-day follow-up was performed. Patients were identified as having CLD with FEV1 more than 75% predicted. Postoperative outcomes and changes in Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) were compared between groups. RESULTS Of the 238 patients identified, 143 (60.0%) had CLD, 50 (35.0%) of whom had an obstructive disease pattern. Patients with CLD were more likely to be male, had higher rates of peripheral artery disease, and had lower baseline ejection fraction. There was no difference in STS Predicted Risk of Mortality, but patients with CLD were more likely to be designated as high-risk by surgeon evaluation. While initial and follow-up KCCQ-12 was lower for patients with CLD, there was no significant difference in degree of improvement (p = .900). When comparing patients with obstructive lung disease (FEV1/FVC < 0.70) to those without CLD, there was also no significant difference in the change of quality of life (p = .720). CONCLUSION Although patients with concomitant severe AS and CLD have reduced baseline quality of life compared to patients without CLD, they experience a comparable degree of improvement following TAVR.
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Affiliation(s)
- Michael A Catalano
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhas, New York, USA
| | | | - Clancy W Mullan
- Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Hugh Cassiere
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhas, New York, USA
| | - Bruce Rutkin
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhas, New York, USA
| | - Greg Maurer
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhas, New York, USA
| | - Jacinda Berg
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhas, New York, USA
| | - Alan Hartman
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhas, New York, USA
| | - Pey-Jen Yu
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhas, New York, USA
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24
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Mendoza CE, Celli D. Is transaortic valve replacement the modality of choice in patients with chronic lung disease? J Card Surg 2020; 36:678-679. [PMID: 33403719 DOI: 10.1111/jocs.15243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Cesar E Mendoza
- Division of Cardiovascular Disease, Jackson Memorial Hospital, Miami, Florida, USA
| | - Diego Celli
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida, USA
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25
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Takagi H, Kuno T, Hari Y, Nakashima K, Yokoyama Y, Ueyama H, Ando T. Transcatheter versus surgical aortic valve replacement in patients with chronic obstructive pulmonary disease. SCAND CARDIOVASC J 2020; 55:168-172. [PMID: 33356924 DOI: 10.1080/14017431.2020.1866210] [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] [Indexed: 10/22/2022]
Abstract
Although a number of studies compared mortality after transcatheter aortic valve implantation (TAVI) with that after surgical aortic replacement (SAVR) in patients with chronic obstructive pulmonary disease (COPD), no meta-analysis of them has been conducted to date. To determine whether TAVI or SAVR is associated with better postprocedural survival in patients with COPD, a meta-analysis of all studies currently available was performed. Design. To identify all comparative studies of TAVI with SAVR in patients with COPD, PubMed and Web of Science were searched through January 2020. Studies meeting the following criteria were included in the present meta-analysis: the design was an observational comparative study or a randomized controlled trial; the study population was patients with COPD; patients were assigned to TAVI versus SAVR; and outcomes included all-cause mortality. Adjusted (if unavailable, unadjusted) odds or hazard ratios with their confidence intervals (CIs) of mortality for TAVI versus SAVR were extracted from each study. Study-specific estimates were combined in the random-effects model. Results. Six eligible studies with a total of 4771 patients with COPD were identified and included in the present meta-analysis. The meta-analysis indicated significantly lower early (in-hospital or 30-day) mortality after TAVI than after SAVR (odds ratio, 0.69; 95% CI, 0.53-0.90; p = .006) but no significant difference in midterm (1-year to 5-year) mortality between TAVI and SAVR (hazard ratio, 1.07; 95% CI, 0.79-1.44; p = .68). Conclusions. In patients with COPD, TAVI was associated with reduced early mortality, while midterm mortality appeared similar, as compared with SAVR.
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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
| | - Toshiki Kuno
- Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - 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
| | | | - Hiroki Ueyama
- Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - Tomo Ando
- Division of Interventional Cardiology, Department of Cardiology, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
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26
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Furzan A, Quraishi SA, Brovman E, Weintraub A, Connors A, Allen D, Patel PA, Cobey FC. Skeletal Muscle Characteristics May Inform Preprocedural Risk Stratification in Transcatheter Aortic Valve Replacement Patients. J Cardiothorac Vasc Anesth 2020; 35:2618-2625. [PMID: 33451956 DOI: 10.1053/j.jvca.2020.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Low psoas muscle mass previously has been associated with mortality after transcatheter aortic valve replacement (TAVR). Evidence from other clinical disciplines suggests that psoas density (PD) may be a better predictor than psoas muscle cross-sectional area indexed to body surface area (PI). The authors hypothesized that PD would be more strongly correlated with patient discharge disposition and survival after TAVR than PI. DESIGN The authors performed a single-center, retrospective study of TAVR patients from 2013 to 2016. PI and PD were assessed at the third lumbar spine level using computed tomography imaging. Propensity-score matching was used to investigate the association of PI and PD with discharge disposition and mortality. SETTING Tertiary university hospital PARTICIPANTS: Cohort of 245 TAVR patients. INTERVENTIONS None MEASUREMENTS AND MAIN RESULTS: A total of 245 patients met inclusion criteria. Following propensity score matching, patients with PI <4 cm2/m2 and PD <25 Hounsfield units (HU) were less likely to survive and to be discharged home compared with patients with PI ≥4 cm2/m2 or PD >25 HU. After repeating the propensity score matching with PI as a covariable, PD remained associated with mortality (90 days: odds ratio [OR] 4.59; 95% confidence interval [CI] 2.96-10.31, p < 0.001, 1 year: OR 6.14; 95% CI 3.45-28.57, p = 0.01, 3 years: OR 4.55; 95% CI 2.41-40.00, p = 0.03). CONCLUSIONS PD may be more relevant than PI in risk stratification for TAVR patients.
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Affiliation(s)
- Alberto Furzan
- Department of Anesthesiology, Tufts Medical Center, Boston, MA
| | - Sadeq A Quraishi
- Department of Anesthesiology, Tufts Medical Center, Boston, MA; Tufts University School of Medicine, Boston, MA
| | - Ethan Brovman
- Department of Anesthesiology, Tufts Medical Center, Boston, MA
| | | | - Ann Connors
- Department of Cardiology, Tufts Medical Center, Boston, MA
| | - David Allen
- Department of Radiology, Tufts Medical Center, Boston, MA
| | - Prakash A Patel
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Frederick C Cobey
- Department of Anesthesiology, Tufts Medical Center, Boston, MA; Tufts University School of Medicine, Boston, MA.
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27
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Short- and medium-term survival after TAVI: Clinical predictors and the role of the FRANCE-2 score. IJC HEART & VASCULATURE 2020; 31:100657. [PMID: 33145391 PMCID: PMC7591343 DOI: 10.1016/j.ijcha.2020.100657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 12/05/2022]
Abstract
Aim The aim of this study was to explore the value of the FRANCE-2 score in associating with clinical outcome in the medium and short-term after TAVI and to compare its relative merits with other risk score models. Methods 187 consecutive patients undergoing TAVI in a single UK centre were retrospectively studied. The FRANCE-2, logistic EuroSCORE, EuroSCORE II, German AV and STS/ACC TVT risk scores were calculated retrospectively and c-statistics associating with mortality were applied. Survival outcomes were compared between different risk groups according to the FRANCE-2 scores. Results Of the 187 patients, 57.2% were male and their mean age was 80.9 ± 6.9 years. The c-index of FRANCE-2 score for predicting 30-day mortality was 0.793 (p = 0.009), for 1-year mortality 0.679 (p = 0.016) and for 2-year mortality was 0.613 (p = 0.088). The mean survival time for patients with a high FRANCE-2 score (18.6 months) was significantly less than for patients with low and moderate scores (p = 0.0004). The logistic EuroSCORE and EuroSCORE II were poorly associated with 30-day and 1-year mortality. STS/ACC TVT score was best predictive of 1-year mortality and German AV score was moderately predictive of 30-day mortality. Conclusions The FRANCE-2 risk score is associated with differential short- and medium-term survival in patients undergoing TAVI. The presence of a high FRANCE-2 score (>5) is associated with poor survival. The FRANCE-2 scoring system could be considered as a useful additional tool by the Heart multidisciplinary team (MDT) in identifying patients who are likely to have limited survival benefit although this requires further prospective evaluation.
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28
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Allen CJ, Joseph J, Patterson T, Hammond-Haley M, McConkey HZR, Prendergast BD, Marber M, Redwood SR. Baseline NT-proBNP Accurately Predicts Symptom Response to Transcatheter Aortic Valve Implantation. J Am Heart Assoc 2020; 9:e017574. [PMID: 33241754 PMCID: PMC7763793 DOI: 10.1161/jaha.120.017574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Up to 30% of patients undergoing transcatheter aortic valve implantation (TAVI) experience minimal symptomatic benefit or die within 1 year, indicating an urgent need for enhanced patient selection. Previous analyses of baseline NT‐proBNP (N‐terminal pro‐brain natriuretic peptide) and TAVI outcomes have assumed a linear relationship, yielding conflicting results. We reexamined the relationship between baseline NT‐proBNP and symptomatic improvement after TAVI. Methods and Results Symptom status, clinical and echocardiographic data, and baseline NT‐proBNP were reviewed from 144 consecutive patients undergoing TAVI for severe symptomatic aortic stenosis. The primary end point was change in New York Heart Association functional class at 1 year. There was a nonlinear, inverted‐U relationship between log‐baseline NT‐proBNP and post‐TAVI change in NYHA class (R2=0.4559). NT‐proBNP thresholds of <800 and >10 000 ng/L accurately predicted no symptomatic improvement at 1 year (sensitivity 88%, specificity 83%, positive predictive value 72%, negative predictive value 93%). In adjusted analyses, baseline NT‐proBNP outside this “sweet‐spot” range was the only factor independently associated with poor functional outcome (high: NT‐proBNP >10 000 ng/L, odds ratio [OR], 65; 95% CI, 6–664; low: NT‐proBNP <800 ng/L, OR, 73; 95% CI, 7–738). Conclusions Baseline NT‐proBNP is a useful prognostic marker to predict poor symptom relief after TAVI and may indicate when intervention is likely to be futile. Both low (<800 ng/L) and very high (>10 000 ng/L) levels are strongly associated with poor functional outcome, suggesting an alternative cause for symptoms in the former scenario and an irrevocably diseased left ventricle in the latter. Further evaluation of this relationship is warranted.
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Affiliation(s)
- Christopher J Allen
- Cardiovascular Division St. Thomas HospitalKing's College London London United Kingdom.,Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Jubin Joseph
- Cardiovascular Division St. Thomas HospitalKing's College London London United Kingdom.,Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Tiffany Patterson
- Cardiovascular Division St. Thomas HospitalKing's College London London United Kingdom.,Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Matthew Hammond-Haley
- Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Hannah Z R McConkey
- Cardiovascular Division St. Thomas HospitalKing's College London London United Kingdom.,Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Bernard D Prendergast
- Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Michael Marber
- Cardiovascular Division St. Thomas HospitalKing's College London London United Kingdom.,Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Simon R Redwood
- Cardiovascular Division St. Thomas HospitalKing's College London London United Kingdom.,Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
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29
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Absence of electrocardiographic left ventricular hypertrophy in patients undergoing Transcatheter aortic valve replacement is associated with increased mortality. J Electrocardiol 2020; 63:12-16. [DOI: 10.1016/j.jelectrocard.2020.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/18/2020] [Accepted: 09/25/2020] [Indexed: 01/15/2023]
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30
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Wessler BS, Weintraub AR, Udelson JE, Kent DM. Can Clinical Predictive Models Identify Patients Who Should Not Receive TAVR? A Systematic Review. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2020; 4:295-299. [PMID: 32905421 DOI: 10.1080/24748706.2020.1782549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background One third of high- and prohibitive-risk TAVR patients remain severely symptomatic or die 1 year after treatment. There is interest in identifying individuals for whom this procedure is futile and should not be offered. Methods We performed a systematic review of the highest reported stratum of risk in TAVR clinical predictive models (CPMs). We explore whether currently available predictive models can identify patients for whom TAVR is futile, based on a quantitative futility definition and the observed and predicted outcomes for patients in the highest stratum of risk. Results 17 TAVR CPMs representing 69,191 treated patients were published from 2013 to 2018. When reported, the median number of patients in the highest stratum of risk was 569 (range 1 to 1759). Observed mortality for this risk stratum ranged from 9% at 30 days to 59% at 1 year after TAVR. Statistical confidence in these observed event rates was low. The highest predicted event rates ranged from 11.0% for in-hospital mortality to 75.1% for the composite of mortality or high symptom burden 1 year after TAVR. Conclusion No high-risk TAVR group in currently available TAVR CPMs had an appropriate event rate and adequate statistical power to meet a quantitative definition of futility.
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Affiliation(s)
- Benjamin S Wessler
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center.,Predictive Analytics and Comparative Effectiveness (PACE) Center, Tufts Medical Center
| | - Andrew R Weintraub
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center
| | - James E Udelson
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center
| | - David M Kent
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Tufts Medical Center
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31
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Auffret V, Bakhti A, Leurent G, Bedossa M, Tomasi J, Belhaj Soulami R, Verhoye JP, Donal E, Galli E, Loirat A, Sharobeem S, Sost G, Le Guellec M, Boulmier D, Le Breton H. Determinants and Impact of Heart Failure Readmission Following Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2020; 13:e008959. [DOI: 10.1161/circinterventions.120.008959] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Heart failure (HF) readmission is common post–transcatheter aortic valve replacement (TAVR). Nonetheless, limited data are available regarding its predictors and clinical impact. This study evaluated the incidence, predictors, and impact of HF readmission within 1-year post-TAVR, and assessed the effects of the prescription of HF therapies at discharge on the risk of HF readmission and death.
Methods:
Patients included in the TAVR registry of a single expert center from 2009 to 2017 were analyzed. Competing-risk and Cox regressions were performed to identify predictors of HF readmission and death.
Results:
Among 750 patients, 102 (13.6%) were readmitted for HF within 1-year post-TAVR. Overall, 53 patients (7.1%) experienced late readmissions (>30 days post-TAVR), and 17 (2.3%) had multiple readmissions. In ≈30% of readmissions, no trigger could be identified. Predominant causes of readmissions were changes in medication/nonadherence and supraventricular arrhythmia. Independent predictors of HF readmission included diabetes mellitus, chronic lung disease, previous acute HF, grade III or IV aortic regurgitation, and pulmonary hypertension both at discharge from the index hospitalization but not HF therapies. Overall, HF readmission did not significantly impact all-cause mortality (hazard ratio [HR], 1.36 [95% CI, 0.99–1.85]). However, late (HR, 1.90 [95% CI, 1.30–2.78]) and multiple HF readmissions (HR, 2.10 [95% CI,1.17–3.76]) were significantly associated with all-cause mortality. Prescription of renin-angiotensin system inhibitors at discharge was associated with a lower rate of all-cause mortality, especially among patients receiving doses of 25% to <50% (HR, 0.67 [95% CI, 0.48–0.94]) and 75% to 100% (HR, 0.61 [95% CI, 0.37–0.98]) of the optimal daily dose.
Conclusions:
HF readmission is common within 1-year of TAVR. Late and multiple HF readmissions associate with an increased risk of long-term all-cause mortality. Baseline comorbidities (diabetes, chronic lung disease, previous acute HF) and echocardiographic findings at discharge (grade III or IV aortic regurgitation, pulmonary hypertension) identified patients at high risk of HF readmission.
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Affiliation(s)
- Vincent Auffret
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Abdelkader Bakhti
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Guillaume Leurent
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Marc Bedossa
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Jacques Tomasi
- Université de Rennes 1, CHU Rennes Service de Chirurgie Cardiaque, Inserm LTSI U1099, F 35000 Rennes, France (J.T., R.B.S., J.-P.V.)
| | - Reda Belhaj Soulami
- Université de Rennes 1, CHU Rennes Service de Chirurgie Cardiaque, Inserm LTSI U1099, F 35000 Rennes, France (J.T., R.B.S., J.-P.V.)
| | - Jean-Philippe Verhoye
- Université de Rennes 1, CHU Rennes Service de Chirurgie Cardiaque, Inserm LTSI U1099, F 35000 Rennes, France (J.T., R.B.S., J.-P.V.)
| | - Erwan Donal
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Elena Galli
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Aurélie Loirat
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Sam Sharobeem
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Gwenaelle Sost
- Université de Rennes 1, CHU Rennes Service de Gériatrie, F 35000 Rennes, France (G.S.)
| | - Marielle Le Guellec
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Dominique Boulmier
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Hervé Le Breton
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
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32
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Tang L, Sorajja P, Mooney M, Garberich R, Kunz M, Stanberry LI, Ahmed A, Bradley SM, Witt D, Bae R, Niikura H, Steffen R, Gössl M. Transcatheter aortic valve replacement in patients with severe comorbidities: A retrospective cohort study. Catheter Cardiovasc Interv 2020; 97:E253-E262. [PMID: 32511872 DOI: 10.1002/ccd.29063] [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: 04/01/2020] [Accepted: 05/24/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the long-term outcomes of patients with severe comorbidities (sCM) undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND The benefit of TAVR may be limited among patients with sCM due to a lack of mortality- or quality-of-life-benefit. METHODS All TAVR patients in the Allina Health System between January 1, 2011 and August 7, 2018 were included (n = 890, 82 ± 8 years, 55% men). sCM included: severe lung disease, severe liver disease, end-stage renal disease, severe, severe dementia, severe dilated cardiomyopathy, and frailty. Outcomes between patients with (n = 215, 24%) and without (n = 675, 76%) sCM were compared. RESULTS At baseline, patients with sCM had worse symptoms, higher STS-PROM and a lower Kansas City Cardiomyopathy Questionnaire (KCCQ) score compared to those without. During a median follow-up of 15 months (IQR, 7-29 months), there were 208 (23%) deaths. Patients with sCM had a lower 3-year survival free from all-cause mortality (40% vs. 79%, p < .001), and lower 3-year survival free from the composite endpoint of all-cause mortality, re-hospitalization for heart failure, myocardial infarction or stroke (31% vs. 64%, p < .001) compared to those without sCM. The estimated monthly increase in KCCQ scores following TAVR was 1.5, 95%CI (1.3, 1.7), p < .001 irrespective of sCM grouping. From Cox regression analysis, severe comorbidities, with the exception of liver disease, were associated with an increased risk of all-cause mortality and any additional comorbidity was associated with a multiplicative increase in risk of mortality of 2.8 (95%CI 2.3, 3.6), p < .001. CONCLUSIONS TAVR patients with sCM have poor 3-year outcomes but may experience improvements in their quality of life.
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Affiliation(s)
- Liang Tang
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.,Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Michael Mooney
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Ross Garberich
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Miranda Kunz
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Larissa I Stanberry
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Aisha Ahmed
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Steven M Bradley
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Dawn Witt
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Richard Bae
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Hiroki Niikura
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Robert Steffen
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Mario Gössl
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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Lin CT, Czarny MJ, Hussien A, Hasan RK, Garibaldi BT, Fishman EK, Resar JR, Zimmerman SL. Fibrotic Lung Disease at CT Predicts Adverse Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement. Radiol Cardiothorac Imaging 2020; 2:e190093. [PMID: 33778552 DOI: 10.1148/ryct.2020190093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 11/25/2019] [Accepted: 12/18/2019] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the relationship between CT findings of diffuse lung disease and post-transcatheter aortic valve replacement (TAVR) outcomes. Materials and Methods Retrospective review of pre-TAVR CT scans obtained during 2012-2017 was conducted. Emphysema, reticulation, and honeycombing were separately scored using a five-point scale and applied to 10 images per examination. The fibrosis score was the sum of reticulation and honeycombing scores. Lung diseases were also assessed as dichotomous variables (zero vs nonzero scores). The two outcomes evaluated were death and the composite of death and readmission. Results The study included 373 patients with median age of 84 years (age range, 51-98 years; interquartile range, 79-88 years) and median follow-up of 333 days. Fibrosis and emphysema were present in 66 (17.7%) and 95 (25.5%) patients, respectively. Fibrosis as a dichotomous variable was independently associated with the composite of death and readmission (hazard ratio [HR], 1.54; P = .030). In those without known chronic lung disease (CLD) (HR, 3.09; P = .024) and those without airway obstruction, defined by a ratio of forced expiratory volume in 1 second to the forced vital capacity greater than or equal to 70% (HR, 1.67, P = .039), CT evidence of fibrosis was a powerful predictor of adverse events. Neither emphysema score nor emphysema as a dichotomous variable was an independent predictor of outcome. Conclusion The presence of fibrosis on baseline CT scans was an independent predictor of adverse events after TAVR. In particular, fibrosis had improved predictive value in both patients without known CLD and patients without airway obstruction.Supplemental material is available for this article.© RSNA, 2020.
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Affiliation(s)
- Cheng Ting Lin
- Department of Radiology (C.T.L., A.H., E.K.F., S.L.Z.), Department of Medicine, Cardiology Division (M.J.C., R.K.H., J.R.R.), and Department of Medicine, Pulmonary and Critical Care Division (B.T.G.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3171B, Baltimore, MD 21287
| | - Matthew J Czarny
- Department of Radiology (C.T.L., A.H., E.K.F., S.L.Z.), Department of Medicine, Cardiology Division (M.J.C., R.K.H., J.R.R.), and Department of Medicine, Pulmonary and Critical Care Division (B.T.G.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3171B, Baltimore, MD 21287
| | - Amira Hussien
- Department of Radiology (C.T.L., A.H., E.K.F., S.L.Z.), Department of Medicine, Cardiology Division (M.J.C., R.K.H., J.R.R.), and Department of Medicine, Pulmonary and Critical Care Division (B.T.G.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3171B, Baltimore, MD 21287
| | - Rani K Hasan
- Department of Radiology (C.T.L., A.H., E.K.F., S.L.Z.), Department of Medicine, Cardiology Division (M.J.C., R.K.H., J.R.R.), and Department of Medicine, Pulmonary and Critical Care Division (B.T.G.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3171B, Baltimore, MD 21287
| | - Brian T Garibaldi
- Department of Radiology (C.T.L., A.H., E.K.F., S.L.Z.), Department of Medicine, Cardiology Division (M.J.C., R.K.H., J.R.R.), and Department of Medicine, Pulmonary and Critical Care Division (B.T.G.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3171B, Baltimore, MD 21287
| | - Elliot K Fishman
- Department of Radiology (C.T.L., A.H., E.K.F., S.L.Z.), Department of Medicine, Cardiology Division (M.J.C., R.K.H., J.R.R.), and Department of Medicine, Pulmonary and Critical Care Division (B.T.G.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3171B, Baltimore, MD 21287
| | - Jon R Resar
- Department of Radiology (C.T.L., A.H., E.K.F., S.L.Z.), Department of Medicine, Cardiology Division (M.J.C., R.K.H., J.R.R.), and Department of Medicine, Pulmonary and Critical Care Division (B.T.G.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3171B, Baltimore, MD 21287
| | - Stefan Loy Zimmerman
- Department of Radiology (C.T.L., A.H., E.K.F., S.L.Z.), Department of Medicine, Cardiology Division (M.J.C., R.K.H., J.R.R.), and Department of Medicine, Pulmonary and Critical Care Division (B.T.G.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3171B, Baltimore, MD 21287
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Freitas-Ferraz AB, Nombela-Franco L, Urena M, Maes F, Veiga G, Ribeiro H, Vilalta V, Silva I, Cheema AN, Islas F, Fischer Q, Fradejas-Sastre V, Rosa VEE, Fernandez-Nofrerias E, Moris C, Junquera L, Mohammadi S, Pibarot P, Rodés-Cabau J. Transcatheter aortic valve replacement in patients with paradoxical low-flow, low-gradient aortic stenosis: Incidence and predictors of treatment futility. Int J Cardiol 2020; 316:57-63. [PMID: 32505373 DOI: 10.1016/j.ijcard.2020.04.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/30/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Few and controversial data exist on the outcomes of patients with paradoxical low-flow, low-gradient aortic stenosis (PLFLG-AS) following transcatheter aortic valve replacement (TAVR). This study aims to better characterize clinical outcomes and predictors of treatment futility in PLFLG-AS patients undergoing TAVR. METHODS In this multicenter study, 318 patients with PLFLG-AS undergoing TAVR were categorized according to treatment futility, defined as all-cause mortality, poor functional status (NYHA class III-IV) or deterioration in functional class at 1-year follow-up. Clinical outcomes and the factors associated with treatment futility were assessed. RESULTS The mean age of the patients was 81.0 ± 8.3 years and 50.3% were women. At 1-year follow-up, 17.6% died and 12.9% had heart failure hospitalization. Residual impaired functional capacity (NYHA ≥ II) was present in 54.4% of patients who were alive at 1-year, and 9.8% remained in NYHA III/IV. The primary endpoint was observed in 103 (32.4%) patients, of which 54% died and 46% had a poor or worsening functional class. Factors independently associated with treatment futility were the presence of atrial fibrillation (AF) (OR:1.79, 95%CI, 1.04-3.10), chronic obstructive pulmonary disease (COPD) (OR:2.66, 95%CI, 1.50-4.74) and a lower SVi (OR per each decrease in 10 ml/m2:1.89, 95%CI, 1.06-3.45). The risk of treatment futility of patients with AF, COPD and a SVi < 30 ml/m2 was 66.38% (95%CI, 54.29%-78.48%). CONCLUSION Close to one-third of patients with PLFLG-AS failed to derive a benefit from TAVR. The presence of AF, COPD and a low SVi were predictors of treatment futility. Being able to identify patients less likely to improve after the procedure may help to guide management and improve outcomes in patients with PLFLG-AS.
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Affiliation(s)
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Marina Urena
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Frederic Maes
- Cliniques Universitaires Saint Luc, Brussels, Belgium
| | | | | | | | - Iria Silva
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Fabian Islas
- Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Quentin Fischer
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | | | | | | | - César Moris
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Lucia Junquera
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
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Hirji SA, Cote C, Lee J, Kiehm S, McGurk S, Pelletier MP, Aranki S, Shekar P, Shah P, Kaneko T. Transcatheter vs surgical aortic valve replacement in patients with interstitial lung disease. J Card Surg 2020; 35:571-579. [PMID: 31981435 DOI: 10.1111/jocs.14421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with underlying interstitial lung disease (ILD) who undergo cardiac surgery are at high risk of postoperative pulmonary complications. It remains unclear if transcatheter aortic valve replacement (TAVR) offers any benefit over surgical aortic valve replacement (SAVR) in ILD patients with severe aortic stenosis. METHODS All adult patients with a diagnosis of ILD who underwent either a TAVR or isolated SAVR between January 2002 and December 2017 were retrospectively reviewed. Operative mortality, 30-day readmissions, and adjusted 1-year survival were compared between the two cohorts. RESULTS The overall cohort included 52 TAVR and 74 SAVR patients. While TAVR patients were significantly older (77.2 vs 72.9 years) with higher Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) scores compared with SAVR patients (6.29 vs 4.49; all P < .02), operative mortality was similar (5.8% vs 4.1%; P = .45). Rates of postoperative stroke, permanent pacemaker implantation, reintubation, and 30-day readmissions did not differ between the two groups (all P > .46). However, TAVR was associated with significantly shorter hospital and intensive care unit (ICU) length of stay, shorter ventilation times, and less requirement for ICU admission (all P < .05). Thirty-day readmissions and adjusted 1-year survival were also similar between the two groups (hazard ratio for TAVR vs SAVR = 1.34; 95% CI: 0.7-2.6). CONCLUSIONS Among ILD patients with symptomatic aortic stenosis, TAVR was associated with comparable operative and risk-adjusted 1-year survival to SAVR. TAVR patients also had shorter ventilator times, ICU and hospital stay despite being at higher risk. Together, our findings suggest that TAVR may be a better option in this unique cohort.
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Affiliation(s)
- Sameer A Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Claudia Cote
- Division of Cardiac Surgery, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jiyae Lee
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Spencer Kiehm
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marc P Pelletier
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sary Aranki
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Prem Shekar
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pinak Shah
- Division of Cardiac Surgery, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Doshi R, Taha M, Dave M, Desai R, Gullapalli N. Sex differences in 30-day readmission rates, etiology, and predictors after transcatheter aortic valve replacement. Indian Heart J 2019; 71:291-296. [PMID: 31779855 PMCID: PMC6890955 DOI: 10.1016/j.ihj.2019.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/01/2019] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The aim of this study is to analyze sex-specific readmission rates, etiology, and predictors of readmission after transcatheter aortic valve replacement (TAVR). Readmissions after TAVR are common, contributing to increased health care utilization and costs. Many factors have been discovered as predictors of readmission; however, sex-specific disparities in readmission rates are limited. METHODS Between January 2012 and September 2015, adult patients after TAVR were identified using appropriate international classifications of diseases, ninth revision, clinical modification from the National Readmission Database. Incidence of unplanned 30-days readmission rate was the primary outcome of this study. In addition, this study includes sex-specific etiology and predictors of readmissions. Multivariate logistic regression was performed to analyze adjusted readmission rates. Hierarchical 2-level logistic models were used to evaluate predictors of readmission. RESULTS Readmission rate at 30 days was 17.3%, with slightly higher readmission rates in women (OR 1.09; CI: 1.01-1.19, p < 0.001) after multivariate adjusted analysis. Noncardiac causes were responsible for most readmissions in both genders. Etiologies for readmissions such as arrhythmias, pulmonary complications, and infections were slightly higher in women, whereas heart failure and bleeding complications were higher in men. History of heart failure, atrial fibrillation, prior pacemaker, and renal failure significantly strongly predicted readmissions in both genders. CONCLUSION Women undergoing TAVR have slightly higher 30-day all-cause readmission rates. These results indicate that women require more attention compared to men to prevent 30-day readmission. In addition, risk stratification for men and women based on predictors will help identify high-risk men and women for readmissions.
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Affiliation(s)
- Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, United States.
| | - Mohamed Taha
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, United States
| | - Mihir Dave
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, Decatur, VA, United States
| | - Nageshwara Gullapalli
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, United States
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Shigemura N, Toyoda Y. Elderly patients with multiple comorbidities: insights from the bedside to the bench and programmatic directions for this new challenge in lung transplantation. Transpl Int 2019; 33:347-355. [DOI: 10.1111/tri.13533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/26/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Norihisa Shigemura
- Division of Cardiovascular Surgery Temple University Health System and Lewis Katz School of Medicine Philadelphia PA USA
| | - Yoshiya Toyoda
- Division of Cardiovascular Surgery Temple University Health System and Lewis Katz School of Medicine Philadelphia PA USA
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Takagi H, Hari Y, Nakashima K, Kuno T, Ando T. A meta-analysis of ≥5-year mortality after transcatheter versus surgical aortic valve replacement. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 61:107-116. [PMID: 31666501 DOI: 10.23736/s0021-9509.19.11030-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION It remains unclear whether long-term survival is superior following transcatheter aortic valve implantation (TAVI) than following surgical aortic valve replacement (SAVR). We performed a meta-analysis of mortality with ≥5-year follow-up in randomized controlled trials (RCTs) and propensity-score matched (PSM) studies of TAVI versus SAVR. EVIDENCE ACQUISITION MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through March 2019. Eligible studies were RCTs or PSM studies of TAVI versus SAVR enrolling patients with severe aortic stenosis and reporting all-cause mortality with ≥5-year follow-up as an outcome. A hazard ratio of mortality for TAVI versus SAVR was extracted from each individual study. EVIDENCE SYNTHESIS Our search identified 3 RCTs and 7 PSM studies enrolling 5498 patients. A pooled analysis of all 10 studies demonstrated a statistically significant 38% increase in mortality with TAVI relative to SAVR. A subgroup meta-analysis showed no statistically significant difference between TAVI and AVR in RCTs and a statistically significant 68% increase with TAVI relative to SAVR in PSM studies. CONCLUSIONS On the basis of a meta-analysis of 7 PSM studies, TAVI is associated with greater all-cause mortality with ≥5-year follow-up than SAVR. However, another meta-analysis of 3 RCTs suggests no difference in mortality between TAVI and SAVR.
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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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Kwak MJ, Bhise V, Warner MT, Balan P, Nguyen TC, Estrera AL, Smalling RW, Dhoble A. National trend of utilization, clinical and economic outcomes of transcatheter aortic valve replacement among patients with chronic obstructive pulmonary disease. Curr Med Res Opin 2019; 35:1321-1329. [PMID: 30761914 DOI: 10.1080/03007995.2019.1583024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: We aimed to trend the utilization of transcatheter aortic valve replacement (TAVR) among COPD patients, compare its outcomes to surgical aortic valve replacement (SAVR) and assess any social disparities in its outcomes. Background: Patients with chronic obstructive pulmonary disease (COPD) have been increasingly undergoing TAVR, but studies to evaluate the national trend of TAVR utilization and outcomes are still lacking. Methods: We conducted a retrospective observational study using a nationally representative database, the National Inpatient Sample (NIS). Results: From 2010 to 2014, the proportion of TAVR among COPD patients has increased from <1% to >50%. Patients who underwent TAVR were older, more likely to be women or white, carried more public insurance and had more comorbidities. There was no overall difference in mortality between TAVR and SAVR (2.74% vs. 2.59%, p = .860), and it has been consistently similar over time. However, patients with TAVR had shorter length of stay in the hospital after the procedure and were more likely to be discharged home than the SAVR group. Among the TAVR group, there were no gender, race or insurance disparities for in-hospital mortality, but female gender was related to lower discharge home rate, higher cost and longer stay in hospital. Conclusions: The rate of TAVR among COPD patients has been increasing nationally since 2011. In spite of higher comorbidities, TAVR did not show a difference in hospital mortality compared to SAVR but demonstrated shorter length of stay and more home discharges. This suggests that TAVR is a viable and potentially better option for patients with COPD.
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Affiliation(s)
- Min Ji Kwak
- a Department of Internal Medicine , University of Texas McGovern Medical School , Houston , TX , USA
- b Department of Management, Policy and Community Health , University of Texas School of Public Health , Houston , TX , USA
| | - Viraj Bhise
- b Department of Management, Policy and Community Health , University of Texas School of Public Health , Houston , TX , USA
- c Department of Internal Medicine, John A Burns School of Medicine , University of Hawaii at Manoa , Honolulu , HI , USA
| | - Mark T Warner
- a Department of Internal Medicine , University of Texas McGovern Medical School , Houston , TX , USA
- d Memorial Herman Heart and Vascular Center , Texas Medical Center , Houston , TX , USA
| | - Prakash Balan
- a Department of Internal Medicine , University of Texas McGovern Medical School , Houston , TX , USA
- d Memorial Herman Heart and Vascular Center , Texas Medical Center , Houston , TX , USA
| | - Tom C Nguyen
- d Memorial Herman Heart and Vascular Center , Texas Medical Center , Houston , TX , USA
- e Department of Cardiovascular Surgery , University of Texas McGovern Medical School , Houston , TX , USA
| | - Anthony L Estrera
- d Memorial Herman Heart and Vascular Center , Texas Medical Center , Houston , TX , USA
- e Department of Cardiovascular Surgery , University of Texas McGovern Medical School , Houston , TX , USA
| | - Richard W Smalling
- a Department of Internal Medicine , University of Texas McGovern Medical School , Houston , TX , USA
- d Memorial Herman Heart and Vascular Center , Texas Medical Center , Houston , TX , USA
| | - Abhijeet Dhoble
- a Department of Internal Medicine , University of Texas McGovern Medical School , Houston , TX , USA
- d Memorial Herman Heart and Vascular Center , Texas Medical Center , Houston , TX , USA
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Tang L, Gössl M, Ahmed A, Garberich R, Bradley SM, Niikura H, Witt D, Pedersen WR, Bae R, Lesser JR, Harris KM, Sun B, Mudy K, Sorajja P. Contemporary Reasons and Clinical Outcomes for Patients With Severe, Symptomatic Aortic Stenosis Not Undergoing Aortic Valve Replacement. Circ Cardiovasc Interv 2018; 11:e007220. [DOI: 10.1161/circinterventions.118.007220] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Liang Tang
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China (L.T.)
| | - Mario Gössl
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Aisha Ahmed
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Ross Garberich
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Steven M. Bradley
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Hiroki Niikura
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Dawn Witt
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Wesley R. Pedersen
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Richard Bae
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - John R. Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Kevin M. Harris
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Benjamin Sun
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Karol Mudy
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN (L.T., M.G., A.A., R.G., S.M.B., H.N., D.W., W.R.P., R.B., J.R.L., K.M.H., B.S., K.M., P.S.)
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Kokkinidis DG, Papanastasiou CA, Jonnalagadda AK, Oikonomou EK, Theochari CA, Palaiodimos L, Karvounis HI, Armstrong EJ, Faillace RT, Giannakoulas G. The predictive value of baseline pulmonary hypertension in early and long term cardiac and all-cause mortality after transcatheter aortic valve implantation for patients with severe aortic valve stenosis: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:859-867. [DOI: 10.1016/j.carrev.2018.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/17/2018] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
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Morozowich ST, Murray AW, Ramakrishna H. Pulmonary Hypertension in Patients for Transcatheter and Surgical Aortic Valve Replacement: A Focus on Outcomes and Perioperative Management. J Cardiothorac Vasc Anesth 2018; 32:2005-2018. [DOI: 10.1053/j.jvca.2017.09.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Indexed: 01/03/2023]
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Lazar HL. One-year outcomes in TAVR patients: Dying from versus dying with aortic stenosis. J Card Surg 2018; 33:250-251. [DOI: 10.1111/jocs.13599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Harold L. Lazar
- Division of Cardiac Surgery; Boston University School of Medicine; Boston Massachusetts
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Ando T, Adegbala O, Akintoye E, Ashraf S, Pahuja M, Briasoulis A, Takagi H, Grines CL, Afonso L, Schreiber T. Is Transcatheter Aortic Valve Replacement Better Than Surgical Aortic Valve Replacement in Patients With Chronic Obstructive Pulmonary Disease? A Nationwide Inpatient Sample Analysis. J Am Heart Assoc 2018; 7:e008408. [PMID: 29606641 PMCID: PMC5907603 DOI: 10.1161/jaha.117.008408] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 01/26/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) patients are at increased risk of respiratory related complications after cardiac surgery. It is unclear whether transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) results in favorable outcomes among COPD patients. METHODS AND RESULTS Patients were identified from the Nationwide Inpatient Sample database from 2011 to 2014. Patients with age ≥60, COPD, and either went transarterial TAVR or SAVR were included in the analysis. A 1:1 propensity-matched cohort was created to examine the outcomes. A matched pair of 1210 TAVR and 1208 SAVR patients was identified. Respiratory-related complications such as tracheostomy (0.8% versus 5.8%; odds ratio [OR], 0.14; P<0.001), acute respiratory failure (16.4% versus 23.7%; OR, 0.63; P=0.002), reintubation (6.5% versus 10.0%; OR, 0.49; P<0.001), and pneumonia (4.5% versus 10.1%; OR, 0.41; P<0.001) were significantly less frequent with TAVR versus SAVR. Use of noninvasive mechanical ventilation was similar between TAVR and SAVR (4.1% versus 4.8%; OR, 0.84; P=0.41). Non-respiratory-related complications, such as in-hospital mortality (3.3% versus 4.2%; OR, 0.64; P=0.035), bleeding requiring transfusion (9.9% versus 21.7%; OR, 0.38; P<0.001), acute kidney injury (17.7% versus 25.3%; OR, 0.63; P<0.001), and acute myocardial infarction (2.4% versus 8.4%; OR, 0.19; P<0.001), were significantly less frequent with TAVR than SAVR. Cost ($56 099 versus $63 146; P<0.001) and hospital stay (mean, 7.7 versus 13.0 days; P<0.001) were also more favorable with TAVR than SAVR. CONCLUSIONS TAVR portended significantly fewer respiratory-related complications compared with SAVR in COPD patients. TAVR may be a preferable mode of aortic valve replacement in COPD patients.
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Affiliation(s)
- Tomo Ando
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI
| | - Oluwole Adegbala
- Department of Internal Medicine, Englewood Hospital and Medical Center Seton Hall University-Hackensack Meridian School of Medicine, Englewood, NJ
| | - Emmanuel Akintoye
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI
| | - Said Ashraf
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI
| | - Mohit Pahuja
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI
| | - Alexandros Briasoulis
- Divison of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Hisato Takagi
- Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Cindy L Grines
- Division of Cardiology, North Shore University Hospital Hofstra Northwell School of Medicine, Manhasset, NY
| | - Luis Afonso
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI
| | - Theodore Schreiber
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI
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Shimura T, Yamamoto M, Kagase A, Kodama A, Kano S, Koyama Y, Tada N, Takagi K, Araki M, Yamanaka F, Shirai S, Watanabe Y, Hayashida K. The incidence, predictive factors and prognosis of acute pulmonary complications after transcatheter aortic valve implantation. Interact Cardiovasc Thorac Surg 2017; 25:191-197. [PMID: 28453816 DOI: 10.1093/icvts/ivx075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 01/30/2017] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Although acute pulmonary complications (APCs), such as the exacerbation of pulmonary disease (PD) or a newly developed pulmonary event, are thought to be catastrophic after invasive therapy, little is known about the occurrence of APCs after transcatheter aortic valve implantation (TAVI). This study aims to clarify the incidence, predictive factors and impact of APCs on prognosis after TAVI. METHODS We identified 749 patients who underwent TAVI, using data from the Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) Japanese multicentre registry. APCs were defined as exacerbation of a comorbidity or newly developed PD during hospitalization. Patients were divided into 2 groups: an APC group (1.5%, 11/749) and a non-APC group (98.5%, 738/749). Clinical and prognostic outcomes were compared, and predictive factors for APCs were assessed. RESULTS Procedure-related death did not differ between the groups (0.4% vs 0.0%, P = 1.00), although 30-day mortality was significantly higher in the APC group than in the non-APC group (27.3% vs 1.6%, P = 0.001) and the difference in cumulative 1-year mortality increased further (72.7% vs 8.6%, log-rank test: P < 0.001). In particular, concomitant PD and transapical (TA) approach were identified as predictors of APCs after TAVI [univariable odds ratio (uOR) = 24.2, 95% confidence interval (CI) = 3.08-189.9, P = 0.002; uOR = 3.69, 95% CI = 1.11-12.3, P = 0.033, respectively]. CONCLUSIONS Although rare, the occurrence of APCs after TAVI was associated with extremely poor prognosis. Patients undergoing TAVI with concomitant PD and/or TA require careful consideration to avoid the risk of APCs.
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Affiliation(s)
- Tetsuro Shimura
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Ai Kagase
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Atsuko Kodama
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Seiji Kano
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Yutaka Koyama
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
| | - Kensuke Takagi
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Lanz J, Pilgrim T. Transcatheter Aortic Valve Replacement in Patients With Chronic Lung Disease: Utile or Futile? JACC Cardiovasc Interv 2017; 10:2294-2296. [PMID: 29102576 DOI: 10.1016/j.jcin.2017.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 08/01/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Jonas Lanz
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
| | - Thomas Pilgrim
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
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Auffret V, Becerra Munoz V, Loirat A, Dumont E, Le Breton H, Paradis JM, Doyle D, De Larochellière R, Mohammadi S, Verhoye JP, Dagenais F, Bedossa M, Boulmier D, Leurent G, Asmarats L, Regueiro A, Chamandi C, Rodriguez-Gabella T, Voisine E, Moisan AS, Thoenes M, Côté M, Puri R, Voisine P, Rodés-Cabau J. Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Lower-Surgical-Risk Patients With Chronic Obstructive Pulmonary Disease. Am J Cardiol 2017; 120:1863-1868. [PMID: 28886850 DOI: 10.1016/j.amjcard.2017.07.097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/17/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
Respiratory complications are a major factor contributing to postoperative morbidity and mortality, especially in patients with chronic obstructive pulmonary disease (COPD). Our objective was to compare the rate of respiratory complications in patients with COPD with severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR). Low-to-intermediate surgical-risk patients with moderate or severe COPD who underwent TAVI or SAVR at 2 tertiary centers were included in this study. COPD was defined by the Global Initiative for Chronic Lung Disease classification. The primary end point was the 30-day composite of respiratory mortality, prolonged ventilation (>24 hours), the need for reintubation for respiratory causes, tracheostomy, acute respiratory distress syndrome, pneumonia, or pneumothorax. The inverse probability of treatment weighting was determined to reduce baseline imbalance between the 2 groups. A total of 321 patients (mean age 72.4 ± 9.3 years old, 74.5% male, mean Society of Thoracic Surgeons predicted risk of mortality 3.8 ± 1.9%, mean forced expiratory volume 1: 59 ± 13%) were included in the analysis. TAVI was performed in 122 patients, whereas 199 underwent SAVR. There were no differences between the 2 groups regarding the composite respiratory primary end point (SAVR 10.6%, TAVR 7.4%, adjusted odds ratio 0.57, 95% confidence interval 0.20 to 1.65, p = 0.30). Transfemoral TAVI without general anesthesia (28 patients) was associated with the lowest rate of respiratory complications (3.6%). Among patients with moderate or severe COPD at low-to-intermediate surgical risk, TAVI patients had a similar rate of 30-day major pulmonary complications compared with SAVR patients despite a higher baseline risk profile. Future studies should further investigate whether TAVI is associated with reduced respiratory complications, comparing transfemoral TAVI recipients treated with local anesthesia with their SAVR counterparts.
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Kolte D, Khera S, Sardar MR, Gheewala N, Gupta T, Chatterjee S, Goldsweig A, Aronow WS, Fonarow GC, Bhatt DL, Greenbaum AB, Gordon PC, Sharaf B, Abbott JD. Thirty-Day Readmissions After Transcatheter Aortic Valve Replacement in the United States: Insights From the Nationwide Readmissions Database. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004472. [PMID: 28034845 DOI: 10.1161/circinterventions.116.004472] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/14/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Readmissions after cardiac procedures are common and contribute to increased healthcare utilization and costs. Data on 30-day readmissions after transcatheter aortic valve replacement (TAVR) are limited. METHODS AND RESULTS Patients undergoing TAVR (International Classification of Diseases-Ninth Revision-CM codes 35.05 and 35.06) between January and November 2013 who survived the index hospitalization were identified in the Nationwide Readmissions Database. Incidence, predictors, causes, and costs of 30-day readmissions were analyzed. Of 12 221 TAVR patients, 2188 (17.9%) were readmitted within 30 days. Length of stay >5 days during index hospitalization (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.24-1.73), acute kidney injury (HR, 1.23; 95% CI, 1.05-1.44), >4 Elixhauser comorbidities (HR, 1.22; 95% CI, 1.03-1.46), transapical TAVR (HR, 1.21; 95% CI, 1.05-1.39), chronic kidney disease (HR, 1.20; 95% CI, 1.04-1.39), chronic lung disease (HR, 1.16; 95% CI, 1.01-1.34), and discharge to skilled nursing facility (HR, 1.16; 95% CI, 1.01-1.34) were independent predictors of 30-day readmission. Readmissions were because of noncardiac causes in 61.8% of cases and because of cardiac causes in 38.2% of cases. Respiratory (14.7%), infections (12.8%), bleeding (7.6%), and peripheral vascular disease (4.3%) were the most common noncardiac causes, whereas heart failure (22.5%) and arrhythmias (6.6%) were the most common cardiac causes of readmission. Median length of stay and cost of readmissions were 4 days (interquartile range, 2-7 days) and $8302 (interquartile range, $5229-16 021), respectively. CONCLUSIONS Thirty-day readmissions after TAVR are frequent and are related to baseline comorbidities, TAVR access site, and post-procedure complications. Awareness of these predictors can help identify and target high-risk patients for interventions to reduce readmissions and costs.
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Affiliation(s)
- Dhaval Kolte
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Sahil Khera
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - M Rizwan Sardar
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Neil Gheewala
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Tanush Gupta
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Saurav Chatterjee
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Andrew Goldsweig
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Wilbert S Aronow
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Gregg C Fonarow
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Deepak L Bhatt
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Adam B Greenbaum
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Paul C Gordon
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Barry Sharaf
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - J Dawn Abbott
- From the Division of Cardiology, Brown University, Providence, RI (D.K., M.R.S., A.G., P.C.G., B.S., J.D.A.); Division of Cardiology, New York Medical College, Valhalla (S.K., W.S.A.); Division of Cardiology, Northeast Ohio Medical University, Aultman Hospital, Canton (M.R.S.); Henry Ford Hospital, Detroit, MI (N.G., A.B.G.); Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G.); Division of Cardiology, Temple University Hospital, Philadelphia, PA (S.C.); Division of Cardiology, University of California at Los Angeles (G.C.F.); and Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.).
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Crestanello JA, Popma JJ, Adams DH, Deeb GM, Mumtaz M, George B, Huang J, Reardon MJ. Long-Term Health Benefit of Transcatheter Aortic Valve Replacement in Patients With Chronic Lung Disease. JACC Cardiovasc Interv 2017; 10:2283-2293. [DOI: 10.1016/j.jcin.2017.07.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/31/2017] [Accepted: 07/02/2017] [Indexed: 01/13/2023]
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50
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Higuchi R, Takayama M, Hagiya K, Saji M, Mahara K, Takamisawa I, Shimizu J, Tobaru T, Iguchi N, Takanashi S. Prolonged Intensive Care Unit Stay Following Transcatheter Aortic Valve Replacement. J Intensive Care Med 2017; 35:154-160. [PMID: 28931366 DOI: 10.1177/0885066617732290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Postoperative intensive care unit (ICU) stay after cardiac surgeries has been extensively studied, but little attention has been given to ICU stay following transcatheter aortic valve replacement (TAVR). This study examined ICU stay after TAVR. METHODS Two hundred and forty-five patients who underwent TAVR between April 2010 and October 2016 were studied retrospectively. We investigated the status of ICU stay, the predictors of prolonged ICU stay (PICUS), and its impact on short- and long-term outcomes. Prolonged ICU stay was defined as post-TAVR ICU stay longer than 2 days (day of TAVR + 1 day). RESULTS Length of ICU stay was 2.6 ± 4.9 days, and PICUS was identified in 14.7% of the patients. The predominant reason for PICUS was congestive heart failure or circulatory failure (41.7%). Pulmonary dysfunction and nontransfemoral approach were independent predictors of PICUS (pulmonary dysfunction: odds ratio = 2.64, 95% confidence interval [CI]: 1.05-7.35; nontransfemoral approach: odds ratio = 2.81, 95% CI: 1.15-6.89). Prolonged ICU stay was associated with higher rate of 30-day combined end point (PICUS vs non-PICUS: 44.4% vs 3.3%, P < .0001), longer postoperative hospital stay (49.9 ± 141.9 days vs 12.0 ± 6.0 days, P < .0001), and lower rate of discharge home (77.8% vs 95.2%, P = .0002). Patients with PICUS had worse long-term survival (P < .0001), and PICUS was a predictor of mortality (hazard ratio: 4.21, 95% CI: 2.09-8.22). CONCLUSION Prolonged ICU stay following TAVR was found in 14.7%, and pulmonary dysfunction and nontransfemoral approach were associated with PICUS. Short- and long-term prognoses were worse in patients with PICUS than those without.
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Affiliation(s)
- Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Morimasa Takayama
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Kenichi Hagiya
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Keitaro Mahara
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Jun Shimizu
- Department of Anesthesiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Tetsuya Tobaru
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
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