1
|
Tan J, Wei G, Ma F, Yan H, Wang X, Hu Q, Wei W, Yang M, Bai Y. Preoperative visit-care for transcatheter aortic valve replacement: a review. BMC Cardiovasc Disord 2024; 24:573. [PMID: 39420265 DOI: 10.1186/s12872-024-04241-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 10/07/2024] [Indexed: 10/19/2024] Open
Abstract
AIM The aim of this review is to evaluate and summarize the evidence for preoperative visit-care of transcatheter aortic valve replacement (TAVR) and to provide evidence-based support for clinical intervention. DESIGN The review presents an evidence summary report, following the standard of the Fudan University Center for Evidence-based Nursing. METHODS Literature related to preoperative visit-care for transcatheter aortic valve replacement have been retrieved based on the "6S" pyramid model of evidence. The types of literature included systematic reviews, expert consensus, evidence summary, and guidelines. DATA SOURCES Up To Date, Cochrane Library, Joanna Briggs Institute, National Institute for Health and Care Excellence, Medlive, American Heart Association, Registered Nurses Association of Ontario, Scottish Intercollegiate Guidelines Network, European Society of Cardiology, American College of Cardiology, PubMed, CINAHL, Wanfang database, VIP database, Chinese biomedical literature database, CNKI. The search period is limited to the time when each database was established until February 2024. RESULTS A total of 18 articles were included in this review, consisting of 1 systematic review, 1 evidence summary, 3 guidelines and 13 expert consensuses. This review summarized 30 pieces of the best evidence for preoperative visit-care for transcatheter aortic valve replacement, encompassing three evidence themes: multidisciplinary team collaboration, preoperative assessment, and preoperative education. CONCLUSION The study has established an ideal foundation of evidence for preoperative visit-care in TAVR. However, throughout the particular application process, it was crucial to assess the feasibility and relevance of the evidence in clinical practice by taking into account elements such as the application setting, recommendations from experts with diverse expertise, and the preferences of the patients.
Collapse
Affiliation(s)
- JunYang Tan
- Cardiology Department, People's Hospital of Yuxi City, Yuxi, China
| | - GuanXing Wei
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, No. 295, Xichang Road, Kunming, 650032, China
| | - Fang Ma
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Han Yan
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, No. 295, Xichang Road, Kunming, 650032, China
| | - XiTing Wang
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, No. 295, Xichang Road, Kunming, 650032, China
| | - QiuLan Hu
- Geriatric Intensive Care Unit Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wei Wei
- Digestive Surgery Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - MingFang Yang
- Department of Nursing, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - YangJuan Bai
- Cardiology Department, The First Affiliated Hospital of Kunming Medical University, No. 295, Xichang Road, Kunming, 650032, China.
| |
Collapse
|
2
|
Hansson EC, Martinsson A, Baranowska J, Törngren C, Pan E, Björklund E, Karlsson M. Betablockers and clinical outcome after surgical aortic valve replacement: a report from the SWEDEHEART registry. Eur J Cardiothorac Surg 2024; 66:ezae365. [PMID: 39374543 DOI: 10.1093/ejcts/ezae365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 09/25/2024] [Accepted: 10/03/2024] [Indexed: 10/09/2024] Open
Abstract
OBJECTIVES Previous reports suggest that betablockers appear non-beneficial after surgical aortic valve replacement (SAVR). This study aims to clarify the associations between betablockers and long-term outcome after SAVR. METHODS All patients with isolated SAVR due to aortic stenosis in Sweden between 2006 and 2020, alive at 6 months after surgery, were included. Patients were identified in the SWEDEHEART registry, and records were merged with data from 3 other mandatory national registries. Association between dispensed betablockers and major adverse cardiovascular events (MACE) (all-cause mortality, myocardial infarction and stroke) was analyzed using Cox proportional hazards models, with time-updated data on medication and adjusted for age, sex and comorbidities at baseline. RESULTS In total, 11 849 patients were included [median follow-up 5.4 years (range 0-13.5)]. Betablockers were prescribed to 79.7% of patients at baseline, decreasing to 62.2% after 5 years. Continuing treatment was associated with higher risk of MACE [adjusted hazard ratio 1.14 (95% confidence interval, CI 1.05-1.23)]. The association was consistent over subgroups based on age, sex and comorbidities except atrial fibrillation [hazard ratio (HR) 1.05 (95% CI 0.93-1.19)]. A sensitivity analysis including time-updated data on comorbidites attenuated the difference between the groups [HR 1.04 (95% CI 0.95-1.14, P = 0.33)]. CONCLUSIONS Treatment with betablockers did not appear to be associated with inferior long-term outcome after SAVR, when adjusting for new concomitant diseases. Thus, it is likely that it is the underlying cardiac diseases that are associated with MACE rather than betablocker treatment.
Collapse
Affiliation(s)
- Emma C Hansson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Martinsson
- Department of Molecular and Clinical Medicine, Institute of medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Julia Baranowska
- Department of Molecular and Clinical Medicine, Institute of medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Charlotta Törngren
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emily Pan
- Department of Surgery and Clinical Medicine, University of Turku, Turku, Finland
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Erik Björklund
- Department of Molecular and Clinical Medicine, Institute of medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, South Älvsborg Hospital, Borås, Sweden
| | - Martin Karlsson
- Department of Molecular and Clinical Medicine, Institute of medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
3
|
Armfield D, Boxwell S, McNamara L, Cook S, Conway S, Celikin M, Cardiff P. Effect of bioprosthetic leaflet anisotropy on stent dynamics of Transcatheter Aortic Valve Replacement devices. J Mech Behav Biomed Mater 2024; 157:106650. [PMID: 39018917 DOI: 10.1016/j.jmbbm.2024.106650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/19/2024]
Abstract
The assessment of stent fatigue in Transcatheter Aortic Valve Replacement (TAVR) systems is critical for the design of next-generation devices, both in vitro and in vivo. The mechanical properties of the bioprosthetic heart valves (BHVs) have a significant impact on the fatigue life of the metallic stent and thus must be taken into consideration when evaluating new TAVR device designs. This study aims to investigate the relationship between BHV anisotropic behaviour and the asymmetric deflections of the stent frame observed during in vitro testing. An explicit dynamics finite element model of the nitinol stent with attached bioprosthetic valve leaflets was developed to evaluate the deflections of the TAVR device under haemodynamic loading. Our results demonstrate that pericardium behaviour plays a dominant role in determining stent frame deflection. The anisotropic behaviour of the leaflets, resulting from collagen fibre orientation, affects the extent of deflection encountered by each commissure of the frame. This leads to asymmetric variation in frame deflection that can influence the overall fatigue life of the nitinol stent. This study highlights the importance of considering both the flexible nature of the metallic stent as well as the leaflet anisotropic behaviour in the design and fatigue assessment of TAVR systems.
Collapse
Affiliation(s)
- Dylan Armfield
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland; SFI I-Form Centre, University College Dublin, Dublin, Ireland.
| | - Sam Boxwell
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland; Mechanobiology and Medical Device Research Group, Department of Biomedical Engineering, University of Galway, Galway, Ireland
| | - Laoise McNamara
- Mechanobiology and Medical Device Research Group, Department of Biomedical Engineering, University of Galway, Galway, Ireland
| | - Scott Cook
- Structural Heart Division, Boston Scientific Corporation, Galway, Ireland
| | - Shane Conway
- Structural Heart Division, Boston Scientific Corporation, Galway, Ireland
| | - Mert Celikin
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland; SFI I-Form Centre, University College Dublin, Dublin, Ireland
| | - Philip Cardiff
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland; SFI I-Form Centre, University College Dublin, Dublin, Ireland.
| |
Collapse
|
4
|
Chen S, Pop A, Prasad Dasi L, George I. Lifetime Management for Aortic Stenosis: Strategy and Decision-Making in the Current Era. Ann Thorac Surg 2024:S0003-4975(24)00690-8. [PMID: 39214440 DOI: 10.1016/j.athoracsur.2024.05.047] [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: 12/03/2023] [Revised: 04/21/2024] [Accepted: 05/13/2024] [Indexed: 09/04/2024]
Abstract
Aortic stenosis, the most common valvular disease in the Western world, has traditionally been treated with surgical aortic valve replacement (SAVR) but is increasingly treated by transcatheter aortic valve replacement (TAVR). Whereas patients older than 65 years are preferably treated with bioprosthetic tissue valves, there is considerable uncertainty in the choice between TAVR and SAVR. We present various considerations for optimizing the lifelong management of patients receiving bioprosthetic valves (SAVR or TAVR). To maximize life expectancy and to minimize cumulative lifetime risk, we suggest decision-making individualized for patient anatomy and overall (current and future) risk.
Collapse
Affiliation(s)
- Shmuel Chen
- Weill Cornell Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Andrei Pop
- Ascension Alexian Brothers Medical Center, Elk Grove Village, Illinois
| | | | - Isaac George
- Structural Heart & Valve Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
| |
Collapse
|
5
|
Andreeva A, Werner P, Coti I, Kocher A, Laufer G, Ehrlich M, Zimpfer D, Andreas M. Decellularized aortic homografts versus mechanical composite grafts for aortic root replacement. Eur J Cardiothorac Surg 2024; 66:ezae314. [PMID: 39178014 PMCID: PMC11361793 DOI: 10.1093/ejcts/ezae314] [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: 03/27/2024] [Revised: 07/23/2024] [Accepted: 08/21/2024] [Indexed: 08/24/2024] Open
Abstract
OBJECTIVES Mechanical composite valve grafts (MCVGs) are the first-line therapy for aortic root replacement in young adults. Decellularized aortic homografts (DAH) present a promising novel alternative due to their lower thrombogenicity. We aimed to compare both treatment options regarding survival and valve-related adverse events. METHODS This study was designed as a single-centre retrospective cohort study including patients who underwent root replacement with MCVG or DAH between 2000 and 2022. Urgent or emergent procedures were excluded. RESULTS The study cohort included 289 patients (MCVG n = 216, DAH n = 73) with a mean age of 48.5 ± 12 years (MCVG 49 ± 12 years vs DAH 47 ± 11 years; P = 0.23) and a median EuroScore II of 1.7% (1.2, 2.6). The 30-day mortality was 1% (n = 3). Cumulative survival at 3 years was 99% for DAH and 94% for MCVG, respectively (P = 0.15). Mean follow-up was 98.9 ± 72.7 months. Bleeding events (n = 14, 6.5%) and thromboembolism (n = 14, 6.5%) were only observed in the MCVG group (P = 0.19 and 0.09, respectively). Four cases (5%) of moderate structural valve deterioration occurred, all in the DAH group (P ≤ 0.001). The cumulative incidence of a composite end point of valve-related adverse events was significantly higher in the MCVG group (P = 0.0295). CONCLUSIONS Aortic root replacement with MCVGs and decellularized aortic homografts showed low mortality in an elective setting. Patients in the homograft cohort demonstrated significantly higher freedom from valve-related adverse events. DAH present a promising treatment option for young patients requiring root replacement; however, data on long-term durability are needed.
Collapse
Affiliation(s)
- Alexandra Andreeva
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Paul Werner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Iuliana Coti
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Alfred Kocher
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Marek Ehrlich
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
6
|
Martinsson A, Rasalingam R, Jeppsson A. Stable incidence and outcomes for patients with incident aortic stenosis: how can we translate excellent trial data into improved clinical outcomes in the population? Eur Heart J 2024; 45:1887-1889. [PMID: 38446140 DOI: 10.1093/eurheartj/ehae078] [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] [Indexed: 03/07/2024] Open
Affiliation(s)
- Andreas Martinsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ravi Rasalingam
- Department of Cardiology, Boston Veteran Affairs Healthcare, West Roxbury, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
7
|
Praz F, Beyersdorf F, Haugaa K, Prendergast B. Valvular heart disease: from mechanisms to management. Lancet 2024; 403:1576-1589. [PMID: 38554728 DOI: 10.1016/s0140-6736(23)02755-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/16/2023] [Accepted: 12/06/2023] [Indexed: 04/02/2024]
Abstract
Valvular heart disease is common and its prevalence is rapidly increasing worldwide. Effective medical therapies are insufficient and treatment was historically limited to the surgical techniques of valve repair or replacement, resulting in systematic underprovision of care to older patients and those with substantial comorbidities, frailty, or left ventricular dysfunction. Advances in imaging and surgical techniques over the past 20 years have transformed the management of valvular heart disease. Better understanding of the mechanisms and causes of disease and an increasingly extensive and robust evidence base provide a platform for the delivery of individualised treatment by multidisciplinary heart teams working within networks of diagnostic facilities and specialist heart valve centres. In this Series paper, we aim to provide an overview of the current and future management of valvular heart disease and propose treatment approaches based on an understanding of the underlying pathophysiology and the application of multidisciplinary treatment strategies to individual patients.
Collapse
Affiliation(s)
- Fabien Praz
- University Hospital Bern Inselspital, University of Bern, Bern, Switzerland.
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Center, University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kristina Haugaa
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| | - Bernard Prendergast
- Heart Vascular and Thoracic Institute, Cleveland Clinic London, London, UK; Department of Cardiology, St Thomas' Hospital, London, UK
| |
Collapse
|
8
|
Rajesh K, Chung M, Levine D, Norton E, Patel P, Childress P, Zhao Y, Wang P, Leshnower B, Kurlansky P, Chen E, Takayama H. Long-term outcomes after aortic root replacement for bicuspid aortic valve-associated aneurysm. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00204-6. [PMID: 38691070 DOI: 10.1016/j.jtcvs.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Patients with congenital bicuspid aortic valve often require root replacement. This study aims to describe their long-term rates of mortality and reoperation. METHODS This is a multicenter retrospective study of 747 patients with bicuspid aortic valve who underwent aortic root replacement for aortic aneurysm between 2004 and 2020. Cumulative incidence curves for aortic valve and aortic reoperations were graphed. A Kaplan-Meier survival curve for the patient cohort was created alongside an age- and sex-matched curve for the US population. Multivariable Cox regression was used to determine characteristics associated with long-term mortality. RESULTS The median age of our cohort was 54 [43-64] years old, and 101 (13.5%) patients were female. In patients with bicuspid aortic valve dysfunction, 274 (36.7%) had aortic insufficiency, 187 (25.0%) had aortic stenosis, and 142 (19.0%) had both. In-hospital mortality occurred in 10 (1.3%) patients. There were 56 aortic valve reoperations and 19 aortic reoperations, with a combined cumulative incidence of 35% (95% confidence interval [CI], 23%-46%) at 15 years. In addition, there was comparable survival between the patient cohort and the age- and sex-matched US population. Age (hazard ratio [HR], 1.04; 95% CI, 1.01-1.06), concomitant CABG (HR, 2.28; 95% CI, 1.29-4.04), and bypass time (HR, 1.01; 95% CI, 1.00-1.01) were associated with increased mortality. CONCLUSIONS Patients who undergo aortic root replacement with bicuspid aortic valve have an increased rate of aortic reoperation (35%; 95% CI, 23%-46%) while their survival appears to be comparable to the general US population (79%; 95% CI, 73%-87%) at 15 years.
Collapse
Affiliation(s)
- Kavya Rajesh
- Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY
| | - Megan Chung
- Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY
| | - Dov Levine
- Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY
| | - Elizabeth Norton
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Parth Patel
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Patra Childress
- Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY
| | - Yanling Zhao
- Center for Innovation and Outcomes Research, Columbia University, New York, NY
| | - Pengchen Wang
- Center for Innovation and Outcomes Research, Columbia University, New York, NY
| | - Bradley Leshnower
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Paul Kurlansky
- Center for Innovation and Outcomes Research, Columbia University, New York, NY
| | - Edward Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Hiroo Takayama
- Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY.
| |
Collapse
|
9
|
Pan E, Nielsen SJ, Landenhed-Smith M, Törngren C, Björklund E, Hansson EC, Jeppsson A, Martinsson A. Statin treatment after surgical aortic valve replacement for aortic stenosis is associated with better long-term outcome. Eur J Cardiothorac Surg 2024; 65:ezae007. [PMID: 38273669 PMCID: PMC11462679 DOI: 10.1093/ejcts/ezae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/11/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the association between statin use after surgical aortic valve replacement for aortic stenosis and long-term risk for major adverse cardiovascular events (MACEs) in a large population-based, nationwide cohort. METHODS All patients who underwent isolated surgical aortic valve replacement due to aortic stenosis in Sweden 2006-2020 and survived 6 months after discharge were included. Individual patient data from 5 nationwide registries were merged. Primary outcome is MACE (defined as all-cause mortality, myocardial infarction or stroke). Multivariable Cox regression model adjusted for age, sex, comorbidities, valve type, operation year and secondary prevention medications is used to evaluate the association between time-updated dispense of statins and long-term outcome in the entire study population and in subgroups based on age, sex and comorbidities. RESULTS A total of 11 894 patients were included. Statins were dispensed to 49.8% (5918/11894) of patients at baseline, and 51.0% (874/1713) after 10 years. At baseline, 3.6% of patients were dispensed low dose, 69.4% medium dose and 27.0% high-dose statins. After adjustments, ongoing statin treatment was associated with a reduced risk for MACE [adjusted hazard ratio 0.77 (95% confidence interval 0.71-0.83). P < 0.001], mainly driven by a reduction in all-cause mortality [adjusted hazard ratio, 0.70 (0.64-0.76)], P < 0.001. The results were consistent in all subgroups. CONCLUSIONS The results suggest that statin therapy might be beneficial for patients undergoing surgical aortic valve replacement for aortic stenosis. Randomized controlled trials are warranted to establish causality between statin treatment and improved outcome.
Collapse
Affiliation(s)
- Emily Pan
- University of Turku, Turku, Finland
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Susanne J Nielsen
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maya Landenhed-Smith
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Charlotta Törngren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Erik Björklund
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Southern Älvborg Hospital, Borås, Sweden
| | - Emma C Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Martinsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
10
|
Martinsson A, Törngren C, Nielsen SJ, Pan E, Hansson EC, Taha A, Jeppsson A. Renin-angiotensin system inhibition after surgical aortic valve replacement for aortic stenosis. Heart 2024; 110:202-208. [PMID: 37460192 PMCID: PMC10850732 DOI: 10.1136/heartjnl-2023-322922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/28/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE The optimal medical therapy after surgical aortic valve replacement (SAVR) for aortic stenosis remains unknown. Renin-angiotensin system (RAS) inhibitors could potentially improve cardiac remodelling and clinical outcomes after SAVR. METHODS All patients undergoing SAVR due to aortic stenosis in Sweden 2006-2020 and surviving 6 months after surgery were included. The primary outcome was major adverse cardiovascular events (MACEs; all-cause mortality, stroke or myocardial infarction). Secondary endpoints included the individual components of MACE and cardiovascular mortality. Time-updated adjusted Cox regression models were used to compare patients with and without RAS inhibitors. Subgroup analyses were performed, as well as a comparison between angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). RESULTS A total of 11 894 patients (mean age, 69.5 years, 40.4% women) were included. Median follow-up time was 5.4 (2.7-8.5) years. At baseline, 53.6% of patients were dispensed RAS inhibitors, this proportion remained stable during follow-up. RAS inhibition was associated with a lower risk of MACE (adjusted hazard ratio (aHR) 0.87 (95% CI 0.81 to 0.93), p<0.001), mainly driven by a lower risk of all-cause death (aHR 0.79 (0.73 to 0.86), p<0.001). The lower MACE risk was consistent in all subgroups except for those with mechanical prostheses (aHR 1.07 (0.84 to 1.37), p for interaction=0.040). Both treatment with ACE inhibitors (aHR 0.89 (95% CI 0.82 to 0.97)) and ARBs (0.87 (0.81 to 0.93)) were associated with lower risk of MACE. CONCLUSION The results of this study suggest that medical therapy with an RAS inhibitor after SAVR is associated with a 13% lower risk of MACE and a 21% lower risk of all-cause death.
Collapse
Affiliation(s)
- Andreas Martinsson
- Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
- Department of Molecular and Clinical Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Charlotta Törngren
- Department of Molecular and Clinical Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Susanne J Nielsen
- Department of Molecular and Clinical Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Emily Pan
- Department of Cardiovascular Medicine, Harvard Medical School, Boston, Massachusetts, USA
- University of Turku, Turku, Finland
| | - Emma C Hansson
- Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Amar Taha
- Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
- Department of Molecular and Clinical Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
- Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
11
|
Sohn SH, Kim KH, Kang Y, Choi JW, Lee SH, Shinn SH, Lim C, Sung K, Yoo JS, Choo SJ. Aortic Valve Replacement in the Era of Transcatheter Aortic Valve Implantation: Current Status in Korea. J Korean Med Sci 2023; 38:e404. [PMID: 38084028 PMCID: PMC10713441 DOI: 10.3346/jkms.2023.38.e404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/12/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND In the era of transcatheter aortic valve implantation, this study was conducted to investigate the current trend of aortic valve procedures in Korea and to evaluate the early and mid-term outcomes of isolated surgical aortic valve replacement (SAVR) using bioprosthetic valves in contemporary Korea. METHODS Contemporary outcomes of isolated bioprosthetic SAVR in Korea were analyzed using the datasets on a multicenter basis. Patients who underwent isolated SAVR using bioprostheses from June 2015 to May 2019 were included, and those with concomitant cardiac procedures, SAVR with mechanical valve, or SAVR for infective endocarditis were excluded. A total of 456 patients from 4 large-volume centers were enrolled in this study. Median follow-up duration was 43.4 months. Early postoperative outcomes, mid-term clinical outcomes, and echocardiographic outcomes were evaluated. RESULTS Mean age of the patients was 73.1 ± 7.3 years, and EuroSCORE II was 2.23 ± 2.09. The cardiopulmonary bypass time and aortic cross-clamp times were median 106 and 76 minutes, respectively. SAVR was performed with full median sternotomy (81.8%), right thoracotomy (14.7%), or partial sternotomy (3.5%). Operative mortality was 1.8%. The incidences of stroke and permanent pacemaker implantation were 1.1% and 1.1%, respectively. Paravalvular regurgitation ≥ mild was detected in 2.6% of the patients. Cumulative incidence of all-cause mortality at 5 years was 13.0%. Cumulative incidences of cardiovascular mortality and bioprosthetic valve dysfunction at 5 years were 7.6% and 6.8%, respectively. CONCLUSION The most recent data for isolated SAVR using bioprostheses in Korea resulted in excellent early and mid-term outcomes in a multicenter study.
Collapse
Affiliation(s)
- Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hyun Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Ho Shinn
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Suk Yoo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
12
|
Lachonius M, Giang KW, Lindgren M, Skoglund K, Pétursson P, Silverborn M, Jeppsson A, Nielsen SJ. Socioeconomic factors and long-term mortality risk after surgical aortic valve replacement. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 19:200223. [PMID: 38023350 PMCID: PMC10661603 DOI: 10.1016/j.ijcrp.2023.200223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/09/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023]
Abstract
Background There is scarce knowledge about the association between socioeconomic status and mortality in patients undergoing surgical aortic valve replacement. This study explores the associations between income, education and marital status, and long-term mortality risk. Methods In this national registry-based observational cohort study we included all 14,537 patients aged >18 years who underwent isolated surgical aortic valve replacement for aortic stenosis in Sweden 1997-2020. Socioeconomic status and comorbidities were collected from three mandatory national registries. Cox regression models adjusted for patient characteristics and comorbidities were used to estimate the mortality risk. Results Mortality risk was higher for patients in the lowest versus the highest income quintile (adjusted hazard ratio [aHR] 1.36, 95 % confidence interval [CI]: 1.11-1.65), for patients with <10 years education versus >12 years (aHR 1.20, 95 % CI:1.08-1.33), and for patients who were not married/cohabiting versus those who were (aHR 1.24, 95 % CI:1.04-1.48). Patients with the most unfavorable socioeconomic status (lowest income, shortest education, never married/cohabiting) had an adjusted median survival of 2.9 years less than patients with the most favorable socioeconomic status (14.6 years, 95 % CI: 13.2-17.4 years vs. 11.7 years, 95 % CI: 9.8-14.4). Conclusions Low socioeconomic status in patients undergoing surgical aortic valve replacement is associated with shorter survival and an increased long-term adjusted mortality risk. These results emphasize the importance of identifying surgical aortic valve replacement patients with unfavorable socioeconomic situation and ensure sufficient post-discharge surveillance.
Collapse
Affiliation(s)
- Maria Lachonius
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kok Wai Giang
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
- Sahlgrenska University Hospital/Östra, Department of Medicine, Geriatrics and Emergency Medicine/Östra, Gothenburg, Sweden
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
- Sahlgrenska University Hospital/Östra, Department of Medicine, Geriatrics and Emergency Medicine/Östra, Gothenburg, Sweden
| | - Kristofer Skoglund
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pétur Pétursson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Silverborn
- Sahlgrenska University Hospital/Östra, Department of Medicine, Geriatrics and Emergency Medicine/Östra, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susanne J. Nielsen
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
13
|
Shimamura J, Takemoto S, Fukuhara S, Miyamoto Y, Yokoyama Y, Takagi H, Kampaktsis PN, Kolte D, Grubb KJ, Kuno T, Latib A. Long-term outcomes after transcatheter aortic valve replacement: Meta-analysis of Kaplan-Meier-derived data. Catheter Cardiovasc Interv 2023; 102:1291-1300. [PMID: 37890015 DOI: 10.1002/ccd.30854] [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: 07/08/2023] [Revised: 07/23/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is as an alternative treatment to surgical AVR, but the long-term outcomes of TAVR remain unclear. AIMS This study aimed to analyze long-term outcomes following TAVR using meta-analysis. METHODS A literature search was performed with MEDLINE, EMBASE, Cochrane Library, Web of Science, and Google Scholar through November 2022; studies reporting clinical outcomes of TAVR with follow-up periods of ≥8 years were included. The outcomes of interest were overall survival and/or freedom from structural valve deterioration (SVD). Surgical risk was assessed with the Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM) score. A subgroup analysis was conducted for intermediate-/high-surgical risk patients only. RESULTS Eleven studies including 5458 patients were identified and analyzed. The mean age was 82.0 ± 6.5 years, and mean STS PROM score ranged from 2.9 to 10.6%. Survival rate at 5 and 10 years was 47.7% ± 1.4% and 12.1 ± 2.0%. Five studies including 1509 patients were analyzed for SVD. Freedom from SVD at 5 and 8 years was 95.5 ± 0.7% and 85.1 ± 3.1%. Similar results for survival and SVD were noted in the subgroup analysis of intermediate-/high-risk patients. CONCLUSIONS Following TAVR, approximately 88% of patients died within 10 years, whereas 85% were free from SVD at 8 years. These date suggest that baseline patient demographic have the greatest impact on survival, and SVD does not seem to have a prognostic impact in this population. Further investigations on longer-term outcomes of younger and lower-risk patients are warranted.
Collapse
Affiliation(s)
- Junichi Shimamura
- Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sho Takemoto
- Department of Cardiovascular Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Yoshihisa Miyamoto
- Division of Nephrology and Endocrinology, University of Tokyo, Tokyo, Japan
| | - Yujiro Yokoyama
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Polydoros N Kampaktsis
- Division of Cardiology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Dhaval Kolte
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kendra J Grubb
- Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical center, Albert Einstein Medical College, New York City, New York, USA
- Division of Cardiology, Jacobi Medical center, Albert Einstein Medical College, New York, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical center, Albert Einstein Medical College, New York City, New York, USA
| |
Collapse
|
14
|
Taniguchi T, Morimoto T, Yamaji K, Shirai S, Ando K, Shiomi H, Takeji Y, Ohno N, Kanamori N, Yamazaki F, Koyama T, Kim K, Ehara N, Furukawa Y, Komiya T, Iwakura A, Shirotani M, Esaki J, Sakaguchi G, Fujii K, Nakayama S, Mabuchi H, Tsuneyoshi H, Eizawa H, Shiraga K, Hanyu M, Nakano A, Ishii K, Tamura N, Higashitani N, Kouchi I, Yamada T, Nishizawa J, Jinnai T, Morikami Y, Minatoya K, Kimura T. Life Expectancy of Patients With Severe Aortic Stenosis in Relation to Age and Surgical Risk Score. Ann Thorac Surg 2023; 116:1195-1203. [PMID: 36739072 DOI: 10.1016/j.athoracsur.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/28/2022] [Accepted: 01/14/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is a paucity of data regarding shorter life expectancy after aortic valve replacement (AVR) in patients with severe aortic stenosis (AS). METHODS Among 3815 patients with severe AS enrolled in the CURRENT AS (Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis) registry, there were 1469 patients (initial AVR: n = 647; conservative strategy: n = 822) with low surgical risk, 1642 patients (initial AVR: n = 433; conservative strategy: n = 1209) with intermediate surgical risk, and 704 patients (initial AVR: n = 117; conservative strategy: n = 587) with high surgical risk. Among 1163 patients who actually underwent surgical AVR as the initial strategy, patients were divided into 4 groups according to age <65 years (n = 185), 65 to 74 (n = 394), 75 to 80 (n = 345), and >80 (n = 239). The expected survival of the general Japanese population was obtained from the Statistics Bureau of Japan. The surgical risk was estimated using The Society of Thoracic Surgery (STS) score. RESULTS The median follow-up was 3.7 years. The cumulative incidences of all-cause death were significantly lower in the initial AVR strategy than in the initial conservative strategy across the 3 STS groups. Shorter life expectancy after surgical AVR was seen especially in younger patients. The observed mortality in low-risk patients was comparable to the expected mortality across all the age-groups, while intermediate-risk patients aged <75 years, and high-risk patients across all age-groups had higher mortality compared with the expected mortality. CONCLUSIONS The risk stratification according to age and STS score might be useful to estimate shorter life expectancy after AVR, and these findings have implications for decision making in the choice of surgical or transcatheter AVR.
Collapse
Affiliation(s)
- Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinichi Shirai
- Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuaki Takeji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Norio Kanamori
- Department of Cardiovascular Medicine, Shimada General Medical Center, Shimada, Japan
| | - Fumio Yamazaki
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Atsushi Iwakura
- Department of Cardiovascular Surgery, Tenri Hospital, Tenri City, Japan
| | - Manabu Shirotani
- Department of Cardiovascular Medicine, Kindai University Nara Hospital, Nara, Japan
| | - Jiro Esaki
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, West Kyoto, Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kindai University Hospital, Osaka Sayama City, Japan
| | - Kosuke Fujii
- Department of Cardiovascular Surgery, Kishiwada City Hospital, Kishiwada, Japan
| | - Shogo Nakayama
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Hiroshi Mabuchi
- Department of Cardiovascular Medicine, Koto Memorial Hospital, Higashiomi, Japan
| | - Hiroshi Tsuneyoshi
- Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Hiroshi Eizawa
- Department of Cardiovascular Medicine, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Kotaro Shiraga
- Department of Cardiovascular Surgery, Kyoto Medical Center, Kyoto Japan
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, Kitano Hospital, Osaka, Japan
| | - Akira Nakano
- Department of Cardiovascular Medicine, Hikone Municipal Hospital, Hikone, Japan
| | - Katsuhisa Ishii
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital, Fukushima, Japan
| | - Nobushige Tamura
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Nobuya Higashitani
- Department of Cardiovascular Medicine, Otsu Red Cross Hospital, Otsu, Japan
| | - Ichiro Kouchi
- Department of Cardiovascular Medicine, Saiseikai Noe Hospital, Osaka, Japan
| | - Tomoyuki Yamada
- Department of Cardiovascular Surgery, Shiga General Hospital, Shiga, Japan
| | - Junichiro Nishizawa
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Hamamatsu City, Japan
| | - Toshikazu Jinnai
- Department of Cardiovascular Medicine, Otsu Red Cross Hospital, Otsu, Japan
| | - Yuko Morikami
- Department of Cardiovascular Medicine, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| |
Collapse
|
15
|
Nguyen D, Marwick T, Moodie M, Gao L. Early offering transcatheter aortic valve replacement to patients with moderate aortic stenosis: quantifying costs and benefits - a Markov model-based simulation study. BMJ Open 2023; 13:e073254. [PMID: 37993164 PMCID: PMC10668295 DOI: 10.1136/bmjopen-2023-073254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVE Aortic stenosis (AS) is one of the most common acquired cardiac valvular diseases. The success of transcatheter aortic valve implantation (TAVI) for severe AS has led to increasing interest in its use to earlier disease-moderate AS (MAS). DESIGN Model-based study using a Markov microsimulation technique to evaluate the long-term costs and benefits associated with 'early' TAVI. Key data inputs were sourced from the international literature and costs were obtained from Australian sources. SETTING Australian health care system perspective. PARTICIPANTS 10 000 hypothetical MAS patients with or without left ventricular diastolic dysfunction or impaired left ventricular ejection fraction. INTERVENTION Comparing early TAVI to medical management over a life time horizon for MAS patients aged >65 years. We evaluated the cost-effectiveness of offering early TAVI in five scenarios (10%, 25%, 50%, 75% and 90% take-up rates). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure is quality-adjusted life years (QALY) gained and the incremental cost-utility ratio (ICUR). Secondary outcomes are life-years gained and the number of heart failure case avoided. RESULTS Offering early TAVI for MAS patients resulted in both higher healthcare costs and greater benefits (an increase of 3.02 QALYs or 3.99 life-years) per person treated. The ICUR was around $A10 867 and $A11 926 per QALY gained for all five scenarios, with the total cost of early TAVI to the healthcare system being anticipated to be up to $A3.66 billion. Sensitivity analyses indicated a 100% probability of being cost-effective with a willingness to pay threshold of $A50 000/QALY. The benefits remained, even with assumptions of high levels of repeat valve replacement after TAVI. CONCLUSION While ongoing randomised controlled trials will define the benefit of TAVI to MAS patients, these results suggest that this intervention is likely to be cost-effective.
Collapse
Affiliation(s)
- Dieu Nguyen
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Tom Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Lan Gao
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University Faculty of Health, Geelong, Victoria, Australia
| |
Collapse
|
16
|
Prosperi-Porta G, Nguyen V, Willner N, Dreyfus J, Eltchaninoff H, Burwash IG, Michel M, Durand E, Gilard M, Dindorf C, Iung B, Cribier A, Vahanian A, Chevreul K, Messika-Zeitoun D. Association of Age and Sex With Use of Transcatheter Aortic Valve Replacement in France. J Am Coll Cardiol 2023; 82:1889-1902. [PMID: 37877906 DOI: 10.1016/j.jacc.2023.08.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Current guidelines recommend selecting surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) based on age, comorbidities, and surgical risk. Nevertheless, reports from the United States suggest a rapid expansion of TAVR in young patients. OBJECTIVES The authors sought to evaluate the trends in TAVR uptake at a nationwide level in France according to age and sex. METHODS Using a nationwide administrative database, we evaluated age- and sex-related trends in TAVR uptake, patient demographics, and in-hospital outcomes between 2015 and 2020. RESULTS A total of 107,397 patients (44.0% female) underwent an isolated aortic valve replacement (AVR) (59.1% TAVR, 40.9% SAVR). In patients <65 years of age, the proportion of TAVR increased by 63.2% (P < 0.001) from 2015 to 2020 but remained uncommon at 11.1% of all AVR by 2020 (12.4% in females, 10.6% in males) while TAVR was the dominant modality in patients ≥65 years of age. In patients undergoing TAVR, the Charlson comorbidity index (CCI) (P = 0.119 for trend) and in-hospital mortality (P = 0.740 for trend) remained unchanged in patients <65 years of age but declined in those ≥65 years of age irrespective of sex (all P < 0.001 for trends). Females were older (P < 0.001), had lower CCI (P < 0.001), were more likely to undergo TAVR (P < 0.001), and experienced higher in-hospital mortality (TAVR, P = 0.015; SAVR, P < 0.001) that persisted despite adjustment for age and CCI. CONCLUSIONS In France, the use of TAVR remained uncommon in young patients, predominantly restricted to those at high risk. Important sex differences were observed in patent demographics, selection of AVR modality, and patient outcomes. Additional research evaluating the long-term impact of TAVR use in young patients and prospective data evaluating sex differences in AVR modality selection and outcomes are needed.
Collapse
Affiliation(s)
- Graeme Prosperi-Porta
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Virginia Nguyen
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | - Nadav Willner
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | - Helene Eltchaninoff
- Univ Rouen Normandie, Inserm U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | - Ian G Burwash
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Morgane Michel
- Université Paris-Cité, Paris, France; Unité d'épidémiologie Clinique, Hôpital Robert Debré, AP-HP, Paris, France; INSERM, ECEVE, U1123, Paris, France
| | - Eric Durand
- Univ Rouen Normandie, Inserm U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, Brest, France
| | - Christel Dindorf
- Université Paris-Cité, Paris, France; INSERM, ECEVE, U1123, Paris, France; URC Eco Ile de France, AP-HP, Hôtel Dieu, Paris, France
| | - Bernard Iung
- Université Paris-Cité, Paris, France; Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, Paris, France
| | - Alain Cribier
- Univ Rouen Normandie, Inserm U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | - Alec Vahanian
- Université Paris-Cité, Paris, France; INSERM U1148, Université Paris-Cité, Paris, France
| | - Karine Chevreul
- Université Paris-Cité, Paris, France; Department of Cardiology, Brest University Hospital, Brest, France; URC Eco Ile de France, AP-HP, Hôtel Dieu, Paris, France
| | - David Messika-Zeitoun
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| |
Collapse
|
17
|
Galper BZ, Chinnakondepalli KM, Wang K, Magnuson EA, Lu M, Thourani VH, Kodali S, Makkar R, Herrmann HC, Kapadia S, Williams M, Webb J, Smith CR, Mack MJ, Leon MB, Cohen DJ. Economic Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Severe Aortic Stenosis and Low Surgical Risk: Results from the PARTNER 3 Trial. Circulation 2023; 147:1594-1605. [PMID: 37154049 DOI: 10.1161/circulationaha.122.062481] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/08/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND In patients with severe symptomatic aortic stenosis at low surgical risk, transfemoral transcatheter aortic valve replacement (TAVR) with the SAPIEN 3 valve has been shown to reduce the composite of death, stroke, or rehospitalization at 2-year follow-up compared with surgical aortic valve replacement (SAVR). Whether TAVR is cost-effective compared with SAVR for low-risk patients remains uncertain. METHODS Between 2016 and 2017, 1000 low-risk patients with aortic stenosis were randomly assigned to TAVR with the SAPIEN 3 valve or SAVR in the PARTNER 3 trial (Placement of Aortic Transcatheter Valves). Of these patients, 929 underwent valve replacement, were enrolled in the United States, and were included in the economic substudy. Procedural costs were estimated using measured resource use. Other costs were determined by linkage with Medicare claims or by regression models when linkage was not feasible. Health utilities were estimated using the EuroQOL 5-item questionnaire. With the use of a Markov model informed by in-trial data, lifetime cost-effectiveness from the perspective of the US health care system was estimated in terms of cost per quality-adjusted life-year gained. RESULTS Although procedural costs were nearly $19 000 higher with TAVR, total index hospitalization costs were only $591 more with TAVR compared with SAVR. Follow-up costs were lower with TAVR such that TAVR led to 2-year cost savings of $2030/patient compared with SAVR (95% CI, -$6222 to $1816) and a gain of 0.05 quality-adjusted life-years (95% CI, -0.003 to 0.102). In our base-case analysis, TAVR was projected to be an economically dominant strategy with a 95% probability that the incremental cost-effectiveness ratio for TAVR would be <$50 000/quality-adjusted life-year gained (consistent with high economic value from a US health care perspective). These findings were sensitive to differences in long-term survival, however, such that a modest long-term survival advantage with SAVR would render SAVR cost-effective (although not cost saving) compared with TAVR. CONCLUSIONS For patients with severe aortic stenosis and low surgical risk similar to those enrolled in the PARTNER 3 trial, transfemoral TAVR with the SAPIEN 3 valve is cost saving compared with SAVR at 2 years and is projected to be economically attractive in the long run as long as there are no substantial differences in late death between the 2 strategies. Long-term follow-up will be critical to ultimately determine the preferred treatment strategy for low-risk patients from both a clinical and economic perspective.
Collapse
Affiliation(s)
| | | | - Kaijun Wang
- Saint-Luke's Mid America Heart Institute, Kansas City, MO (K.M.C., K.W., E.A.M.)
| | - Elizabeth A Magnuson
- Saint-Luke's Mid America Heart Institute, Kansas City, MO (K.M.C., K.W., E.A.M.)
| | | | | | - Susheel Kodali
- New York-Presbyterian/Columbia University Irving Medical Center, New York (S. Kodali, C.R.S., M.B.L.)
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, CA (R.M.)
| | | | | | | | - John Webb
- St. Paul's Hospital, Vancouver, BC, Canada (J.W.)
| | - Craig R Smith
- New York-Presbyterian/Columbia University Irving Medical Center, New York (S. Kodali, C.R.S., M.B.L.)
| | | | - Martin B Leon
- New York-Presbyterian/Columbia University Irving Medical Center, New York (S. Kodali, C.R.S., M.B.L.)
- Cardiovascular Research Foundation, New York, NY (M.B.L., D.J.C.)
| | - David J Cohen
- Cardiovascular Research Foundation, New York, NY (M.B.L., D.J.C.)
- St. Francis Hospital, Roslyn, NY (D.J.C.)
| |
Collapse
|
18
|
Khera S, Tang GHL. Subclinical Thrombosis on Valve Durability in Low-Risk Transcatheter Aortic Valve Replacement Patients: Mid-Term Data Reassuring, but Longer Follow-Up Needed. Circ Cardiovasc Interv 2023; 16:e013111. [PMID: 37192314 DOI: 10.1161/circinterventions.123.013111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Affiliation(s)
- Sahil Khera
- Division of Cardiology, Mount Sinai Hospital, New York, NY (S.K.)
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY (G.H.L.T.)
| |
Collapse
|
19
|
Tarantini G, Fabris T. Redo Aortic Valve Interventions: A Good Start Is Half the Job to Subsequent Permutations. JACC Cardiovasc Interv 2023; 16:954-957. [PMID: 37100558 DOI: 10.1016/j.jcin.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 04/28/2023]
Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy.
| | - Tommaso Fabris
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| |
Collapse
|
20
|
Jolliffe J, Moten S, Tripathy A, Skillington P, Tatoulis J, Muneretto C, Di Bacco L, Galvao HBF, Goldblatt J. Perceval valve intermediate outcomes: a systematic review and meta-analysis at 5-year follow-up. J Cardiothorac Surg 2023; 18:129. [PMID: 37041628 PMCID: PMC10091543 DOI: 10.1186/s13019-023-02273-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 04/04/2023] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVES New technologies for the treatment of Aortic Stenosis are evolving to minimize risk and treat an increasingly comorbid population. The Sutureless Perceval Valve is one such alternative. Whilst short-term data is promising, limited mid-term outcomes exist, until now. This is the first systematic review and meta-analysis to evaluate mid-term outcomes in the Perceval Valve in isolation. METHODS A systematic literature review of 5 databases was performed. Articles included evaluated echocardiographic and mortality outcomes beyond 5 years in patients who had undergone Perceval Valve AVR. Two reviewers extracted and reviewed the articles. Weighted estimates were performed for all post-operative and mid-term data. Aggregated Kaplan Meier curves were reconstructed from digitised images to evaluate long-term survival. RESULTS Seven observational studies were identified, with a total number of 3196 patients analysed. 30-day mortality was 2.5%. Aggregated survival at 1, 2, 3, 4 and 5 years was 93.4%, 89.4%, 84.9%, 82% and 79.5% respectively. Permanent pacemaker implantation (7.9%), severe paravalvular leak (1.6%), structural valve deterioration (1.5%), stroke (4.4%), endocarditis (1.6%) and valve explant (2.3%) were acceptable at up to mid-term follow up. Haemodynamics were also acceptable at up mid-term with mean-valve gradient (range 9-13.6 mmHg), peak-valve gradient (17.8-22.3 mmHg) and effective orifice area (1.5-1.8 cm2) across all valve sizes. Cardiopulmonary bypass (78 min) and Aortic cross clamp times (52 min) were also favourable. CONCLUSION To our knowledge, this represents the first meta-analysis to date evaluating mid-term outcomes in the Perceval Valve in isolation and demonstrates good 5-year mortality, haemodynamic and morbidity outcomes. KEY QUESTION What are the mid-term outcomes at up to 5 years follow up in Perceval Valve Aortic Valve Replacement? KEY FINDINGS Perceval Valve AVR achieves 80% freedom from mortality at 5 years with low valve gradients and minimal morbidity. KEY OUTCOMES Perceval Valve Aortic Valve Replacement has acceptable mid-term mortality, durability and haemodynamic outcomes.
Collapse
Affiliation(s)
- Jarrod Jolliffe
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia.
| | - Simon Moten
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | - Amit Tripathy
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | - Peter Skillington
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | - James Tatoulis
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | | | - Lorenzo Di Bacco
- School of Cardiac Surgery, University of Brescia, Brescia, Italy
| | | | - John Goldblatt
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| |
Collapse
|
21
|
Iliuță L, Andronesi AG, Scafa-Udriște A, Rădulescu B, Moldovan H, Furtunescu FL, Panaitescu E. Incidence and Risk Factors for Long-Term Persistence of Diastolic Dysfunction after Aortic Valve Replacement for Aortic Stenosis Compared with Aortic Regurgitation. J Cardiovasc Dev Dis 2023; 10:jcdd10030131. [PMID: 36975895 PMCID: PMC10052670 DOI: 10.3390/jcdd10030131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
(1) Background: Severe left ventricular (LV) diastolic dysfunction with a restrictive diastolic pattern (LVDFP) is generally associated with a worse prognosis. Its evolution and reversibility in the short- and medium-term after aortic valve replacement (AVR) has been little-studied. We aimed to evaluate the evolution of LV remodeling and LV systolic and diastolic function after AVR in aortic stenosis (AS) patients compared to aortic regurgitation (AR). Moreover, we tried to identify the main predictive parameters for postoperative evolution (cardiovascular hospitalization or death and quality of life) and the independent predictors for the persistence of restrictive LVDFP after AVR. (2) Methods: A five-year prospective study on 397 patients undergoing AVR for AS (226 pts) or AR (171 pts), evaluated clinically and by echocardiography preoperatively and until 5 years postoperatively. (3) Results: 1. In patients with AS, early post AVR, LV dimensions decreased and diastolic filling and LV ejection fraction (LVEF) improved more rapidly compared to patients with AR. At 1 year postoperatively, persistent restrictive LVDFP was found especially in the AR group compared to the AS group (36.84% vs. 14.16%). 2. Cardiovascular event-free survival at the 5-year follow-up was lower in the AR group (64.91% vs. 87.17% in the AS group). The main independent predictors of short- and medium-term prognosis after AVR were: restrictive LVDFP, severe LV systolic dysfunction, severe pulmonary hypertension (PHT), advanced age, severe AR, and comorbidities. 3. The persistence of restrictive LVDFP after AVR was independently predicted by: preoperative AR, the E/Ea ratio > 12, the LA dimension index > 30 mm/m2, an LV endsystolic diameter (LVESD) > 55 mm, severe PHT, and associated second-degree MR (p < 0.05). (4) Conclusions: AS patients had an immediate postoperative evolution in terms of LV remodeling, and LV systolic and diastolic function were more favorable compared to those with AR. The restrictive LVDFP was reversible, especially after the AVR for AS. The main prognostic predictors were the presence of restrictive LVDFP, advanced age, preoperative AR, severe LV systolic dysfunction, and severe PHT.
Collapse
Affiliation(s)
- Luminița Iliuță
- Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
- Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania
| | - Andreea Gabriella Andronesi
- Nephrology Department, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
- Nephrology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Alexandru Scafa-Udriște
- Department of Cardio-Thoracic Pathology, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
- Department of Cardiology, Clinical Emergency Hospital, 014461 Bucharest, Romania
| | - Bogdan Rădulescu
- Department of Cardio-Thoracic Pathology, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
- Department of Cardiovascular Surgery, Emergency Institute for cardiovascular diseases "C.C Iliescu", 022328 Bucharest, Romania
| | - Horațiu Moldovan
- Department of Cardio-Thoracic Pathology, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
- Academy of Romanian Scientists (AOSR), 3 Ilfov Street, 050044 Bucharest, Romania
- Department of Cardiovascular Surgery, Clinical Emergency Hospital, 014461 Bucharest, Romania
| | - Florentina Ligia Furtunescu
- Department of Public Health and Management, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
| | - Eugenia Panaitescu
- Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
| |
Collapse
|
22
|
Pollari F, Mamdooh H, Hitzl W, Grossmann I, Vogt F, Fischlein T. Ten years' experience with the sutureless aortic valve replacement: incidence and predictors for survival and valve durability at follow-up. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2023; 63:6935788. [PMID: 36534823 DOI: 10.1093/ejcts/ezac572] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 11/25/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Aortic valve replacement with a sutureless prosthesis [sutureless aortic valve replacement (Su-AVR)] is an option for patients with severe aortic valve stenosis. However, data regarding long-term outcomes and prosthesis durability are still lacking. METHODS All consecutive patients who successfully underwent Su-AVR with the Perceval valve in our centre between 2010 and 2020 were included in the analysis and followed prospectively with echocardiography. Risk factor analysis was performed to assess variables associated with worse survival and bioprosthetic valve failure. RESULTS Study population consisted of 547 patients: the mean age was 76.4 (5.2) years, 51% were female and the mean logistic EuroSCORE was 13% (11). The median survival was 7.76 years [95% confidence interval (CI) = 6.9-8.6]. Risk factor analysis identified age [hazard ratio (HR) 1.06, 95% CI 1.03-1.11; P < 0.001), EuroSCORE II (HR 1.08, 1.02-1.13; P < 0.001), baseline dialysis (HR 2.14, 95% CI 1.4-4.4; P = 0.038) and postoperative acute kidney injury ≥2 (HR 8.97, 95% CI 4.58-17.6; P < 0.001) as factors significantly correlated with worse survival. The reported HRs for age are per 1 year and for EuroSCORE II is 1 percentage point. Structural valve deterioration (SVD) was observed in 23 patients, of whom 19 underwent reintervention (median freedom from SVD 10.3 years). In multivariable Cox analysis, age (HR 0.89, 95% CI 0.82-0.95; P < 0.001) was found to be a significant predictor of SVD. Overall, 1.8% was referred for prosthetic valve endocarditis (confirmed or suspected) during follow-up. One patient showed moderate non-SVD and none developed prosthetic valve thrombosis. CONCLUSIONS The sutureless valve represents a reliable bioprosthesis for aortic valve replacement in patients with a 10-year life expectancy. Younger age at the time of implant is the only factor associated with the risk of long-term SVD.
Collapse
Affiliation(s)
- Francesco Pollari
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| | - Hazem Mamdooh
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| | - Wolfgang Hitzl
- Research and Innovation Management (RIM) Department, Biostatistics and Publication of Clinical Trials, Paracelsus Medical University, Salzburg, Austria.,Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
| | - Irena Grossmann
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| | - Ferdinand Vogt
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nuremberg, Germany
| |
Collapse
|
23
|
O'Hair D, Yakubov SJ, Grubb KJ, Oh JK, Ito S, Deeb GM, Van Mieghem NM, Adams DH, Bajwa T, Kleiman NS, Chetcuti S, Søndergaard L, Gada H, Mumtaz M, Heiser J, Merhi WM, Petrossian G, Robinson N, Tang GHL, Rovin JD, Little SH, Jain R, Verdoliva S, Hanson T, Li S, Popma JJ, Reardon MJ. Structural Valve Deterioration After Self-Expanding Transcatheter or Surgical Aortic Valve Implantation in Patients at Intermediate or High Risk. JAMA Cardiol 2023; 8:111-119. [PMID: 36515976 PMCID: PMC9857153 DOI: 10.1001/jamacardio.2022.4627] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance The frequency and clinical importance of structural valve deterioration (SVD) in patients undergoing self-expanding transcatheter aortic valve implantation (TAVI) or surgery is poorly understood. Objective To evaluate the 5-year incidence, clinical outcomes, and predictors of hemodynamic SVD in patients undergoing self-expanding TAVI or surgery. Design, Setting, and Participants This post hoc analysis pooled data from the CoreValve US High Risk Pivotal (n = 615) and SURTAVI (n = 1484) randomized clinical trials (RCTs); it was supplemented by the CoreValve Extreme Risk Pivotal trial (n = 485) and CoreValve Continued Access Study (n = 2178). Patients with severe aortic valve stenosis deemed to be at intermediate or increased risk of 30-day surgical mortality were included. Data were collected from December 2010 to June 2016, and data were analyzed from December 2021 to October 2022. Interventions Patients were randomized to self-expanding TAVI or surgery in the RCTs or underwent self-expanding TAVI for clinical indications in the nonrandomized studies. Main Outcomes and Measures The primary end point was the incidence of SVD through 5 years (from the RCTs). Factors associated with SVD and its association with clinical outcomes were evaluated for the pooled RCT and non-RCT population. SVD was defined as (1) an increase in mean gradient of 10 mm Hg or greater from discharge or at 30 days to last echocardiography with a final mean gradient of 20 mm Hg or greater or (2) new-onset moderate or severe intraprosthetic aortic regurgitation or an increase of 1 grade or more. Results Of 4762 included patients, 2605 (54.7%) were male, and the mean (SD) age was 82.1 (7.4) years. A total of 2099 RCT patients, including 1128 who received TAVI and 971 who received surgery, and 2663 non-RCT patients who received TAVI were included. The cumulative incidence of SVD treating death as a competing risk was lower in patients undergoing TAVI than surgery (TAVI, 2.20%; surgery, 4.38%; hazard ratio [HR], 0.46; 95% CI, 0.27-0.78; P = .004). This lower risk was most pronounced in patients with smaller annuli (23 mm diameter or smaller; TAVI, 1.32%; surgery, 5.84%; HR, 0.21; 95% CI, 0.06-0.73; P = .02). SVD was associated with increased 5-year all-cause mortality (HR, 2.03; 95% CI, 1.46-2.82; P < .001), cardiovascular mortality (HR, 1.86; 95% CI, 1.20-2.90; P = .006), and valve disease or worsening heart failure hospitalizations (HR, 2.17; 95% CI, 1.23-3.84; P = .008). Predictors of SVD were developed from multivariate analysis. Conclusions and Relevance This study found a lower rate of SVD in patients undergoing self-expanding TAVI vs surgery at 5 years. Doppler echocardiography was a valuable tool to detect SVD, which was associated with worse clinical outcomes. Trial Registration ClinicalTrials.gov Identifiers: NCT01240902, NCT01586910, and NCT01531374.
Collapse
Affiliation(s)
- Daniel O'Hair
- Cardiovascular Service Line, Boulder Community Health, Boulder, Colorado
| | - Steven J Yakubov
- Department of Interventional Cardiology, Ohio Health Riverside Methodist Hospital, Columbus
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jae K Oh
- Echocardiography Core Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Saki Ito
- Echocardiography Core Laboratory, Mayo Clinic, Rochester, Minnesota
| | - G Michael Deeb
- Department of Interventional Cardiology, University of Michigan Hospitals, Ann Arbor.,Department of Cardiac Surgery, University of Michigan Hospitals, Ann Arbor
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - David H Adams
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York
| | - Tanvir Bajwa
- Department of Cardiothoracic Surgery, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Neal S Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.,Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Stanley Chetcuti
- Department of Interventional Cardiology, University of Michigan Hospitals, Ann Arbor.,Department of Cardiac Surgery, University of Michigan Hospitals, Ann Arbor
| | - Lars Søndergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hemal Gada
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle Health, Harrisburg, Pennsylvania.,Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pinnacle Health, Harrisburg, Pennsylvania
| | - Mubashir Mumtaz
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle Health, Harrisburg, Pennsylvania.,Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pinnacle Health, Harrisburg, Pennsylvania
| | - John Heiser
- Department of Interventional Cardiology, Spectrum Health, Grand Rapids, Michigan.,Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan
| | - William M Merhi
- Department of Interventional Cardiology, Spectrum Health, Grand Rapids, Michigan.,Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan
| | - George Petrossian
- Department of Cardiothoracic and Vascular Surgery, Saint Francis Hospital, Roslyn, New York
| | - Newell Robinson
- Department of Cardiothoracic and Vascular Surgery, Saint Francis Hospital, Roslyn, New York
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York
| | - Joshua D Rovin
- Center for Advanced Valve and Structural Heart Care, Morton Plant Hospital, Clearwater, Florida
| | - Stephen H Little
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.,Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Renuka Jain
- Aurora Cardiovascular Services, Aurora-St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Sarah Verdoliva
- Structural Heart and Aortic, Medtronic, Minneapolis, Minnesota
| | - Tim Hanson
- Structural Heart and Aortic, Medtronic, Minneapolis, Minnesota
| | - Shuzhen Li
- Structural Heart and Aortic, Medtronic, Minneapolis, Minnesota
| | - Jeffrey J Popma
- Structural Heart and Aortic, Medtronic, Minneapolis, Minnesota
| | - Michael J Reardon
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.,Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| |
Collapse
|
24
|
Desai PV, Goel SS, Kleiman NS, Reardon MJ. Transcatheter Aortic Valve Implantation: Long-Term Outcomes and Durability. Methodist Debakey Cardiovasc J 2023; 19:15-25. [PMID: 37213878 PMCID: PMC10198228 DOI: 10.14797/mdcvj.1201] [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] [Received: 03/24/2023] [Accepted: 04/27/2023] [Indexed: 05/23/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has become the standard of care in symptomatic older patients with severe aortic stenosis regardless of surgical risk. With the development of newer generation transcatheter bioprostheses, improved delivery systems, better preprocedure planning with imaging guidance, increased operator experience, shorter hospital length of stay, and low short- and mid-term complication rates, TAVI is gaining popularity among younger patients at low or intermediate surgical risk. Long-term outcomes and durability of transcatheter heart valves have become substantially important for this younger population due to their longer life expectancy. The lack of standardized definitions of bioprosthetic valve dysfunction and disagreement about how to account for the competing risks made comparison of transcatheter heart valves with surgical bioprostheses challenging until recently. In this review, the authors discuss the mid- to long-term (≥ 5 years) clinical outcomes observed in the landmark TAVI trials and analyze the available long-term durability data emphasizing the importance of using standardized definitions of bioprosthetic valve dysfunction.
Collapse
Affiliation(s)
| | - Sachin S. Goel
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Neal S. Kleiman
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Michael J. Reardon
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| |
Collapse
|
25
|
Iliuta L, Andronesi AG, Diaconu CC, Moldovan H, Rac-Albu M, Rac-Albu ME. Diastolic versus Systolic Left Ventricular Dysfunction as Independent Predictors for Unfavorable Postoperative Evolution in Patients with Aortic Regurgitation Undergoing Aortic Valve Replacement. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111676. [PMID: 36422215 PMCID: PMC9699235 DOI: 10.3390/medicina58111676] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/05/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022]
Abstract
Background and Objectives: Chronic severe aortic valve disease is associated with important changes in left ventricle (LV) performance associated with eccentric or concentric LV hypertrophy. We aimed to assess the immediate prognostic implications of the type of the LV diastolic filling pattern (LVDFP) compared with LV systolic performance in patients with severe aortic regurgitation (AR) undergoing aortic valve replacement (AVR) and to define the independent echographic predictors for the immediate and long-term prognoses. Materials and Methods: We performed a prospective study enrolling 332 AR patients undergoing AVR, divided into two groups: Group A—201 pts with normal LV systolic function, divided into two subgroups (A1: 129 pts with a nonrestrictive LVDFP and A2: 72 pts with restrictive LVDFP), and Group B—131 pts with LV systolic dysfunction (LV ejection fraction LVEF < 50%), divided into two subgroups (B1: 83 pts with a nonrestrictive LVDFP and B2: 48 pts with restrictive LVDFP). Results: The early postoperative mortality rate was higher in patients with a restrictive LVDFP (11.12% in A2 and 12.5% in B2) compared with normal LV filling (2.32% in A1 and 7.63% in B1, p < 0.0001), regardless of the LVEF. The restrictive LVDFP—defined by at least one of the following echographic parameters: an E/A > 2 with an E wave deceleration time (EDt) < 100 ms; an isovolumetric relaxation time (IVRT) < 60 ms; or an S/D ratio < 1 in the pulmonary vein flow—was an independent predictor for early postoperative mortality, increasing the relative risk by 8.2-fold. Other independent factors associated with early poor prognosis were an LV end-systolic diameter (LVESD) > 58 mm, an age > 75 years, and the presence of comorbidities (chronic obstructive pulmonary disease-COPD or diabetes mellitus). On a medium-term, an unfavorable evolution was associated with: an age > 75 years (RR = 8.1), an LV end-systolic volume (LVESV) > 95 cm3 (RR = 6.7), a restrictive LVDFP (RR = 9.8, p < 0.0002), and pulmonary hypertension (RR = 8.2). Conclusions: The presence of a restrictive LVDFP in patients with AR undergoing AVR is associated with both increased early and medium-term mortality rates. The LV diastolic function is a more reliable parameter for prognosis than LV systolic performance (RR 9.2 versus 2.1). Other independent predictors for increased early postoperative mortality rate were: an age > 75 years, an LVESD > 58 mm, and comorbidities (diabetes mellitus, COPD), and for unfavorable evolution at 2 years postoperatively: an age > 75 years, an LVESV > 95 cm3, and severe pulmonary hypertension.
Collapse
Affiliation(s)
- Luminita Iliuta
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania
| | - Andreea Gabriella Andronesi
- Nephrology Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Nephrology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Correspondence:
| | - Camelia Cristina Diaconu
- Internal Medicine Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Internal Medicine Clinic, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
- Academy of Romanian Scientists, 3 Ilfov Street, 050044 Bucharest, Romania
| | - Horatiu Moldovan
- Academy of Romanian Scientists, 3 Ilfov Street, 050044 Bucharest, Romania
- Department of Cardio-Thoracic Pathology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Department of Cardiovascular Surgery, Clinical Emergency Hospital, 014461 Bucharest, Romania
| | - Marius Rac-Albu
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania
| | - Madalina-Elena Rac-Albu
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| |
Collapse
|
26
|
Baranowska J, Törngren C, Nielsen SJ, Lindgren M, Björklund E, Ravn-Fischer A, Skoglund K, Jeppsson A, Martinsson A. Associations between medical therapy after surgical aortic valve replacement for aortic stenosis and long-term mortality: a report from the SWEDEHEART registry. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 8:837-846. [PMID: 35583235 PMCID: PMC9716862 DOI: 10.1093/ehjcvp/pvac034] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/10/2022] [Accepted: 05/14/2022] [Indexed: 12/29/2022]
Abstract
AIMS The association between the use of statins, renin-angiotensin system (RAS) inhibitors, and/or β-blockers and long-term mortality in patients with aortic stenosis (AS) who underwent surgical aortic valve replacement (SAVR) is unknown. METHODS AND RESULTS All patients with AS who underwent isolated first-time SAVR in Sweden from 2006 to 2017 and survived 6 months after discharge were included. Individual patient data from four mandatory nationwide registries were merged. Cox proportional hazards models, with time-updated data on medication status and adjusted for age, sex, comorbidities, type of prosthesis, and year of surgery, were used to investigate associations between dispensed statins, RAS inhibitors, and β-blockers and all-cause mortality. In total, 9553 patients were included, and the median follow-up time was 4.9 years (range 0-11); 1738 patients (18.2%) died during follow-up. Statins were dispensed to 49.1% and 49.0% of the patients within 6 months of discharge from the hospital and after 10 years, respectively. Corresponding figures were 51.4% and 53.9% for RAS inhibitors and 79.3% and 60.7% for β-blockers. Ongoing treatment was associated with lower mortality risk for statins {adjusted hazard ratio (aHR) 0.67 [95% confidence interval (95% CI) 0.60-0.74]; P < 0.001} and RAS inhibitors [aHR 0.84 (0.76-0.93); P < 0.001] but not for β-blockers [aHR 1.17 (1.05-1.30); P = 0.004]. The associations were robust in subgroups based on age, sex, and comorbidities (P for interactions >0.05). CONCLUSIONS The results of this large population-based real-world study support the use of statins and RAS inhibitors for patients who underwent SAVR due to AS.
Collapse
Affiliation(s)
- Julia Baranowska
- Department of Cardiology, Sahlgrenska University Hospital, SE 41345 Gothenburg, Sweden,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Charlotta Törngren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susanne J Nielsen
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden,Department of Cardiology, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Erik Björklund
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden,Department of Medicine, South Älvsborg Hospital, Borås, Sweden
| | - Annica Ravn-Fischer
- Department of Cardiology, Sahlgrenska University Hospital, SE 41345 Gothenburg, Sweden,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Kristofer Skoglund
- Department of Cardiology, Sahlgrenska University Hospital, SE 41345 Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | |
Collapse
|
27
|
Dhanekula AS, Nishath T, Aldea GS, Burke CR. Use of the Perceval Sutureless Aortic Valve in Re-Operative Aortic Valve Replacement. JTCVS Tech 2022; 13:31-39. [PMID: 35711205 PMCID: PMC9196321 DOI: 10.1016/j.xjtc.2022.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/17/2022] [Indexed: 10/25/2022] Open
|
28
|
Can TAVR Match the Excellent Survival After SAVR in Younger, Low-Risk Patients? J Am Coll Cardiol 2021; 78:2158-2160. [PMID: 34823658 DOI: 10.1016/j.jacc.2021.09.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 11/23/2022]
|