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López Martínez H, Vilalta V, Farjat-Pasos J, Ferrer-Sistach E, Mohammadi S, Escabia C, Kalavrouziotis D, Resta H, Borrellas A, Dumont E, Carrillo X, Paradis JM, Fernández-Nofrerías E, Delgado V, Rodés-Cabau J, Bayes-Genis A. Heart failure hospitalization following surgical or transcatheter aortic valve implantation in low-risk aortic stenosis. ESC Heart Fail 2024. [PMID: 38894578 DOI: 10.1002/ehf2.14887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 06/21/2024] Open
Abstract
AIMS In low-risk patients with severe aortic stenosis (AS), sutureless surgical aortic valve replacement (SU-SAVR) may be an alternative to transcatheter aortic valve implantation (TAVI). The risk of heart failure hospitalization (HFH) after aortic valve replacement (AVR) in this population is incompletely characterized. This study aims to investigate the incidence, predictors, and outcomes of HFH in patients undergoing SU-SAVR versus TAVI. METHODS AND RESULTS Patients referred for AVR between 2013 and 2020 at two centres were consecutively included. The decision for SU-SAVR or TAVI was determined by a multidisciplinary Heart Team. Cox regression and competing risk analysis were conducted to assess adverse events. Of 594 patients (mean age 77.5 ± 6.4, 59.8% male), 424 underwent SU-SAVR, while 170 underwent TAVI. Following a mean follow-up of 34.1 ± 23.1 months, HFH occurred in 112 (27.8%) SU-SAVR patients and in 8 (4.8%) TAVI patients (P < 0.001). The SU-SAVR cohort exhibited higher all-cause mortality (138 [32.5%] patients compared with 30 [17.6%] in the TAVI cohort [P < 0.001]). These differences remained significant after sensitivity analyses with 1:1 propensity score matching for baseline variables. SU-SAVR with HFH was associated with increased all-cause mortality (61.6% vs. 23.1%, P < 0.001). Independent associates of HFH in SU-SAVR patients included diabetes, atrial fibrillation, chronic obstructive pulmonary disease, lower glomerular filtration rate and lower left ventricular ejection fraction. SU-SAVR patients with HFH had a 12-month LVEF of 59.4 ± 12.7. CONCLUSIONS In low-risk AS, SU-SAVR is associated with a higher risk of HFH and all-cause mortality compared to TAVI. In patients with severe AS candidate to SU-SAVR or TAVI, TAVI may be the preferred intervention.
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Affiliation(s)
| | - Victoria Vilalta
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | | | - Claudia Escabia
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Helena Resta
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Andrea Borrellas
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Eric Dumont
- Quebec Heart & Lung Institute, Laval University, Quebec, Canada
| | - Xavier Carrillo
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Victoria Delgado
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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2
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Angellotti D, Manzo R, Castiello DS, Immobile Molaro M, Mariani A, Iapicca C, Nappa D, Simonetti F, Avvedimento M, Leone A, Canonico ME, Spaccarotella CAM, Franzone A, Ilardi F, Esposito G, Piccolo R. Hemodynamic Performance of Transcatheter Aortic Valves: A Comprehensive Review. Diagnostics (Basel) 2023; 13:diagnostics13101731. [PMID: 37238215 DOI: 10.3390/diagnostics13101731] [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: 03/26/2023] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a widely adopted treatment option for patients with severe aortic stenosis. Its popularity has grown significantly in recent years due to advancements in technology and imaging. As TAVI use is increasingly expanded to younger patients, the need for long-term assessment and durability becomes paramount. This review aims to provide an overview of the diagnostic tools to evaluate the hemodynamic performance of aortic prosthesis, with a special focus on the comparison between transcatheter and surgical aortic valves and between self-expandable and balloon-expandable valves. Moreover, the discussion will encompass how cardiovascular imaging can effectively detect long-term structural valve deterioration.
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Affiliation(s)
- Domenico Angellotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Rachele Manzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | | | | | - Andrea Mariani
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Cristina Iapicca
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Dalila Nappa
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Fiorenzo Simonetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Marisa Avvedimento
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Attilio Leone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Mario Enrico Canonico
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | | | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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3
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Fong KY, Yap JJL, Chan YH, Ewe SH, Chao VTT, Amanullah MR, Govindasamy SP, Aziz ZA, Tan VH, Ho KW. Network Meta-Analysis Comparing Transcatheter, Minimally Invasive, and Conventional Surgical Aortic Valve Replacement. Am J Cardiol 2023; 195:45-56. [PMID: 37011554 DOI: 10.1016/j.amjcard.2023.02.017] [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: 12/13/2022] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 04/05/2023]
Abstract
The landscape of aortic valve replacement (AVR) has evolved dramatically over the years, but time-varying outcomes have yet to be comprehensively explored. This study aimed to compare the all-cause mortality among 3 AVR techniques: transcatheter (TAVI), minimally invasive (MIAVR), and conventional AVR (CAVR). An electronic literature search was performed for randomized controlled trials (RCTs) comparing TAVI with CAVR and RCTs or propensity score-matched (PSM) studies comparing MIAVR with CAVR or MIAVR to TAVI. Individual patient data for all-cause mortality were derived from graphical reconstruction of Kaplan-Meier curves. Pairwise comparisons and network meta-analysis were conducted. Sensitivity analyses were performed in the TAVI arm for high risk and low/intermediate risk, as well as patients who underwent transfemoral (TF) TAVI. A total of 27 studies with 16,554 patients were included. In the pairwise comparisons, TAVI showed superior mortality to CAVR until 37.5 months, beyond which there was no significant difference. When restricted to TF TAVI versus CAVR, a consistent mortality benefit favoring TF TAVI was seen (shared frailty hazard ratio [HR] = 0.86, 95% confidence interval [CI] = 0.76 to 0.98, p = 0.024). In the network meta-analysis involving majority PSM data, MIAVR demonstrated significantly lower mortality than TAVI (HR = 0.70, 95% CI = 0.59 to 0.82) and CAVR (HR = 0.69, 95% CI = 0.59 to 0.80); this association remained compared with TF TAVI but with a lower extent of benefit (HR = 0.80, 95% CI = 0.65 to 0.99). In conclusion, the initial short- to medium-term mortality benefit for TAVI over CAVR was attenuated over the longer term. In the subset of patients who underwent TF TAVI, a consistent benefit was found. Among majority PSM data, MIAVR showed improved mortality compared with TAVI and CAVR but less than the TF TAVI subset, which requires validation by robust RCTs.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Victor T T Chao
- Department of Cardiothoracic Surgery, National Heart Center Singapore, Singapore
| | | | | | - Zameer Abdul Aziz
- Department of Cardiothoracic Surgery, National Heart Center Singapore, Singapore
| | - Vern Hsen Tan
- Department of Cardiology, Changi General Hospital, Singapore
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4
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Comparison of Sutureless Bioprosthetic Valve With Surgical or TAVR for Severe Aortic Stenosis. JACC: ASIA 2021; 1:317-329. [PMID: 36341221 PMCID: PMC9627931 DOI: 10.1016/j.jacasi.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/21/2021] [Accepted: 08/09/2021] [Indexed: 12/02/2022]
Abstract
Background Clinical advantages of sutureless rapid-deployment (RD) aortic valve replacement (AVR) for severe aortic valve stenosis (AS) have not been elucidated compared with surgical (SAVR) or transcatheter (TAVR) aortic valve replacement. Objectives This study sought to investigate comparative effectiveness and safety of RD-AVR compared with SAVR and TAVR in a prospective cohort of patients with severe AS. Methods The primary outcome was a composite of death, stroke, or rehospitalization at 12 months. Propensity score matching was used to assemble a cohort of patients with similar baseline characteristics. Results Among 1,020 eligible patients, 107 (10.5%) underwent RD-AVR, 437 (42.8%) underwent SAVR, and 476 (46.7%) underwent TAVR. In the matched cohorts of RD-AVR and SAVR (n = 107), the incidence of primary composite outcome at 12 months was similar between the 2 groups (8.0% vs 10.8%, respectively; hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.30-1.84; P = 0.52). In the matched cohorts of RD and TAVR (n = 58), the incidence of primary composite outcome at 12 months did not statistically differ between the 2 groups (9.4% vs 16.2%, respectively; HR: 0.53; 95% CI: 0.18-1.57; P = 0.25). Conclusions In this propensity-matched cohort of patients who underwent AVR for severe AS, we did not detect significant differences in the rates of the primary composite of death, stroke, or rehospitalization at 12 months when comparing RD-AVR with SAVR and TAVR. Because the study was underpowered, the results should be considered as hypothesis generating highlighting the need for further research. (ASAN Medical Center Aortic Valve Replacement Registry [ASAN-AVR]; NCT03298178)
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5
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Kim KS, Makhdoum A, Koziarz A, Gupta S, Alsagheir A, Pandey A, Reza S, Um K, Teoh K, Alhazzani W, Lamy A, Yanagawa B, Belley-Côté EP, Whitlock RP. Outcomes of sutureless aortic valve replacement versus conventional aortic valve replacement and transcatheter aortic valve replacement, updated systematic review, and meta-analysis. J Card Surg 2021; 36:4734-4742. [PMID: 34617322 DOI: 10.1111/jocs.16044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/26/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sutureless aortic valve replacement (SuAVR) is an alternative to surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). This study compares the effectiveness of SuAVR to SAVR and TAVR. METHODS We searched MEDLINE and EMBASE from inception to July 2021 for studies evaluating SuAVR, SAVR, and TAVR in adults with aortic stenosis. We performed screening, full-text assessment, data collection, and risk of bias evaluation independently and in duplicate. We evaluated risk of bias using by Cochrane and CLARITY's tools, and certainty in evidence using the GRADE framework. Data were pooled using a random-effects model. RESULTS We identified one randomized and 78 observational studies (n = 60,689; SuAVR vs. SAVR = 39,171, vs. TAVR = 21,518). All studies were at high or unclear risk of bias, with very-low certainty in effect estimates. Compared to TAVR, SuAVR demonstrates no significant difference in mortality at 30-days (odds ratio [OR]: 0.52, 95% confidence interval [CI: 0.85, 1.16], I2 = 0%), but decreased odds at 2-years (OR: 0.39, 95% CI [0.17, 0.88], I2 = 0%). SuAVR also reduced odds of mild paravalvular regurgitation (OR: 0.11, 95% CI [0.06, 0.21], I2 = 50%). Compared to SAVR, SuAVR was associated with a similar mortality at 30-days (OR: 0.99, 95% CI [0.85, 1.16], I2 = 0%) and 2-years (OR: 0.99, 95% CI [0.43-2.30], I2 = 7%). SuAVR significantly increased odds of permanent pacemaker implantation (OR: 2.5, 95% CI [2.25, 2.77], I2 = 0%). Pooled effect estimates were consistent with results from the randomized trial comparing SuAVR and SAVR. CONCLUSION Based on very-low quality evidence, SuAVR is associated with similar short- and midterm outcomes compared to TAVR and SAVR. Comparative randomized data with long-term follow-up are required to clarify the role of SuAVR.
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Affiliation(s)
- Kevin S Kim
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Ahmad Makhdoum
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Alex Koziarz
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Saurabh Gupta
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ali Alsagheir
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Arjun Pandey
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Seleman Reza
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Kevin Um
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Teoh
- Southlake Regional Health Sciences Centre, Newmarket, Ontario, Canada
| | - Waleed Alhazzani
- Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - André Lamy
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Emilie P Belley-Côté
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Richard P Whitlock
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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6
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Al-Maisary S, Farag M, Te Gussinklo WH, Kremer J, Pleger ST, Leuschner F, Karck M, Szabo G, Arif R. Are Sutureless and Rapid-Deployment Aortic Valves a Serious Alternative to TA-TAVI? A Matched-Pairs Analysis. J Clin Med 2021; 10:jcm10143072. [PMID: 34300238 PMCID: PMC8306831 DOI: 10.3390/jcm10143072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/01/2021] [Accepted: 07/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation is a feasible alternative to conventional aortic valve replacement with expanding indication extending to low-risk patients. Sutureless and rapid-deployment aortic valves were developed to decrease procedural risks in conventional treatment. This paired-match analysis aims to compare patients undergoing surgical transcatheter aortic valve implantation to sutureless and rapid-deployment aortic valve implantation. METHODS Retrospective database analysis between 2010 and 2016 revealed 214 patients undergoing transcatheter aortic valve implantation procedures through surgical access (predominantly transapical) and 62 sutureless and rapid-deployment aortic valve procedures including 26 patients in need of concomitant coronary artery bypass surgery. After matching, 52 pairs of patients were included and analyzed. RESULTS In-hospital death (5.8% vs. 3.8%; p = 0.308) was comparable between transcatheter aortic valve implantation (mean age 77 ± 4.3 years) and sutureless and rapid-deployment aortic valve implantation groups (mean age 75 ± 4.0 years), including 32 females in each group. The logistic EuroSCORE was similar (19 ± 12 vs. 17 ± 10; p = 0.257). Postoperative renal failure (p = 0.087) and cerebrovascular accidents (p = 0.315) were without significant difference. The incidence of complete heart block requiring permanent pacemaker treatment was relatively low for both groups (1.9% vs. 7.7%; p = 0.169) for TAVI and sutureless and rapid-deployment valves respectively. Intraoperative use of blood transfusion was higher in the sutureless and rapid-deployment aortic valve implantation group (0.72 U vs. 1.46 U, p = 0.014). Estimated survival calculated no significant difference between both groups after 6 months (transcatheter aortic valve implantation: 74 ± 8% vs. sutureless and rapid-deployment aortic valve implantation: 92 ± 5%; log rank p = 0.097). CONCLUSION Since sutureless and rapid-deployment aortic valve implantation is as safe and effective as transapical transcatheter aortic valve implantation, combining the advantage of standard diseased-valve removal with shorter procedural times, sutureless and rapid-deployment aortic valve replacement may be considered as an alternative for patients with elevated operative risk considered to be in the "gray zone" between transcatheter aortic valve implantation and conventional surgery, especially if concomitant myocardial revascularization is required.
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Affiliation(s)
- Sameer Al-Maisary
- Department of Cardiac Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.F.); (W.H.T.G.); (J.K.); (M.K.); (G.S.); (R.A.)
- Correspondence: ; Tel.: +49-(0)-6221-56-6272; Fax: +49-(0)-6221-56-5585
| | - Mina Farag
- Department of Cardiac Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.F.); (W.H.T.G.); (J.K.); (M.K.); (G.S.); (R.A.)
| | - Willem Hendrik Te Gussinklo
- Department of Cardiac Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.F.); (W.H.T.G.); (J.K.); (M.K.); (G.S.); (R.A.)
| | - Jamila Kremer
- Department of Cardiac Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.F.); (W.H.T.G.); (J.K.); (M.K.); (G.S.); (R.A.)
| | - Sven T. Pleger
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.T.P.); (F.L.)
| | - Florian Leuschner
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.T.P.); (F.L.)
| | - Matthias Karck
- Department of Cardiac Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.F.); (W.H.T.G.); (J.K.); (M.K.); (G.S.); (R.A.)
| | - Gabor Szabo
- Department of Cardiac Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.F.); (W.H.T.G.); (J.K.); (M.K.); (G.S.); (R.A.)
- Department of Cardiac Surgery, Halle University, 06120 Halle, Germany
| | - Rawa Arif
- Department of Cardiac Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.F.); (W.H.T.G.); (J.K.); (M.K.); (G.S.); (R.A.)
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7
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Panoulas VF, Chandrasekhar J, Busi G, Ruparelia N, Zhang Z, Mehilli J, Sartori S, Lefèvre T, Presbitero P, Capranzano P, Tchetche D, Iadanza A, Sardella G, Van Mieghem NM, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Sharma S, Ferrer‐Gracia M, Naber CK, Kievit PC, Snyder C, Sutaria N, Sen S, Malik IS, Morice M, Nihoyannopoulos P, Petronio AS, Mehran R, Chieffo A, Mikhail GW. Prevalence, predictors, and outcomes of patient prosthesis mismatch in women undergoing
TAVI
for severe aortic stenosis: Insights from the
WIN‐TAVI
registry. Catheter Cardiovasc Interv 2020; 97:516-526. [DOI: 10.1002/ccd.29227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/05/2020] [Accepted: 08/08/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Vasileios F. Panoulas
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
| | - Jaya Chandrasekhar
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Gherardo Busi
- Interventional cardiology unit San Raffaele Scientific Institute Milan Italy
| | - Neil Ruparelia
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
| | - Zhongjie Zhang
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Julinda Mehilli
- Department of cardiology Ludwig‐Maximilians‐University of Munich Munich Germany
| | - Samantha Sartori
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Thierre Lefèvre
- Institut Cardiovasculaire Paris Sud Hôpital privé Jacques cartier, Ramsay Générale de santé Massy France
| | - Patrizia Presbitero
- Department of Cardiology IRCCS Humanitas Clinical and Research Centre Milan Italy
| | | | | | - Alessandro Iadanza
- Emodinamica Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte Siena Italy
| | - Gennaro Sardella
- Interventional cardiology unit Policlinico “Umberto I Rome Italy
| | - Nicolas M. Van Mieghem
- Department of interventional cardiology Erasmus Medical Center, Thoraxcenter Rotterdam The Netherlands
| | - Emanuele Meliga
- Interventional cardiology unit Mauriziano Hospital Turin Italy
| | | | - Chiara Fraccaro
- Interventional cardiology unit University of Padova Padova Italy
| | - Daniela Trabattoni
- Invasive Cardiology Unit 3 Centro Cardiologico Monzino, IRCCS Milan Italy
| | - Samin Sharma
- Department of cardiology Mount Sinai Hospital New York New York USA
| | - Maria‐Cruz Ferrer‐Gracia
- Department of Cardiology, Interventional Cardiology Unit Hospital Universitario Miguel Servet Zaragoza Spain
| | - Christoph K. Naber
- Department of cardiology Contilia Heart and Vascular Centre, Elisabeth Krankenhaus Essen Germany
| | - Peter C. Kievit
- Department of cardiology Radboud University Nijmegen Medical Center Nijmegan, The Netherlands
| | - Clayton Snyder
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Nilesh Sutaria
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
| | - Sayan Sen
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
| | - Iqbal S. Malik
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
| | - Marie‐Claude Morice
- Department of cardiology Ludwig‐Maximilians‐University of Munich Munich Germany
| | - Petros Nihoyannopoulos
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
| | - Anna Sonia Petronio
- Interventional cardiology unit AOUP Cisanello, University Hospital Pisa Italy
| | - Roxana Mehran
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Alaide Chieffo
- Interventional cardiology unit San Raffaele Scientific Institute Milan Italy
| | - Ghada W. Mikhail
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
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8
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Bilkhu R, Borger MA, Briffa NP, Jahangiri M. Sutureless aortic valve prostheses. Heart 2020; 105:s16-s20. [PMID: 30846520 DOI: 10.1136/heartjnl-2018-313513] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 11/03/2022] Open
Abstract
Conventional surgical aortic valve replacement (AVR) is the 'gold standard' for treatment of severe or symptomatic aortic valve stenosis. The increasing age of patients and increasing comorbidities has led to the development of procedures to minimise operative time and reduce risks of surgery. One method of reducing operative times is the use of sutureless aortic valves (SU-AVR). We examine the current literature surrounding the use of SU-AVR. Alternatives to AVR are SU-AVR, sometimes referred to as rapid deployment valves, or transcatheter aortic valve implantation (TAVI). TAVI has been demonstrated to be superior over medical therapy in patients deemed inoperable and non-inferior in high and intermediate-risk patients compared with surgical AVR. However, the lack of excision of the calcified aortic valve and annulus raises concerns regarding long-term durability and possibly thromboembolic complications. TAVI patients have increased rates of paravalvular leaks, major vascular complications and pacemaker implantation when compared with conventional AVR. SU-AVR minimises the need for suturing, leading to reduced operative times, while enabling complete removal of the calcified valve. The increase in use of SU-AVR has been mostly driven by minimally invasive surgery. Other indications include patients with a small and/or calcified aortic root, as well as patients requiring AVR and concomitant surgery. SU-AVR is associated with decreased operative times and possibly improved haemodynamics when compared with conventional AVR. However, this has to be weighed against the increased risk of paravalvular leak and pacemaker implantation when deciding which prosthesis to use for AVR.
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Affiliation(s)
- Rajdeep Bilkhu
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
| | - Michael A Borger
- Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Norman Paul Briffa
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Marjan Jahangiri
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
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9
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He S, Fang Z. Incidence, predictors, and outcome of prosthesis-patient mismatch after transcatheter aortic valve replacement: A meta-analysis. Medicine (Baltimore) 2020; 99:e20717. [PMID: 32541522 PMCID: PMC7302587 DOI: 10.1097/md.0000000000020717] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/14/2020] [Accepted: 05/09/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Prosthesis-patient mismatch (PPM) following transcatheter aortic valve replacement (TAVR) is common, but the incidence, predictors and outcome of PPM are still controversial. METHODS A total of 18 articles incorporating 72,016 patients were identified form PubMed and Embase online database. RESULTS The pooled incidences of overall, and severe PPM following TAVR were 32.0% and 10.0% separately. Comparing to surgical aortic valve replacement (SAVR), TAVR had lower incidence of overall (OR, 0.31, 95% CI, 0.20-0.50) and severe PPM (OR, 0.38, 95% CI, 0.28-0.52). PPM was associated with a larger body surface area (BSA), larger body mass index (BMI) and previous myocardial infarction in comparison with those patients without PPM. Although PPM was not rare after TAVR, no significant differences were observed both in short- and mid-term all-cause mortality (30 day: OR: 1.51, 95% CI, 0.79-2.87, 1 year: OR: 1.02, 95% CI, 0.96-1.08, and 2 years: OR: 0.99, 95% CI, 0.79-1.24) between patients with PPM and those without PPM. CONCLUSIONS Despite the fact that the incidence of PPM was lower than that of SAVR, PPM was not seen to have an impact on short- and mid-term survival.
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Guimarães L, Voisine P, Mohammadi S, Kalavrouzioutis D, Dumont E, Doyle D, Paradis JM, Delarochellière R, Wintzer-Wehekind J, Junquera L, del Val D, Muntané-Carol G, Freitas-Ferraz AB, Pibarot P, Dagenais F, Rodés-Cabau J. Valve Hemodynamics Following Transcatheter or Surgical Aortic Valve Replacement in Patients With Small Aortic Annulus. Am J Cardiol 2020; 125:956-963. [PMID: 31948662 DOI: 10.1016/j.amjcard.2019.12.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/06/2019] [Accepted: 12/12/2019] [Indexed: 01/10/2023]
Abstract
This study aimed to compare the hemodynamic performance of transcatheter and surgical aortic valves in patients with severe symptomatic aortic stenosis and small aortic annulus (SAA) and to determine the valve hemodynamics according to transcatheter valve type. Consecutive surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) patients with SAA were case-matched (1:1) on the basis of sex, body surface area, aortic annulus diameter, and left ventricular ejection fraction. A total of 357 patients in each group constituted the final study population. A second match on the basis of aortic annulus diameter and valve/annulus calcium burden was performed within the TAVR group to compare the valve performance between balloon- (n = 52) and self-expanding (n = 52) transcatheter valve systems (BEV, SEV). The echocardiograms performed at hospital discharge were used for evaluating valve hemodynamics. The mean annulus diameter of the study population was 19.2 ± 0.3 mm. The TAVR group (vs SAVR) exhibited lower mean gradient (12 ± 7 mm Hg vs 15 ± 6 mm Hg, p <0.001), larger effective orifice area (1.46 ± 0.39 cm2 vs 1.25 ± 0.37 cm2, p <0.001) and a lower rate of severe prosthesis-patient mismatch (PPM) (14% vs 24%, p = 0.001). Moderate-severe AR was present in 2.5% of the TAVR recipients versus none patient in the SAVR group. There were no differences in valve hemodynamics between balloon-expanding transcatheter valve system and self-expanding transcatheter valve system, and similar rates of severe PPM were observed in both groups (p = 0.488). In conclusion, TAVR presented superior valve hemodynamics and lower incidence of severe PPM compared with SAVR in SAA patients. Similar valve performance results were observed between transcatheter valve types.
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11
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Goel H, Kumar A, Garg N, Mills JD. Men are from mars, women are from venus: Factors responsible for gender differences in outcomes after surgical and trans-catheter aortic valve replacement. Trends Cardiovasc Med 2019; 31:34-46. [PMID: 31902553 DOI: 10.1016/j.tcm.2019.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 11/21/2019] [Accepted: 11/23/2019] [Indexed: 01/09/2023]
Abstract
Females suffer higher operative (30-day) mortality than males after surgical aortic valve replacement (SAVR). In contrast, outcomes after trans-catheter aortic valve replacement (TAVR) seem to favor females, both in terms of procedural mortality, and more prominently, medium to long-term survival. With an ever-greater number of TAVR procedures being performed, an understanding of factors responsible for gender differences in outcomes after the two AVR modalities is critical for better patient selection. Current evidence suggests that this gender difference in outcomes after SAVR and TAVR stems from differences in baseline risk profiles, as well as inherent anatomic/physiological differences between genders. This review attempts to examine these clinical and physiological factors, with a goal of guiding better patient selection for each AVR modality, and to highlight areas that beg further investigation.
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Affiliation(s)
- Harsh Goel
- Department of Medicine, St. Luke's University Hospital, Bethlehem, PA, United States; Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States.
| | - Ashish Kumar
- Department of Medicine, Wellspan York Hospital, York, PA, United States
| | - Nadish Garg
- Department of Medicine, St Barnabas Medical Center, Livingston, NJ, United States
| | - James D Mills
- Department of Medicine, Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, United States
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12
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Freitas-Ferraz AB, Tirado-Conte G, Dagenais F, Ruel M, Al-Atassi T, Dumont E, Mohammadi S, Bernier M, Pibarot P, Rodés-Cabau J. Aortic Stenosis and Small Aortic Annulus. Circulation 2019; 139:2685-2702. [DOI: 10.1161/circulationaha.118.038408] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Afonso B. Freitas-Ferraz
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Gabriela Tirado-Conte
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Francois Dagenais
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Marc Ruel
- University of Ottawa Heart Institute, University of Ottawa, Ontario, Canada (M.R., T.A.-A.)
| | - Talal Al-Atassi
- University of Ottawa Heart Institute, University of Ottawa, Ontario, Canada (M.R., T.A.-A.)
| | - Eric Dumont
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Mathieu Bernier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
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13
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Hwang IC, Hayashida K, Kim HS. Current Key Issues in Transcatheter Aortic Valve Replacement Undergoing a Paradigm Shift. Circ J 2019; 83:952-962. [PMID: 30956265 DOI: 10.1253/circj.cj-19-0096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As a new technology in the management of valvular heart disease, transcatheter aortic valve replacement (TAVR) has drawn much attention since its emergence. To date, numerous studies have investigated the safety and efficacy of TAVR in patients of various risk profiles with severe aortic stenosis (AS) and demonstrated comparable or superior outcomes of TAVR when compared with surgical aortic valve replacement (SAVR). The favorable outcomes of TAVR in inoperable patients, as well as in high- and intermediate-risk patients, are endorsed in current guidelines, and trials of low-risk patients have shown non-inferior or even superior results of TAVR than for SAVR, suggesting that the clinical indications of TAVR can be expanded to low-risk patients. Moreover, a therapeutic role of TAVR has been suggested in various aortic valve (AV) diseases, such as bicuspid AV, moderate AS with heart failure, aortic regurgitation, and bioprosthetic valve failure. In this review, we summarize the current issues of TAVR in various patient populations and discuss the expanding clinical indications of TAVR, which are driving a major paradigm shift in the management of AV disease.
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Affiliation(s)
- In-Chang Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital.,Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital
| | | | - Hyo-Soo Kim
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital
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14
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Lloyd D, Luc JGY, Indja BE, Leung V, Wang N, Phan K. Transcatheter, sutureless and conventional aortic-valve replacement: a network meta-analysis of 16,432 patients. J Thorac Dis 2019; 11:188-199. [PMID: 30863588 DOI: 10.21037/jtd.2018.12.27] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Minimally invasive surgical techniques pose alternatives to conventional surgery for the treatment of aortic stenosis (AS). We present a Bayesian network analysis comparing Valve Academic Research Consortium-2 clinical outcomes between transcatheter aortic valve implantation (TAVI), sutureless (SL-AVR) and conventional aortic valve replacement (CAVR). Methods Electronic searches of databases were conducted and seven two-arm randomized-controlled trials and 25 propensity-score-matched studies comparing clinical outcomes of TAVI, SL-AVR and CAVR for treatment of AS were identified. Bayesian Markov chain Monte Carlo modelling was used to analyze clinical outcomes. Results The analysis included 16,432 patients who underwent TAVI [7,056], SL-AVR [1,238] or CAVR [8,138]. Compared to CAVR, TAVI and SL-AVR were associated with reduced postoperative major bleeding of 59% (OR 0.41, 95% CI: 0.28-0.59) and 44% (OR 0.56, 95% CI: 0.30-0.99) respectively. TAVI had a 41% reduction in postoperative myocardial infarction (OR 0.59, 95% CI: 0.40-0.86) and SL-AVR had a 40% reduction in postoperative acute kidney injury (AKI) (OR 0.62, 95% CI: 0.42-0.86). Compared to TAVI, CAVR and SL-AVR had a reduction in moderate/severe paravalvular regurgitation of 89% (OR 0.11, 95% CI: 0.07-0.16) and 92% (OR 0.08, 95% CI: 0.03-0.17). CAVR had a 67% decreased postoperative permanent pacemaker (PPM) implantation compared to TAVI (OR 0.33, 95% CI: 0.24-0.45) and a 63% reduction compared to SL-AVR (OR 0.37, 95% CI: 0.22-0.61). There were no differences in 30-day mortality or postoperative stroke between the groups. Conclusions In selected patients, minimally invasive surgical interventions including TAVI and SL-AVR for severe AS are viable alternatives to conventional surgery. However, TAVI is associated with increased paravalvular regurgitation, whereas TAVI and SL-AVR are associated with increased conduction disturbances compared to CAVR.
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Affiliation(s)
- Declan Lloyd
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ben Elias Indja
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Vannessa Leung
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Nelson Wang
- Faculty of Medicine, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Kevin Phan
- Faculty of Medicine, University of Sydney, Sydney, Australia.,Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
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15
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Lazkani M, Yerasi C, Prakash S, Pershad A, Fang K. Permanent pacemaker implantation and paravalvular leak rates following sutureless aortic valve operations. J Card Surg 2018; 33:808-817. [DOI: 10.1111/jocs.13938] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Mohamad Lazkani
- University of Colorado HealthMedical Center of the RockiesLovelandColorado
| | | | - Sheena Prakash
- University of ArizonaBanner University Medical CenterPhoenixArizona
| | - Ashish Pershad
- University of ArizonaBanner University Medical CenterPhoenixArizona
| | - Kenith Fang
- University of ArizonaBanner University Medical CenterPhoenixArizona
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16
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Shinn SH, Altarabsheh SE, Deo SV, Sabik JH, Markowitz AH, Park SJ. A Systemic Review and Meta-Analysis of Sutureless Aortic Valve Replacement Versus Transcatheter Aortic Valve Implantation. Ann Thorac Surg 2018; 106:924-929. [PMID: 29709503 DOI: 10.1016/j.athoracsur.2018.03.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 03/18/2018] [Accepted: 03/19/2018] [Indexed: 11/21/2022]
Affiliation(s)
- Sung Ho Shinn
- Department of Thoracic and Cardiovascular Surgery, Cheju Halla General Hospital, Jeju, Republic of Korea.
| | - Salah E Altarabsheh
- Department of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan
| | - Salil V Deo
- Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Case Western University Hospital, Cleveland, Ohio
| | - Joseph H Sabik
- Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Case Western University Hospital, Cleveland, Ohio
| | - Alan H Markowitz
- Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Case Western University Hospital, Cleveland, Ohio
| | - Soon J Park
- Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Case Western University Hospital, Cleveland, Ohio
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17
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Abstract
PURPOSE OF REVIEW Sutureless aortic valve replacement (AVR) has emerged as an alternative to traditional AVR for patients with aortic stenosis who present a higher surgical risk, such as the elderly, or those with small or highly calcified aortic roots. With transcatheter aortic valve implantation - the other major AVR alternative - being used in increasingly lower-risk patients, the place of sutureless valves in the AVR landscape needs to be defined. In this review, we discuss recent data and expert opinion as it pertains to the subject of sutureless AVR. RECENT FINDINGS Several recent studies have evaluated the performance of sutureless valves in a variety of clinical contexts, including minimally invasive operations and high-risk surgical procedures. The optimal surgical technique for sutureless AVR has been refined through the publication of several reports addressing technical considerations. Reduction in operative times represents the main advantage of sutureless valves over conventional surgical prostheses, and the possibility of complete annular decalcification - and hence a reduced incidence of paravalvular leak - is the primary advantage over TAVI. SUMMARY Sutureless valves have emerged as an attractive option for high-risk patients or for complex surgeries where a minimization of bypass time is critical. However, there is limited data regarding long-term outcomes, durability or reoperation.
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18
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Patient-prosthesis mismatch in patients treated with transcatheter aortic valve implantation - predictors, incidence and impact on clinical efficacy. A preliminary study. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2017; 13:281-287. [PMID: 29362569 PMCID: PMC5770857 DOI: 10.5114/aic.2017.71608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/17/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Patient-prosthesis mismatch (PPM) is relatively frequent after surgical aortic valve replacement (SAVR) and negatively impacts prognosis. Aim We sought to determine the frequency and clinical effects of PPM after transcatheter aortic valve implantation (TAVI). Material and methods Overall, 238 patients who underwent TAVI were screened. Moderate PPM was defined as indexed effective orifice area (EOAi) between 0.65 and 0.85 cm2/m2, and severe PPM as < 0.65 cm2/m2. All-cause mortality and the Valve Academic Research Consortium 2 (VARC-2) defined composite of clinical efficacy at 1 year were the primary endpoints. Results Finally, 201 patients were included (mean age: 79.6 ±7.4 years, 52% females). The femoral artery served as the delivery route in 79% and most of the prostheses were self-expanding (68%). Any PPM was present in 48 (24%) subjects, and only 7 (3.5%) had severe PPM. Body surface area (BSA) independently predicted any PPM (OR = 16.9, p < 0.001) whereas post-dilation tended to protect against PPM (OR = 0.46, p = 0.09). All-cause mortality was similar in patients with moderate or severe PPM as compared to those with no PPM (14.6% vs. 14.3% vs. 13.1%, respectively, log-rank p = 0.98). Neither moderate (OR = 1.6, 95% CI: 0.8-3.2, p = 0.16) nor severe PPM (OR = 1.67, 95% CI: 0.36-7.7, p = 0.51) had a significant impact on composite endpoint, or its elements, with the exception of transvalvular pressure gradient > 20 mm Hg. Conclusions Severe PPM after TAVI is rare, can be predicted by larger BSA and does not seem to affect mid-term mortality or composite clinical outcome. Larger studies are needed to find different independent predictors of PPM and elucidate its impact in terms of device durability and long-term clinical efficacy.
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19
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Liao YB, Li YJ, Jun-Li L, Zhao ZG, Wei X, Tsauo JY, Xiong TY, Xu YN, Feng Y, Chen M. Incidence, Predictors and Outcome of Prosthesis-Patient Mismatch after Transcatheter Aortic Valve Replacement: a Systematic Review and Meta-analysis. Sci Rep 2017; 7:15014. [PMID: 29118326 PMCID: PMC5678180 DOI: 10.1038/s41598-017-15396-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/26/2017] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to investigate the incidence, predictors and outcome of prosthesis-patient mismatch (PPM) following transcatheter aortic valve replacement (TAVR). A total of 30 articles incorporating 4,691 patients were identified. The pooled incidences of overall, moderate and severe PPM following TAVR were 33.0%, 25.0% and 11.0% respectively. Medtronic CoreValve (MCV) had lower incidence of overall (32% vs: 40%, P < 0.0001) and moderate (23% vs 32%, P < 0.0001) than Edwards Sapien (ESV). PPM was associated with a younger age, smaller annulus diameter and lower left ventricular ejection fraction in comparison with those patients without PPM. Post-dilation (OR, 0.51, 95% CI, 0.38 to 0.68, p < 0.001) during TAVR would decrease the incidence of PPM. Although PPM was common after TAVR, no significant differences were observed both in short- and mid-term all-cause mortality (30 day: OR: 1.1, 95% CI, 0.70 to 1.73 and 2 year: OR: 1.01, 95% CI, 0.74 to 1.38) between patients with PPM and those without PPM. In conclusion, despite being common after TAVR, the incidence of PPM was lower than that of surgical aortic valve replacement (SAVR) and decreased with the experience accumulating, and PPM was not seen to impact on short- and mid-term survival, regardless of its magnitude.
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Affiliation(s)
- Yan-Biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Yi-Jian Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Li Jun-Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Zhen-Gang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Jiay-Yu Tsauo
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Yuan-Ning Xu
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China.
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China.
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Subramaniam K, Nazarnia S. Prosthesis-patient mismatch - what cardiac anesthesiologists need to know? Ann Card Anaesth 2017; 20:234-242. [PMID: 28393786 PMCID: PMC5408531 DOI: 10.4103/aca.aca_9_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Prosthesis-patient Mismatch (PPM) is not uncommon with an incidence reported up to 70% after aortic valve (AV) replacement. Severe forms of PPM are less common (up to 20%); PPM can lead to increased short- and long-term morbidity and mortality. It is important to discriminate PPM from other forms of prosthetic valve dysfunction. Sometimes, prosthetic valve degenerative disease may coexist with PPM. Echocardiography plays an important role in the prevention and diagnosis of PPM. Preemptive strategies to prevent PPM include insertion of newer generation prosthetic valves with better hemodynamic characteristics, stentless prosthesis, aortic root enlargement to insert a larger prosthesis, aortic homograft, and transcutaneous AV implantation. We present an illustrative case and review the literature on PPM pertinent to anesthesiologists.
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21
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Meco M, Miceli A, Montisci A, Donatelli F, Cirri S, Ferrarini M, Lio A, Glauber M. Sutureless aortic valve replacement versus transcatheter aortic valve implantation: a meta-analysis of comparative matched studies using propensity score matching. Interact Cardiovasc Thorac Surg 2017; 26:202-209. [DOI: 10.1093/icvts/ivx294] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 07/30/2017] [Indexed: 11/13/2022] Open
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22
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D'Onofrio A, Fabozzo A, Gerosa G. Comparison of hemodynamic and clinical outcomes of transcatheter and sutureless aortic bioprostheses: how to make the right choice in intermediate risk patients. Ann Cardiothorac Surg 2017; 6:510-515. [PMID: 29062747 DOI: 10.21037/acs.2017.09.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Current surgical treatment options for aortic valve stenosis (AS), as alternatives to that of conventional operation with a midline sternotomy, include sutureless valve replacement (SUAVR) and transcatheter valve implantation (TAVI). Patients with high surgical risk, or those who are judged to be inoperable, are typically good candidates for the TAVI procedure. The best treatment option in patients with an intermediate risk profile, however, the so called "grey zone", is still currently under debate. Sutureless aortic valve replacement has been recently presented as a valid alternative for patients with low- to intermediate-risk. Data available on prostheses' hemodynamic performance and patients' clinical outcomes play a crucial role in the process of device selection. Compared to TAVI, SUAVR provides lower rate of significant postoperative paravalvular leak (PVL), which has shown to be a predictor for mortality. On the contrary, transcatheter valves seem to perform better in terms of transvalvular mean and peak gradients. Therefore, SUAVR and TAVI are both reliable options in patients with severe aortic valve stenosis, as an alternative to conventional surgery, and the choice of the best device should be tailored to patient's anatomical and surgical characteristics.
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Affiliation(s)
| | - Assunta Fabozzo
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, University of Padova, Padova, Italy
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23
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Tam DY, Vo TX, Wijeysundera HC, Ko DT, Rocha RV, Friedrich J, Fremes SE. Transcatheter vs Surgical Aortic Valve Replacement for Aortic Stenosis in Low-Intermediate Risk Patients: A Meta-analysis. Can J Cardiol 2017; 33:1171-1179. [PMID: 28843328 DOI: 10.1016/j.cjca.2017.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 06/06/2017] [Accepted: 06/09/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has emerged as the treatment of choice for patients with severe aortic stenosis at high surgical risk; the role of TAVR compared with surgical aortic valve replacement (SAVR) in the low-intermediate surgical risk population remains uncertain. Our primary objective was to determine differences in 30-day and late mortality in patients treated with TAVR compared with SAVR at low-intermediate risk (Society of Thoracic Surgeons Predicted Risk of Mortality < 10%). METHODS Medline and Embase were searched from 2010 to March 2017 for studies that compared TAVR with SAVR in the low-intermediate surgical risk population, restricted to randomized clinical trials and matched observational studies. Two investigators independently abstracted the data and a random effects meta-analysis was performed. RESULTS Four randomized clinical trials (n = 4042) and 9 propensity score-matched observational studies (n = 4192) were included in the meta-analysis (n = 8234). There was no difference in 30-day mortality between TAVR and SAVR (3.2% vs 3.1%, pooled risk ratio: 1.02; 95% confidence interval, 0.80-1.30; P = 0.89; I2 = 0%) or mortality at a median of 1.5-year follow-up (incident rate ratio: 1.01; 95% confidence interval, 0.90-1.15; P = 0.83; I2 = 0%). There was a higher risk of pacemaker implantation and greater than trace aortic insufficiency in the TAVR group whereas the risk of early stroke, atrial fibrillation, acute kidney injury, cardiogenic shock, and major bleeding was higher in the SAVR group. CONCLUSIONS Although there was no difference in 30-day and late mortality, the rate of complications differed between TAVR and SAVR in the low-intermediate surgical risk population.
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Affiliation(s)
- Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Thin Xuan Vo
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dennis T Ko
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rodolfo Vigil Rocha
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jan Friedrich
- Division of Critical Care Medicine, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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Bedeir K, Reardon M, Cohn LH, Ramlawi B. Sutureless Aortic Valves: Combining the Best or the Worst? Semin Thorac Cardiovasc Surg 2017; 28:341-352. [PMID: 28043442 DOI: 10.1053/j.semtcvs.2016.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2016] [Indexed: 11/11/2022]
Abstract
Aortic valve replacement is a life saving intervention. Significant progress has been made toward reducing surgical trauma through minimally invasive surgery and transcatheter techniques. Each of these approaches has its advantages and limitations. Sutureless aortic valves have been proposed to overcome these limitations and have been in use in Europe. It is however less than clear whether these valves will prove advantageous and whether they will have a role in the future. We review the published literature for sutureless aortic valves and their performance against standard and transcatheter aortic valve replacements.
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Affiliation(s)
- Kareem Bedeir
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael Reardon
- Cardiovascular surgery, Methodist DeBakey Cardiovascular Center, Houston, Texas
| | - Lawrence H Cohn
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Basel Ramlawi
- Cardiothoracic Surgery, Heart & Vascular Center, Valley Health System, Virginia.
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Karangelis D, Mazine A, Roubelakis A, Alexiou C, Fragoulis S, Mazer CD, Yanagawa B, Latter D, Bonneau D. What is the role of sutureless aortic valves in today’s armamentarium? Expert Rev Cardiovasc Ther 2016; 15:83-91. [DOI: 10.1080/14779072.2017.1273108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Dimos Karangelis
- Department of Surgery, Division of Cardiac Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Amine Mazine
- Department of Surgery, Division of Cardiac Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Apostolos Roubelakis
- Department of Surgery, Division of Cardiac Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Christos Alexiou
- Department of Cardiac Surgery, Interbalkan European Medical Center, Thessaloniki, Greece
| | | | - C. David Mazer
- Department of Anesthesia, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Bobby Yanagawa
- Department of Surgery, Division of Cardiac Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - David Latter
- Department of Surgery, Division of Cardiac Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Daniel Bonneau
- Department of Surgery, Division of Cardiac Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Canada
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26
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Villablanca PA, Mathew V, Thourani VH, Rodés-Cabau J, Bangalore S, Makkiya M, Vlismas P, Briceno DF, Slovut DP, Taub CC, McCarthy PM, Augoustides JG, Ramakrishna H. A meta-analysis and meta-regression of long-term outcomes of transcatheter versus surgical aortic valve replacement for severe aortic stenosis. Int J Cardiol 2016; 225:234-243. [DOI: 10.1016/j.ijcard.2016.10.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/04/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
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Wang N, Tsai YC, Niles N, Tchantchaleishvili V, Di Eusanio M, Yan TD, Phan K. Transcatheter aortic valve implantation (TAVI) versus sutureless aortic valve replacement (SUAVR) for aortic stenosis: a systematic review and meta-analysis of matched studies. J Thorac Dis 2016; 8:3283-3293. [PMID: 28066608 DOI: 10.21037/jtd.2016.11.100] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND With improving technologies and an increasingly elderly populations, there have been an increasing number of therapeutic options available for patients requiring aortic valve replacement. Recent evidence suggests that transcatheter aortic valve implantation (TAVI) is one suitable option for high risk inoperable patients, as well as high risk operable patients. Sutureless valve technology has also been developed concurrently, with facilitates surgical aortic valve replacement (SUAVR) by allow resection and replacement of the native aortic valve with minimal sutures and prosthesis anchoring required. For patients amenable for both TAVI and SUAVR, the evidence is unclear with regards to the benefits and risks of either approach. The objectives are to compare the perioperative outcomes and intermediate-term survival rates of TAVI and SUAVR in matched or propensity score matched studies. METHODS A systematic literature search was performed to include all matched or propensity score matched studies comparing SUAVR versus TAVI for severe aortic stenosis. A meta-analysis with odds ratios (OR) and mean differences were performed to compare key outcomes including paravalvular regurgitation and short and intermediate term mortality. RESULTS Six studies met our inclusion criteria giving a total of 741 patients in both the SUAVR and TAVI arm of the study. Compared to TAVI, SUAVR had a lower incidence of paravalvular leak (OR =0.06; 95% CI: 0.03-0.12, P<0.01). There was no difference in perioperative mortality, however SUAVR patients had significantly better survival rates at 1 (OR =2.40; 95% CI: 1.40-4.11, P<0.01) and 2 years (OR =4.62; 95% CI: 2.62-8.12, P<0.01). CONCLUSIONS The present study supports the use of minimally invasive SUAVR as an alternative to TAVI in high risk patients requiring aortic replacement. The presented results require further validation in prospective, randomized controlled studies.
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Affiliation(s)
- Nelson Wang
- Department of Medicine, University of Sydney, Sydney, Australia
| | - Yi-Chin Tsai
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Natasha Niles
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | | | - Marco Di Eusanio
- Cardiac Surgery Unit, Cardiovascular Department, 'G. Mazzini' Hospital Piazza Italia, Teramo, Italy
| | - Tristan D Yan
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Kevin Phan
- Department of Medicine, University of Sydney, Sydney, Australia;; The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
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Takagi H, Umemoto T. Worse survival after transcatheter aortic valve implantation than surgical aortic valve replacement: A meta-analysis of observational studies with a propensity-score analysis. Int J Cardiol 2016; 220:320-7. [DOI: 10.1016/j.ijcard.2016.06.261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/15/2016] [Accepted: 06/27/2016] [Indexed: 12/24/2022]
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29
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O'Neal JB, Shaw AD, Billings FT. Acute kidney injury following cardiac surgery: current understanding and future directions. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:187. [PMID: 27373799 PMCID: PMC4931708 DOI: 10.1186/s13054-016-1352-z] [Citation(s) in RCA: 315] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Acute kidney injury (AKI) complicates recovery from cardiac surgery in up to 30 % of patients, injures and impairs the function of the brain, lungs, and gut, and places patients at a 5-fold increased risk of death during hospitalization. Renal ischemia, reperfusion, inflammation, hemolysis, oxidative stress, cholesterol emboli, and toxins contribute to the development and progression of AKI. Preventive strategies are limited, but current evidence supports maintenance of renal perfusion and intravascular volume while avoiding venous congestion, administration of balanced salt as opposed to high-chloride intravenous fluids, and the avoidance or limitation of cardiopulmonary bypass exposure. AKI that requires renal replacement therapy occurs in 2–5 % of patients following cardiac surgery and is associated with 50 % mortality. For those who recover from renal replacement therapy or even mild AKI, progression to chronic kidney disease in the ensuing months and years is more likely than for those who do not develop AKI. Cardiac surgery continues to be a popular clinical model to evaluate novel therapeutics, off-label use of existing medications, and nonpharmacologic treatments for AKI, since cardiac surgery is fairly common, typically elective, provides a relatively standardized insult, and patients remain hospitalized and monitored following surgery. More efficient and time-sensitive methods to diagnose AKI are imperative to reduce this negative outcome. The discovery and validation of renal damage biomarkers should in time supplant creatinine-based criteria for the clinical diagnosis of AKI.
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Affiliation(s)
- Jason B O'Neal
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Andrew D Shaw
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Frederic T Billings
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
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30
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Takagi H, Umemoto T. Sutureless aortic valve replacement may improve early mortality compared with transcatheter aortic valve implantation: A meta-analysis of comparative studies. J Cardiol 2016; 67:504-12. [DOI: 10.1016/j.jjcc.2015.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 09/08/2015] [Accepted: 09/10/2015] [Indexed: 10/22/2022]
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31
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Morita S. Aortic valve replacement and prosthesis-patient mismatch in the era of trans-catheter aortic valve implantation. Gen Thorac Cardiovasc Surg 2016; 64:435-40. [PMID: 27234223 PMCID: PMC4956702 DOI: 10.1007/s11748-016-0657-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/13/2016] [Indexed: 11/27/2022]
Abstract
Objective The treatment strategy for aortic stenosis (AS) has been changing due to newly developed valvular prostheses and trans-catheter aortic valve implantation (TAVI). To determine the role of new modalities for AS with a small aortic root, papers using the concept of prosthesis-patient mismatch (PPM) were reviewed. Methods First, to determine the cut-off value of the indexed effective orifice area (IEOA) for defining PPM, the studies of surgical aortic valve replacement (SAVR) with a follow-up longer than 5 years and a patient number larger than 500 were reviewed. Second, the papers comparing TAVI and SAVR were reviewed. Furthermore, the prevalence of PPM was reviewed, with the addition of papers on aortic root enlargement, sutureless AVR, and aortic valve reconstruction with autologous pericardium. Results and conclusion The results of the long-term survival after aortic valve replacement (AVR) have indicated that an IEOA less than 0.65 cm2/m2 should be avoided in all cases, whereas the indications for patients with an IEOA between 065 and 0.85 cm2/m2 should be determined by considering multiple factors. A large body size and younger age have a significantly negative influence on the long-term survival. In Asian population, the prevalence of PPM was low, despite the fact that the size of the aortic annulus was small. The IEOA after TAVI was larger than after surgical AVR in population-matched studies. To evaluate the role of TAVI and other modalities for a small aortic root, studies with a longer follow-up and larger volume are thus warranted.
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Affiliation(s)
- Shigeki Morita
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga, 849-8501, Japan.
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Utsunomiya H, Mihara H, Itabashi Y, Kobayashi S, Siegel RJ, Chakravarty T, Jilaihawi H, Makkar RR, Shiota T. Geometric changes in ventriculoaortic complex after transcatheter aortic valve replacement and its association with post-procedural prosthesis-patient mismatch: an intraprocedural 3D-TEE study. Eur Heart J Cardiovasc Imaging 2016; 18:1-10. [PMID: 27025512 DOI: 10.1093/ehjci/jew039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/13/2016] [Indexed: 11/14/2022] Open
Abstract
AIMS Prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) leads to increased mortality. However, its peri-procedural determinants remain unknown. We investigated geometric changes in aortic annulus (AoA) and left ventricular outflow tract (LVOT) during TAVR by three-dimensional transoesophageal echocardiography (3D-TEE) and its association with post-procedural PPM. METHODS AND RESULTS A total of 131 patients with severe aortic stenosis underwent intraprocedural 3D-TEE during balloon-expandable TAVR. The severity of PPM was graded using the indexed effective orifice area calculated by Doppler echocardiography at discharge, with moderate defined as ≥0.65 and ≤0.85 cm2/m2 and severe defined as <0.65 cm2/m2. 3D planimetered AoA area decreased after TAVR (P< 0.001), whereas the LVOT increased (P= 0.004). The eccentricity of both AoA and LVOT decreased after TAVR (both, P< 0.001). At discharge, the incidence of overall and severe PPM was 44 and 12%, respectively. Patients with PPM had a larger body surface area, smaller aortic valve area, and less frequent balloon dilation (all P< 0.05). Patients with PPM had a lower post-TAVR AoA area/pre-TAVR AoA area (91 ± 8 vs. 95 ± 7%, P= 0.001) than those without PPM. The post-TAVR AoA area/pre-TAVR AoA area was independently associated with overall PPM (odds ratio, 1.80; 95% CI, 1.06-3.05; P= 0.031) and severe PPM (odds ratio, 2.50; 95% CI, 1.05-5.36; P= 0.04). Additionally, a cut-off value of this ratio >86.3% had a sensitivity of 84% and a specificity of 44% for the prevention of severe PPM. CONCLUSION 3D-TEE can evaluate geometric changes in AoA and LVOT during balloon-expandable TAVR and predicts post-procedural PPM.
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Affiliation(s)
- Hiroto Utsunomiya
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Hirotsugu Mihara
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Yuji Itabashi
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Sayuki Kobayashi
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Robert J Siegel
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA.,University of California, Los Angeles, CA, USA
| | - Tarun Chakravarty
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Hasan Jilaihawi
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Raj R Makkar
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Takahiro Shiota
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA .,University of California, Los Angeles, CA, USA
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Takagi H, Umemoto T. Prosthesis–Patient Mismatch After Transcatheter Aortic Valve Implantation. Ann Thorac Surg 2016; 101:872-80. [DOI: 10.1016/j.athoracsur.2015.11.048] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/10/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
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Harjai KJ, Grines CL, Leon MB. Transcatheter Aortic Valve Replacement: 2015 in Review. J Interv Cardiol 2016; 29:27-46. [DOI: 10.1111/joic.12274] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Kishore J. Harjai
- Geisinger Clinic; Pearsall Heart Hospital; Wilkes-Barre Pennsylvania
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Takagi H, Umemoto T. Midterm Mortality After Transcatheter Aortic Valve Implantation Versus Sutureless Aortic Valve Replacement. Am J Cardiol 2016; 117:490-1. [PMID: 26742469 DOI: 10.1016/j.amjcard.2015.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/01/2015] [Indexed: 12/01/2022]
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Carabello B. The ever-increasing choices for aortic valve replacement: which one will win in the marketplace? JACC Cardiovasc Interv 2015; 8:678-80. [PMID: 25946439 DOI: 10.1016/j.jcin.2015.01.019] [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: 12/20/2014] [Accepted: 01/01/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Blase Carabello
- Department of Cardiology, Mount Sinai Beth Israel Hospital, New York, New York.
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