3
|
Laakso T, Moriyama N, Raivio P, Dahlbacka S, Kinnunen EM, Juvonen T, Valtola A, Husso A, Jalava MP, Ahvenvaara T, Tauriainen T, Piuhola J, Lahtinen A, Niemelä M, Mäkikallio T, Virtanen M, Maaranen P, Eskola M, Savontaus M, Airaksinen J, Biancari F, Laine M. Impact of Major Vascular Complication Access Site Status on Mortality After Transfemoral Transcatheter Aortic Valve Replacement - Results From the FinnValve Registry. Circ Rep 2020; 2:182-191. [PMID: 33693226 PMCID: PMC7921363 DOI: 10.1253/circrep.cr-20-0007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: The aim of this study was to investigate the impact of anatomical site status and major vascular complication (MVC) severity on the outcome of transfemoral transcatheter aortic valve replacement (TF-TAVR). Methods and Results: The FinnValve registry enrolled consecutive TAVR patients from 2008 to 2017. MVC was divided into 2 groups: non-access site-related MVC (i.e., MVC in aorta, aortic valve annulus or left ventricle); and access site-related MVC (i.e., MVC in iliac or femoral arteries). Severity of access site-related MVC was measured as units of red blood cell (RBC) transfusion. Of 1,842 patients who underwent TF-TAVR, 174 had MVC (9.4%; non-access site related, n=29; access site related, n=145). Patients with MVC had a significantly higher 3-year mortality than those without MVC (40.8% vs. 24.3%; HR, 2.01; 95% CI: 1.16-3.62). Adjusted 3-year mortality risk was significantly increased in the non-access site-related MVC group (mortality, 77.8%; HR, 4.30; 95% CI: 2.63-7.02), but not in the access site-related MVC group (mortality, 32.6%; HR, 1.38; 95% CI: 0.86-2.15). In the access site-related MVC group, only those with RBC transfusion ≥4 units had a significantly increased 3-year mortality risk (mortality, 51.8%; HR, 2.18; 95% CI: 1.19-3.89). Conclusions: In patients undergoing TF-TAVR, MVC was associated with an increased 3-year mortality risk, incrementally correlating with anatomical site and bleeding severity.
Collapse
Affiliation(s)
- Teemu Laakso
- Heart and Lung Center, Helsinki University Hospital Helsinki Finland
| | - Noriaki Moriyama
- Heart and Lung Center, Helsinki University Hospital Helsinki Finland
| | - Peter Raivio
- Heart and Lung Center, Helsinki University Hospital Helsinki Finland
| | | | | | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital Helsinki Finland
| | - Antti Valtola
- Heart Center, Kuopio University Hospital Kuopio Finland
| | | | - Maina P Jalava
- Heart Center, Turku University Hospital and University of Turku Turku Finland
| | - Tuomas Ahvenvaara
- Department of Surgery, Oulu University Hospital and University of Oulu Oulu Finland
| | - Tuomas Tauriainen
- Department of Surgery, Oulu University Hospital and University of Oulu Oulu Finland
| | - Jarkko Piuhola
- Department of Internal Medicine, Oulu University Hospital Oulu Finland
| | - Asta Lahtinen
- Department of Internal Medicine, Oulu University Hospital Oulu Finland
| | - Matti Niemelä
- Department of Internal Medicine, Oulu University Hospital Oulu Finland
| | - Timo Mäkikallio
- Department of Internal Medicine, Oulu University Hospital Oulu Finland
| | - Marko Virtanen
- Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University Tampere Finland
| | - Pasi Maaranen
- Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University Tampere Finland
| | - Markku Eskola
- Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University Tampere Finland
| | - Mikko Savontaus
- Heart Center, Turku University Hospital and University of Turku Turku Finland
| | - Juhani Airaksinen
- Heart Center, Turku University Hospital and University of Turku Turku Finland
| | - Fausto Biancari
- Heart Center, Turku University Hospital and University of Turku Turku Finland.,Department of Surgery, Oulu University Hospital and University of Oulu Oulu Finland.,Department of Surgery, University of Turku Turku Finland
| | - Mika Laine
- Heart and Lung Center, Helsinki University Hospital Helsinki Finland
| |
Collapse
|
5
|
Shen Y, Zhang H, Zhang L, Li H, Mao H, Pei Y, Jing Z, Lu Q. Transcatheter aortic valve replacement with balloon-expandable valve : Analysis of initial experience in China. Herz 2017; 43:746-751. [PMID: 29236149 PMCID: PMC6280821 DOI: 10.1007/s00059-017-4622-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/21/2017] [Accepted: 08/31/2017] [Indexed: 11/28/2022]
Abstract
Background Transcatheter aortic valve replacement (TAVR) is widely applied for the treatment of severe aortic stenosis (AS) in developed countries; however, in China, it is still in the early stage of utilization. On the basis of previous studies, this work explored the feasibility of TAVR in patients with severe AS in China and analyzed the cause of death in four cases. Methods This retrospective study included 20 patients who had severe AS and underwent TAVR with a balloon-expandable system (Edwards SAPIEN XT) in our hospital from January 2011 to June 2016. The valve and heart functions of 16 survivors before and after the TAVR procedure were compared. TAVR endpoints, device success, and adverse events were assessed according to the definitions of the Valve Academic Research Consortium-2 (VARC-2). Results There were 13 male and seven female patients aged 65–81 years (average, 73.15) who underwent TAVR. The TAVR approach was transfemoral in 19 patients and transapical in one patient. Four patients died (two of coronary artery occlusion and two of aortic annulus rupture) during the TAVR procedure or shortly after; six patients had mild paravalvular leakage, and the rest of the patients showed a significant improvement in cardiac function. During the follow-up period (2–62 months), one patient died of lung cancer 13 months after the TAVR procedure. Conclusion TAVR with a balloon-expandable system is safe and effective and can be used for patients with severe AS in China. It requires careful patient selection and preoperative assessment so as to reduce the 30-day postoperative mortality rate.
Collapse
Affiliation(s)
- Y Shen
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
| | - H Zhang
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
| | - L Zhang
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
| | - H Li
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
| | - H Mao
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
| | - Y Pei
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
| | - Z Jing
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
| | - Q Lu
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.
| |
Collapse
|
6
|
Langer NB, Hamid NB, Nazif TM, Khalique OK, Vahl TP, White J, Terre J, Hastings R, Leung D, Hahn RT, Leon M, Kodali S, George I. Injuries to the Aorta, Aortic Annulus, and Left Ventricle During Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004735. [DOI: 10.1161/circinterventions.116.004735] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The experience with transcatheter aortic valve replacement is increasing worldwide; however, the incidence of potentially catastrophic cardiac or aortic complications has not decreased. In most cases, significant injuries to the aorta, aortic valve annulus, and left ventricle require open surgical repair. However, the transcatheter aortic valve replacement patient presents a unique challenge as many patients are at high or prohibitive surgical risk and, therefore, an open surgical procedure may not be feasible or appropriate. Consequently, prevention of these potentially catastrophic injuries is vital, and practitioners need to understand when open surgical repair is required and when alternative management strategies can be used. The goal of this article is to provide an overview of current management and prevention strategies for major complications involving the aorta, aortic valve annulus, and left ventricle.
Collapse
Affiliation(s)
- Nathaniel B. Langer
- From the Division of Cardiothoracic Surgery (N.B.L., D.L., I.G.) and Division of Cardiology (N.B.H., T.M.N., O.K.K., T.P.V., J.W., J.T., R.H., R.T.H., M.L., S.K., I.G.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Nadira B. Hamid
- From the Division of Cardiothoracic Surgery (N.B.L., D.L., I.G.) and Division of Cardiology (N.B.H., T.M.N., O.K.K., T.P.V., J.W., J.T., R.H., R.T.H., M.L., S.K., I.G.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Tamim M. Nazif
- From the Division of Cardiothoracic Surgery (N.B.L., D.L., I.G.) and Division of Cardiology (N.B.H., T.M.N., O.K.K., T.P.V., J.W., J.T., R.H., R.T.H., M.L., S.K., I.G.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Omar K. Khalique
- From the Division of Cardiothoracic Surgery (N.B.L., D.L., I.G.) and Division of Cardiology (N.B.H., T.M.N., O.K.K., T.P.V., J.W., J.T., R.H., R.T.H., M.L., S.K., I.G.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Torsten P. Vahl
- From the Division of Cardiothoracic Surgery (N.B.L., D.L., I.G.) and Division of Cardiology (N.B.H., T.M.N., O.K.K., T.P.V., J.W., J.T., R.H., R.T.H., M.L., S.K., I.G.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Jonathon White
- From the Division of Cardiothoracic Surgery (N.B.L., D.L., I.G.) and Division of Cardiology (N.B.H., T.M.N., O.K.K., T.P.V., J.W., J.T., R.H., R.T.H., M.L., S.K., I.G.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Juan Terre
- From the Division of Cardiothoracic Surgery (N.B.L., D.L., I.G.) and Division of Cardiology (N.B.H., T.M.N., O.K.K., T.P.V., J.W., J.T., R.H., R.T.H., M.L., S.K., I.G.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Ramin Hastings
- From the Division of Cardiothoracic Surgery (N.B.L., D.L., I.G.) and Division of Cardiology (N.B.H., T.M.N., O.K.K., T.P.V., J.W., J.T., R.H., R.T.H., M.L., S.K., I.G.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Diana Leung
- From the Division of Cardiothoracic Surgery (N.B.L., D.L., I.G.) and Division of Cardiology (N.B.H., T.M.N., O.K.K., T.P.V., J.W., J.T., R.H., R.T.H., M.L., S.K., I.G.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Rebecca T. Hahn
- From the Division of Cardiothoracic Surgery (N.B.L., D.L., I.G.) and Division of Cardiology (N.B.H., T.M.N., O.K.K., T.P.V., J.W., J.T., R.H., R.T.H., M.L., S.K., I.G.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Martin Leon
- From the Division of Cardiothoracic Surgery (N.B.L., D.L., I.G.) and Division of Cardiology (N.B.H., T.M.N., O.K.K., T.P.V., J.W., J.T., R.H., R.T.H., M.L., S.K., I.G.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Susheel Kodali
- From the Division of Cardiothoracic Surgery (N.B.L., D.L., I.G.) and Division of Cardiology (N.B.H., T.M.N., O.K.K., T.P.V., J.W., J.T., R.H., R.T.H., M.L., S.K., I.G.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Isaac George
- From the Division of Cardiothoracic Surgery (N.B.L., D.L., I.G.) and Division of Cardiology (N.B.H., T.M.N., O.K.K., T.P.V., J.W., J.T., R.H., R.T.H., M.L., S.K., I.G.), Columbia University College of Physicians and Surgeons, New York, NY
| |
Collapse
|