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Sattar Y, Song D, Almas T, Zghouzi M, Talib U, Suleiman ARM, Ahmad B, Arshad J, Ullah W, Zia Khan M, Bianco CM, Bagur R, Rashid M, Mamas MA, Alraies MC. Cardiovascular outcomes and trends of Transcatheter vs. Surgical aortic valve replacement among octogenarians with heart failure: A Propensity Matched national cohort analysis. IJC HEART & VASCULATURE 2022; 42:101119. [PMID: 36161232 PMCID: PMC9489740 DOI: 10.1016/j.ijcha.2022.101119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/17/2022] [Accepted: 09/01/2022] [Indexed: 11/26/2022]
Abstract
Background Methods Results Conclusion
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Zhang H, Xie JJ, Li RJ, Wang YL, Niu BR, Song L, Li J, Yang Y. Change and impact of left ventricular global longitudinal strain during transcatheter aortic valve implantation. World J Clin Cases 2022; 10:1806-1814. [PMID: 35317147 PMCID: PMC8891760 DOI: 10.12998/wjcc.v10.i6.1806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although transcatheter aortic valve implantation (TAVI) is a safe and effective treatment for aortic stenosis, it still carries some risks, such as valve leaks, stroke, and even death. The left ventricular global longitudinal strain (LVGLS) measurement may be useful for the prediction of adverse events during this operation.
AIM To explore the change of LVGLS during TAVI procedure and the relationship between LVGLS and perioperative adverse events.
METHODS In this study, 61 patients who had undergone percutaneous transfemoral TAVI were evaluated by transthoracic echocardiography. Before surgery, data on left ventricular ejection fraction (LVEF) and LVGLS were collected separately following balloon expansion and stent implantation. Difference in values of LVGLS and LVEF during preoperative balloon expansion (pre-ex), preoperative stent implantation (pre-im) and balloon expansion-stent implantation (ex-im) were also examined. Adverse events were defined as perioperative death, cardiac rupture, heart arrest, moderate or severe perivalvular leakage, significant mitral regurgitation during TAVI, perioperative moderate or severe mitral regurgitation, perioperative left ventricular outflow tract obstruction, reoperation, and acute heart failure.
RESULTS The occurrence of perioperative adverse events was associated with differences in pre-ex LVGLS, but not with difference in pre-ex LVEF. There were significant differences between pre-LVGLS and ex-LVGLS, and between pre-LVGLS and im-LVGLS (P = 0.037 and P = 0.020, respectively). However, differences in LVEF were not significant (P = 0.358, P = 0.254); however differences in pre-ex LVGLS were associated with pre-LVGLS (P = 0.045). Compared to LVEF, LVGLS is more sensitive as a measure of left heart function during TAVI and the perioperative period. Moreover, the differences in LVGLS were associated with the occurrence of perioperative adverse events, and changes in LVGLS were apparent in patients with undesirable LVGLS before the surgery. Furthermore, LVGLS is useful to predict changes in cardiac function during TAVI.
CONCLUSION Greater attention should be paid to the patients who plan to undergo TAVI with normal LVEF but poor LVGLS.
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Affiliation(s)
- Han Zhang
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jin-Jie Xie
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Rong-Juan Li
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yue-Li Wang
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Bao-Rong Niu
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Li Song
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jing Li
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Ya Yang
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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Al-Khadra Y, Sattar Y, Ullah W, Moussa Pacha H, Baibars M, Darmoch F, Abu-Mahfouz M, Afonso L, Devireddy C, Anwaruddin S, Sorajja P, Ajmal R, Kwok CS, Asfour AI, Zehr K, Mamas MA, Alraies MC. Temporal trends and outcomes in utilisation of transcatheter and surgical aortic valve therapies in aortic valve stenosis patients with heart failure. Int J Clin Pract 2021; 75:e13711. [PMID: 32955776 DOI: 10.1111/ijcp.13711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTIONS & AIMS Heart failure (HF) is a common comorbidity in patients undergoing surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). We sought to access the temporal trends and outcomes of TAVR or SAVR in HF patients. METHOD The NIS database from 2011-2014 was queried for patients that underwent TAVR or SAVR and were subsequently diagnosed with HF. Temporal trends in the utilisation of TAVR or SAVR in HF patients were analysed. RESULTS Among 27 982 patients who were diagnosed with HF of whom 17 681 (63.2%) had heart failure with reduced ejection fraction (HFrEF) while 10 301 (36.8%) had heart failure with preserved ejection fraction (HFpEF), 9049 (32.3%) underwent TAVR and 16 933 (76.7%) underwent SAVR. Patients with HFrEF and HFpEF had higher utilisation of TAVR compared with SAVR over the course of the study period (P trend < .001). TAVR was associated with lower mortality [2.8% in 2012 and 1.8% in 2014 (P .013)] compared with SAVR. Similarly, multiple logistic regression showed a statistically significant lower in-hospital mortality in the TAVR group compared with SAVR (aOR 0.634; CI 0.504, 0.798, P < .001). CONCLUSION For patients with severe aortic valve stenosis and heart failure who undergo aortic valve intervention, TAVR is associated with less odds of in-hospital mortality compared with SAVR.
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Affiliation(s)
| | - Yasar Sattar
- Icahn School of Medicine at Mount, Sinai Elmhurst Hospital, Queens, NY, USA
| | - Waqas Ullah
- Abington Jefferson Health, Abington, PA, USA
| | - Homam Moussa Pacha
- McGovern Medical School, Memorial Hermann Heart & Vascular Institute, University of Texas Health Science Center, Houston, TX, USA
| | - Motaz Baibars
- Department of Medicine, John Hopkins University, Baltimore, MD, USA
| | - Fahed Darmoch
- Harvard School of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mohammed Abu-Mahfouz
- Detroit Medical Center, Wayne State University, DMC Heart Hospital, Detroit, MI, USA
| | - Luis Afonso
- Detroit Medical Center, Wayne State University, DMC Heart Hospital, Detroit, MI, USA
| | | | - Saif Anwaruddin
- Department of Cardiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul Sorajja
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Rasikh Ajmal
- Detroit Medical Center, Wayne State University, DMC Heart Hospital, Detroit, MI, USA
| | - Chun Shing Kwok
- Cardiovascular Research Group, Institute for Science & Technology in Medicine, Keel University, Newcastle upon Tyne, UK
| | | | - Kenton Zehr
- Detroit Medical Center, Wayne State University, DMC Heart Hospital, Detroit, MI, USA
| | - Mamas A Mamas
- Department of Cardiology, Keele University, Stoke on Trent, UK
| | - M Chadi Alraies
- Detroit Medical Center, Wayne State University, DMC Heart Hospital, Detroit, MI, USA
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Kim HJ, Park SJ, Koo HJ, Kang JW, Yang DH, Jung SH, Choo SJ, Chung CH, Lee JW, Kim JB. Determinants of effective orifice area in aortic valve replacement: anatomic and clinical factors. J Thorac Dis 2020; 12:1942-1951. [PMID: 32642097 PMCID: PMC7330291 DOI: 10.21037/jtd-20-188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Obtaining adequate effective orifice area (EOA) in surgical aortic valve replacement (SAVR) is important to minimize pressure gradients across the prosthetic aortic valve (AV) and improve clinical outcomes. However, the predictors of EOA are unclear. Methods From July 2011 to March 2016, patients undergoing SAVR who were preoperatively evaluated using a computed tomography (CT) on the aortic root were enrolled. Indexed EOA (iEOA) was used as an indicator of prosthetic AV opening area. The aortic root parameters investigated were the annular diameter (max and min), annular perimeter, annular area, and maximal dimensions of the proximal ascending aorta. These variables were evaluated as predictors of EOA, and an individual surgeon was incorporated in analysis for verifying surgeon dependent factors. Results Among the 710 patients included in this study [age: 64.9±10.8 years; females: n=285 (40.1%)], 370 (52.1%) were implanted with bio-prosthesis. Mean prosthetic iEOA was 1.1±0.3 cm2/m2. Univariable linear regression analysis showed that all indexed aortic root parameters (maximal and minimal annular diameters, annular perimeter, annular area, and sinus dimensions) were significantly associated with iEOA (P<0.001). Multivariable analysis showed that indexed aortic annular area, indexed maximal diameter of the Valsalva sinus, female sex, and bio-prosthesis, supra-annular type prosthesis and surgeon were significant and independent determinants of iEOA (adjusted R2=0.513, P<0.001). Conclusions Aortic annular area and Valsalva sinus diameter are independent determinants for iEOA measured by preoperative CT; surgeon-dependent factors are also significant determinants in SAVR.
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Affiliation(s)
- Hee Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University, Seoul, Korea
| | - Sung Jun Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Schmidt T, Frerker C. Treatment Challenges in Patients with Acute Heart Failure and Severe Aortic Valve Stenosis. Curr Cardiol Rep 2019; 21:47. [PMID: 31011842 DOI: 10.1007/s11886-019-1135-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The goal of this paper is to describe the treatment challenges in patients with aortic stenosis in combination with a reduced left ventricular function. RECENT FINDINGS Since the risk of mortality is increased in this patient population, transcatheter aortic valve implantation emerged as an important treatment option. Concomitant factors such as mitral regurgitation or coronary artery disease are important co-factors that need to be evaluated and taken into account for treatment decision. Treatment of the severe aortic stenosis is key in this complex setting. Since several co-factors may exist in addition to aortic stenosis, treatment needs to be decided by a Heart Team.
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Affiliation(s)
- Tobias Schmidt
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany.
| | - Christian Frerker
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
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Shiino K, Yamada A, Scalia GM, Putrino A, Chamberlain R, Poon K, Walters DL, Chan J. Early Changes of Myocardial Function After Transcatheter Aortic Valve Implantation Using Multilayer Strain Speckle Tracking Echocardiography. Am J Cardiol 2019; 123:956-960. [PMID: 30594290 DOI: 10.1016/j.amjcard.2018.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/05/2018] [Accepted: 12/13/2018] [Indexed: 02/06/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is an effective therapeutic option for severe symptomatic aortic valve stenosis (AS) with intermediate or high surgical risk. The purpose of this study was to examine the effects of TAVI on left ventricular (LV) mechanics using multilayer global longitudinal strain (GLS) by 2D speckle-tracking echocardiography. A total of 119 patients (mean age 83 ± 7.0 years, male 54%) with severe symptomatic AS and normal LV ejection fraction (LVEF) underwent echocardiography at baseline and 1 month after TAVI. Global longitudinal strain was measured from the endocardial layer (GLSendo), mid-ventricular layer (GLSmyo), epicardial layer (GLSepi) and full thickness of myocardium (GLSwhole). There was significant improvement in all 3 layers of GLS after TAVI compared with baseline, but there was no significant change in LVEF. The relative % increment in GLS in each layer strain were 11.2 ± 23.4% (GLSendo), 13.4 ± 33.0% (GLSmyo) and 18.0 ± 46.6% (GLSepi) with significant difference between GLSendo and GLSepi (p < 0.05). In conclusion, multilayer GLS is more sensitive than conventional LVEF to detect early improvement in LV systolic function after TAVI in patients with severe AS. There is a disproportional improvement in different layers with least improvement in the endocardium. Multilayer strain analysis may provide new insights into understanding mechanics of AS.
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Imnadze G, Hofmann S, Billion M, Ferdosi A, Kowalski M, Smith KH, Deutsch C, Bramlage P, Warnecke H, Franz N. Transapical transcatheter aortic valve implantation in patients with a low ejection fraction. Interact Cardiovasc Thorac Surg 2019; 26:224-229. [PMID: 29049741 DOI: 10.1093/icvts/ivx315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/21/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES It may be expected that patients with left ventricular dysfunction may be at greater risk of complications after transcatheter aortic valve implantation (TAVI) via transapical (TA) access compared with via transfemoral (TF) access. There is a lack of data comparing the outcomes of TAVI using TA and TF access in patients with a reduced left ventricular ejection fraction (EF). METHODS This is a retrospective analysis of data from a high-volume heart centre in Germany. TAVI access route assignment was based on a 'best for TF' approach, where only patients who met a strict set of criteria underwent TF-TAVI, with the remainder receiving TA-TAVI. For this analysis, patients were included if they had a pre-TAVI EF of ≤ 40%. Early mortality and late (1-year) mortality were compared through multivariate logistic regression. RESULTS A total of 342 patients in the registry had an EF of ≤ 40%, of which 74.9% underwent TA-TAVI and 25.1% underwent TF-TAVI. Higher proportions of the TA group presented with certain comorbidities, and their logistic EuroSCORE and Society of Thoracic Surgeons (STS) risk scores were higher than in the TF group. At 1 year, TA access was associated with greater mortality in the univariate analysis (odd ratio 2.43; 95% confidence interval 1.04-5.69). However, after multivariate adjustment, no significant differences were found in either 30-day or 1-year mortality rates. CONCLUSIONS The data suggest that, for patients with a reduced EF, TA-TAVI is not associated with a poorer outcome compared with TF-TAVI. Therefore, TA access should not be discounted based on the presence of left ventricular dysfunction alone.
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Affiliation(s)
- Guram Imnadze
- Institut für Gesundheitsforschung und Bildung, Universität Osnabrück, Osnabrück, Germany.,Department of Cardiology, Klinikum Osnabrück, Am Finkenhügel 1, Osnabrück, Germany
| | - Steffen Hofmann
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Michael Billion
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Abbas Ferdosi
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Marek Kowalski
- Department of Cardiology, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Katherine H Smith
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Henning Warnecke
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany.,Department of Cardiology, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Norbert Franz
- Department of Cardiology, Schüchtermann Clinic, Bad Rothenfelde, Germany.,University Witten-Herdecke, Witten, Germany
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Bavishi C, Kolte D, Gordon PC, Abbott JD. Transcatheter aortic valve replacement in patients with severe aortic stenosis and heart failure. Heart Fail Rev 2018; 23:821-829. [DOI: 10.1007/s10741-018-9726-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Heart failure (HF) is often associated with different valve diseases, predominantly functional mitral and tricuspid regurgitation. However, the association between HF and aortic stenosis, particularly low-flow low-gradient aortic stenosis, is not infrequent. Severe mitral and tricuspid regurgitations, as well as aortic stenosis, in HF patients worsen prognosis and left ventricular dilatation and induce further reduction in left ventricular ejection fraction. Transcatheter edge-to-edge mitral and tricuspid valve repair and transcatheter aortic valve implantation could be an important therapeutic option with a satisfactory long-term outcome in HF patients with comorbidities and even in patients with severely depressed ejection fraction.
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Affiliation(s)
- Marijana Tadic
- Department of Internal Medicine and Cardiology, Department of Cardiology, Campus Virchow Klinikum (CVK), Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Viale della Resistenza 23, 20036, Meda, Italy
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Mechanical Intervention for Aortic Valve Stenosis in Patients With Heart Failure and Reduced Ejection Fraction. J Am Coll Cardiol 2017; 70:3026-3041. [PMID: 29241492 DOI: 10.1016/j.jacc.2017.10.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 12/11/2022]
Abstract
The risk and benefit of mechanical interventions in valvular heart disease have been primarily described among patients with normal ejection fraction. The advent of nonsurgical mechanical interventions for aortic stenosis (transcatheter aortic valve replacement) may alter the risk-benefit ratio for patients who would otherwise be at increased risk for valve surgery. This review describes the epidemiology and pathophysiology of aortic stenosis with heart failure and reduced ejection fraction and summarizes the current registry and clinical trial data applicable to this frequently encountered high-risk group. It concludes with discussion of ongoing trials, new approaches, emerging indications, and a potential clinical algorithm incorporating optimal mechanical intervention for patients with aortic stenosis and concomitant reduced ejection fraction.
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Dauerman HL, Reardon MJ, Popma JJ, Little SH, Cavalcante JL, Adams DH, Kleiman NS, Oh JK. Early Recovery of Left Ventricular Systolic Function After CoreValve Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003425. [PMID: 27296201 DOI: 10.1161/circinterventions.115.003425] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/29/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Approximately one third of patients with symptomatic aortic stenosis have reduced left ventricular ejection fraction (LVEF) before transcatheter aortic valve replacement. The incidence, predictors, and significance of early LVEF recovery after CoreValve transcatheter aortic valve replacement have not been described. METHODS AND RESULTS We studied 156 patients from the CoreValve Extreme and High-Risk trials with LVEF ≤40% at baseline who had 30-day LVEF data. All patients underwent core laboratory echocardiographic assessment of LVEF at baseline, post procedure, discharge, 30 days, 6 months, and 1 year. Early LVEF recovery was defined as an absolute increase of ≥10% in EF at 30 days. One-year outcomes were compared between patients with and without early recovery. Multivariable analysis was performed to determine independent predictors of early recovery. Early LVEF recovery occurred in 62% of patients, generally before discharge. By 30 days LVEF increased >17% compared with baseline in the early recovery group with minimal increase in the no-early recovery group (48.9±8.8% versus 31.5±6.9%; P<0.001). One-year all-cause mortality was numerically (but not statistically) higher in the no-early recovery group (24% versus 12%; P=0.07). Absence of previous myocardial infarction (odds ratio, 0.44; 95% confidence interval, 0.19-1.03) and baseline mean gradient ≥40 mm Hg (odds ratio, 4.59; 95% confidence interval, 1.76-11.96) were identified as predictors of early LVEF recovery. CONCLUSIONS Nearly two thirds of patients with reduced LVEF will have a marked early improvement after transcatheter aortic valve replacement. Early LVEF recovery is associated with improved clinical outcomes and is most likely among patients with higher baseline aortic valve gradients and no previous myocardial infarction. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01240902.
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Affiliation(s)
- Harold L Dauerman
- From the University of Vermont College of Medicine, Burlington (H.L.D); Houston DeBakey Heart and Vascular Center, The Houston Methodist Hospital, TX (M.J.R., S.H.L., N.S.K.); Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.); University of Pittsburgh Medical Center, PA (J.L.C.); Mount Sinai School of Medicine, New York, NY (D.H.A.); and Mayo Clinic, Rochester, MN (J.K.O.).
| | - Michael J Reardon
- From the University of Vermont College of Medicine, Burlington (H.L.D); Houston DeBakey Heart and Vascular Center, The Houston Methodist Hospital, TX (M.J.R., S.H.L., N.S.K.); Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.); University of Pittsburgh Medical Center, PA (J.L.C.); Mount Sinai School of Medicine, New York, NY (D.H.A.); and Mayo Clinic, Rochester, MN (J.K.O.)
| | - Jeffrey J Popma
- From the University of Vermont College of Medicine, Burlington (H.L.D); Houston DeBakey Heart and Vascular Center, The Houston Methodist Hospital, TX (M.J.R., S.H.L., N.S.K.); Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.); University of Pittsburgh Medical Center, PA (J.L.C.); Mount Sinai School of Medicine, New York, NY (D.H.A.); and Mayo Clinic, Rochester, MN (J.K.O.)
| | - Stephen H Little
- From the University of Vermont College of Medicine, Burlington (H.L.D); Houston DeBakey Heart and Vascular Center, The Houston Methodist Hospital, TX (M.J.R., S.H.L., N.S.K.); Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.); University of Pittsburgh Medical Center, PA (J.L.C.); Mount Sinai School of Medicine, New York, NY (D.H.A.); and Mayo Clinic, Rochester, MN (J.K.O.)
| | - João L Cavalcante
- From the University of Vermont College of Medicine, Burlington (H.L.D); Houston DeBakey Heart and Vascular Center, The Houston Methodist Hospital, TX (M.J.R., S.H.L., N.S.K.); Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.); University of Pittsburgh Medical Center, PA (J.L.C.); Mount Sinai School of Medicine, New York, NY (D.H.A.); and Mayo Clinic, Rochester, MN (J.K.O.)
| | - David H Adams
- From the University of Vermont College of Medicine, Burlington (H.L.D); Houston DeBakey Heart and Vascular Center, The Houston Methodist Hospital, TX (M.J.R., S.H.L., N.S.K.); Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.); University of Pittsburgh Medical Center, PA (J.L.C.); Mount Sinai School of Medicine, New York, NY (D.H.A.); and Mayo Clinic, Rochester, MN (J.K.O.)
| | - Neil S Kleiman
- From the University of Vermont College of Medicine, Burlington (H.L.D); Houston DeBakey Heart and Vascular Center, The Houston Methodist Hospital, TX (M.J.R., S.H.L., N.S.K.); Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.); University of Pittsburgh Medical Center, PA (J.L.C.); Mount Sinai School of Medicine, New York, NY (D.H.A.); and Mayo Clinic, Rochester, MN (J.K.O.)
| | - Jae K Oh
- From the University of Vermont College of Medicine, Burlington (H.L.D); Houston DeBakey Heart and Vascular Center, The Houston Methodist Hospital, TX (M.J.R., S.H.L., N.S.K.); Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.); University of Pittsburgh Medical Center, PA (J.L.C.); Mount Sinai School of Medicine, New York, NY (D.H.A.); and Mayo Clinic, Rochester, MN (J.K.O.)
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D’Onofrio A, Salizzoni S, Filippini C, Agrifoglio M, Alfieri O, Chieffo A, Tarantini G, Gabbieri D, Savini C, Immè S, Ribichini F, Cugola D, Raviola E, Loi B, Pompei E, Cappai A, Cassese M, Luzi G, Aiello M, Santini F, Rinaldi M, Gerosa G. Transapical aortic valve replacement is a safe option in patients with poor left ventricular ejection fraction: results from the Italian Transcatheter Balloon-Expandable Registry (ITER)†. Eur J Cardiothorac Surg 2017; 52:874-880. [DOI: 10.1093/ejcts/ezx227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 05/29/2017] [Indexed: 12/13/2022] Open
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Concomitant Valve-In-Valve Transcatheter Aortic Valve Replacement and Left Ventricular Assist Device Implantation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:147-149. [DOI: 10.1097/imi.0000000000000360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Redo aortic valve replacement (AVR) performed simultaneously with left ventricular assist device (LVAD) implantation carries potential for increased mortality rates. Although transcatheter AVR has been used for patients with previous LVAD placement, no literature reports concomitant valve-in-valve transcatheter AVR and LVAD implantation. Our patient had severe aortic prosthetic valve deterioration and advanced heart failure. Given the risks associated with reoperative aortic valve surgery, we chose transcatheter AVR at the time of LVAD implantation. Transthoracic echocardiography results showed severe aortic prosthetic valve deterioration with moderate aortic regurgitation as well as severe left ventricular dysfunction (ejection fraction, 11%). After redosternotomy, we performed transcatheter AVR via the ascending aorta and subsequent LVAD implantation. The postoperative course was uneventful. Generally, patients with structural deterioration of a bioprosthetic valve who report for LVAD therapy present considerable challenges to the surgeon. Concomitant transcatheter AVR offers a less-invasive alternative to surgical AVR that minimizes ischemic injury to myocardium.
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Murashita T, Joyce DL, Pochettino A, Stulak JM, Joyce LD. Concomitant Valve-In-Valve Transcatheter Aortic Valve Replacement and Left Ventricular Assist Device Implantation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Takashi Murashita
- From the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN USA
| | - David L. Joyce
- From the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN USA
| | - Alberto Pochettino
- From the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN USA
| | - John M. Stulak
- From the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN USA
| | - Lyle D. Joyce
- From the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN USA
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Fraccaro C, Tarantini G, Rosato S, Tellaroli P, D'Errigo P, Tamburino C, Onorati F, Ranucci M, Barbanti M, Grossi C, Santoro G, Santini F, Covello RD, Fusco D, Seccareccia F. Early and Midterm Outcome of Propensity-Matched Intermediate-Risk Patients Aged ≥80 Years With Aortic Stenosis Undergoing Surgical or Transcatheter Aortic Valve Replacement (from the Italian Multicenter OBSERVANT Study). Am J Cardiol 2016; 117:1494-501. [PMID: 26993427 DOI: 10.1016/j.amjcard.2016.02.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/08/2016] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Abstract
The aim of this study was to analyze procedural and postprocedural outcomes of patients aged ≥80 years treated by transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) as enrolled in the OBservational Study of Effectiveness of SAVR-TAVR procedures for severe Aortic steNosis Treatment (OBSERVANT) Study. TAVI is offered to patients with aortic stenosis judged inoperable or at high surgical risk. Nevertheless, it is common clinical practice to treat elderly (≥80 years) patients by TAVI regardless of surgical risk for traditional SAVR. OBSERVANT is a multicenter, observational, prospective cohort study that enrolled patients with symptomatic severe aortic stenosis who underwent SAVR or TAVI from December 2010 to June 2012 in 93 Italian participating hospitals. Information on demographic characteristics, health status before intervention, therapeutic approach, and intraprocedural and 30-day outcomes was collected. An administrative follow-up was set up to collect data on midterm to long-term outcomes. We reviewed baseline and procedural data of patients aged ≥80 years, looking for different early and late outcome after TAVI or SAVR. Patients treated by TAVI were sicker than SAVR because of higher rate of co-morbidities, advanced illness, frailty, and Logistic EuroSCORE. After propensity matching, early and midterm mortality were comparable between the 2 groups. However, patients treated by TAVI had higher rate of vascular complications (6.0% vs 0.5%; p <0.0001), permanent pacemaker implantation (13.4% vs 3.7%; p <0.0001), and paravalvular leak (8.9% vs 2.4%; p <0.0001). Patients who underwent SAVR had more frequent bleedings needing transfusion (63.2% vs 34.5%; p <0.0001) and acute kidney injury (9.6% vs 3.9%; p = 0.0010). In conclusion, patients aged ≥80 years treated by TAVI or SAVR had similar early and midterm mortality.
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Cheungpasitporn W, Thongprayoon C, Kashani K. Transcatheter Aortic Valve Replacement: a Kidney's Perspective. J Renal Inj Prev 2016; 5:1-7. [PMID: 27069960 PMCID: PMC4827378 DOI: 10.15171/jrip.2016.01] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 01/05/2016] [Indexed: 12/24/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has now emerged as a viable treatment option for high-risk patients with severe aortic stenosis (AS) who are not suitable candidates for surgical aortic valve replacement (SAVR). Despite encouraging published outcomes, acute kidney injury (AKI) is common and lowers the survival of patients after TAVR. The pathogenesis of AKI after TAVR is multifactorial including TAVR specific factors such as the use of contrast agents, hypotension during rapid pacing, and embolization; preventive measures may include pre-procedural hydration, limitation of contrast dye exposure, and avoidance of intraprocedural hypotension. In recent years, the number of TAVR performed worldwide has been increasing, as well as published data on renal perspectives of TAVR including AKI, chronic kidney disease, end-stage kidney disease, and kidney transplantation. This review aims to present the current literature on the nephrology aspects of TAVR, ultimately to improve the patients' quality of care and outcomes.
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Affiliation(s)
- Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Charat Thongprayoon
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - Kianoush Kashani
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Thongprayoon C, Cheungpasitporn W, Srivali N, Harrison AM, Gunderson TM, Kittanamongkolchai W, Greason KL, Kashani KB. AKI after Transcatheter or Surgical Aortic Valve Replacement. J Am Soc Nephrol 2015; 27:1854-60. [PMID: 26487562 DOI: 10.1681/asn.2015050577] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/16/2015] [Indexed: 12/16/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for patients with symptomatic severe aortic stenosis who are at high risk of perioperative mortality. Previous studies showed increased risk of postoperative AKI with TAVR, but it is unclear whether differences in patient risk profiles confounded the results. To conduct a propensity-matched study, we identified all adult patients undergoing isolated aortic valve replacement for aortic stenosis at Mayo Clinic Hospital in Rochester, Minnesota from January 1, 2008 to June 30, 2014. Using propensity score matching on the basis of clinical characteristics and preoperative variables, we compared the postoperative incidence of AKI, defined by Kidney Disease Improving Global Outcomes guidelines, and major adverse kidney events in patients treated with TAVR with that in patients treated with SAVR. Major adverse kidney events were the composite of in-hospital mortality, use of RRT, and persistent elevated serum creatinine ≥200% from baseline at hospital discharge. Of 1563 eligible patients, 195 matched pairs (390 patients) were created. In the matched cohort, baseline characteristics, including Society of Thoracic Surgeons risk score and eGFR, were comparable between the two groups. Furthermore, no significant differences existed between the TAVR and SAVR groups in postoperative AKI (24.1% versus 29.7%; P=0.21), major adverse kidney events (2.1% versus 1.5%; P=0.70), or mortality >6 months after surgery (6.0% versus 8.3%; P=0.51). Thus, TAVR did not affect postoperative AKI risk. Because it is less invasive than SAVR, TAVR may be preferred in high-risk individuals.
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Affiliation(s)
| | | | - Narat Srivali
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
| | | | | | | | - Kevin L Greason
- Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine,
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Abstract
For the year 2014, more than 17,000 published references can be found in Pubmed when entering the search term "cardiac surgery". The last year has been characterized by a vivid discussion in the fields where classic cardiac surgery and modern interventional techniques overlap. Specifically, there have been important contributions in the field of coronary revascularization with either percutaneous coronary intervention or bypass surgery as well as in the fields of interventional valve therapy. Here, the US core valve trial with the first demonstration of a survival advantage at 1 year with transcatheter valves compared to surgical aortic valve replacement or the 5-year outcome of the SYNTAX trial with significant advantages for bypass surgery has been the landmark. However, in addition to these most visible publications, there have been several highly relevant and interesting contributions. This review article will summarize the most pertinent publications in the fields of coronary revascularization, surgical treatment of valve disease, heart failure (i.e., transplantation and ventricular assist devices) and aortic surgery. This condensed summary will provide the reader with "solid ground" for up-to-date decision-making in cardiac surgery.
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Thongprayoon C, Cheungpasitporn W, Srivali N, Ungprasert P, Kittanamongkolchai W, Greason KL, Kashani KB. Acute kidney injury after transcatheter aortic valve replacement: a systematic review and meta-analysis. Am J Nephrol 2015; 41:372-82. [PMID: 26113391 DOI: 10.1159/000431337] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 03/29/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND The objective of this meta-analysis was to evaluate the risk of acute kidney injury (AKI) in patients who underwent transcatheter aortic valve replacement (TAVR). METHODS A literature search was performed using MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews and clinicaltrials.gov from inception through October, 2014. Studies that reported relative risks, ORs, or hazard ratios comparing the AKI risk in patients who underwent TAVR versus those who underwent surgical aortic valve replacement were included. We performed the pre-specified sensitivity analysis including only propensity score-based studies. Mortality risk was evaluated among the studies that reported AKI outcome. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS Three randomized controlled trials (RCTs) with 1,852 patients and 14 cohort studies with 3,113 patients were analyzed to assess the AKI risk in patients undergoing TAVR. The pooled RRs of AKI in patients undergoing TAVR were 0.65 (95% CI 0.36-1.15, I(2) = 75%) in the analysis of RCTs and propensity score-based studies and 0.76 (95% CI 0.44-1.34, I(2) = 79%) in the analysis of observational studies. Sensitivity analysis in RCTs and propensity score-based studies using a standard AKI definition demonstrated a significant association between TAVR and lower AKI risk (RR 0.35, 95% CI 0.25-0.50, I(2) = 0%). Our meta-analyses of RCTs and propensity score-based studies did not find associations between TAVR and reduced risks of severe AKI requiring dialysis (RR 0.82, 95% CI 0.38-1.79, I(2) = 63%). CONCLUSIONS Our meta-analysis demonstrates an association between TAVR and lower AKI risk.
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Saeedi M, Thomas A, Shellock FG. Evaluation of MRI issues at 3-Tesla for a transcatheter aortic valve replacement (TAVR) bioprosthesis. Magn Reson Imaging 2015; 33:497-501. [DOI: 10.1016/j.mri.2015.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/13/2015] [Accepted: 01/18/2015] [Indexed: 12/29/2022]
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Early effects of transcatheter aortic valve implantation and aortic valve replacement on myocardial function and aortic valve hemodynamics: Insights from cardiovascular magnetic resonance imaging. J Thorac Cardiovasc Surg 2015; 149:462-70. [DOI: 10.1016/j.jtcvs.2014.10.064] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/07/2014] [Accepted: 10/11/2014] [Indexed: 11/20/2022]
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