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Al‐Farra H, Ravelli ACJ, Henriques JPS, Houterman S, de Mol BAJM, Abu‐Hanna A. Development and validation of a prediction model for early mortality after transcatheter aortic valve implantation (TAVI) based on the Netherlands Heart Registration (NHR): The TAVI-NHR risk model. Catheter Cardiovasc Interv 2022; 100:879-889. [PMID: 36069120 PMCID: PMC9826169 DOI: 10.1002/ccd.30398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 08/02/2022] [Accepted: 08/25/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The currently available mortality prediction models (MPM) have suboptimal performance when predicting early mortality (30-days) following transcatheter aortic valve implantation (TAVI) on various external populations. We developed and validated a new TAVI-MPM based on a large number of predictors with recent data from a national heart registry. METHODS We included all TAVI-patients treated in the Netherlands between 2013 and 2018, from the Netherlands Heart Registration. We used logistic-regression analysis based on the Akaike Information Criterion for variable selection. We multiply imputed missing values, but excluded variables with >30% missing values. For internal validation, we used ten-fold cross-validation. For temporal (prospective) validation, we used the 2018-data set for testing. We assessed discrimination by the c-statistic, predicted probability accuracy by the Brier score, and calibration by calibration graphs, and calibration-intercept and calibration slope. We compared our new model to the updated ACC-TAVI and IRRMA MPMs on our population. RESULTS We included 9144 TAVI-patients. The observed early mortality was 4.0%. The final MPM had 10 variables, including: critical-preoperative state, procedure-acuteness, body surface area, serum creatinine, and diabetes-mellitus status. The median c-statistic was 0.69 (interquartile range [IQR] 0.646-0.75). The median Brier score was 0.038 (IQR 0.038-0.040). No signs of miscalibration were observed. The c-statistic's temporal-validation was 0.71 (95% confidence intervals 0.64-0.78). Our model outperformed the updated currently available MPMs ACC-TAVI and IRRMA (p value < 0.05). CONCLUSION The new TAVI-model used additional variables and showed fair discrimination and good calibration. It outperformed the updated currently available TAVI-models on our population. The model's good calibration benefits preprocedural risk-assessment and patient counseling.
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Affiliation(s)
- Hatem Al‐Farra
- Department of Medical Informatics, Amsterdam UMCLocation University of AmsterdamAmsterdamThe Netherlands
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMCLocation University of AmsterdamAmsterdamThe Netherlands
- Amsterdam Public HealthAmsterdamThe Netherlands
| | - Anita C. J. Ravelli
- Department of Medical Informatics, Amsterdam UMCLocation University of AmsterdamAmsterdamThe Netherlands
- Amsterdam Public HealthAmsterdamThe Netherlands
| | - José P. S. Henriques
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMCLocation University of AmsterdamAmsterdamThe Netherlands
| | | | - Bas A. J. M. de Mol
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMCLocation University of AmsterdamAmsterdamThe Netherlands
| | - Ameen Abu‐Hanna
- Department of Medical Informatics, Amsterdam UMCLocation University of AmsterdamAmsterdamThe Netherlands
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2
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Rostagno C, Falchetti G, Rostagno AC, Mattesini A. TAVR in patients with hip fracture and severe aortic stenosis: how and when? Intern Emerg Med 2021; 16:1419-1422. [PMID: 34014487 DOI: 10.1007/s11739-021-02752-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
Comorbidities are common in elderly patients with hip fracture and are associated with an increased mortality after surgery. Internal medicine/geriatric leaded multidisciplinary hip fracture teams may play a pivotal role in the clinical management of complex patients. Treatment strategy is particular relevant in patients with severe aortic stenosis that represent more than 5% of patients with hip fracture. These patients have a high in-hospital mortality and poor 1-year survival (less than 50%). Transcatheter aortic valve replacement (TAVR) may be an option in selected patients; however, the choice to treat and, in the case, the timing of valve replacement in relation to hip surgery is highly dependent on clinical conditions before trauma. In this paper, three different scenario of TAVR timing after hip fracture are reported.
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Affiliation(s)
- Carlo Rostagno
- Dipartimento Medicina Sperimentale e Clinica, Università di Firenze, Viale Morgagni 85, 50134, Florence, Italy.
| | - Giorgia Falchetti
- Dipartimento Medicina Sperimentale e Clinica, Università di Firenze, Viale Morgagni 85, 50134, Florence, Italy
| | - Andrea Carlo Rostagno
- Dipartimento Medicina Sperimentale e Clinica, Università di Firenze, Viale Morgagni 85, 50134, Florence, Italy
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3
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Brennan JM, Lowenstern A, Sheridan P, Boero IJ, Thourani VH, Vemulapalli S, Wang TY, Liska O, Gander S, Jager J, Leon MB, Peterson ED. Association Between Patient Survival and Clinician Variability in Treatment Rates for Aortic Valve Stenosis. J Am Heart Assoc 2021; 10:e020490. [PMID: 34387116 PMCID: PMC8475044 DOI: 10.1161/jaha.120.020490] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patients with symptomatic severe aortic stenosis (ssAS) have a high mortality risk and compromised quality of life. Surgical/transcatheter aortic valve replacement (AVR) is a Class I recommendation, but it is unclear if this recommendation is uniformly applied. We determined the impact of managing cardiologists on the likelihood of ssAS treatment. Methods and Results Using natural language processing of Optum electronic health records, we identified 26 438 patients with newly diagnosed ssAS (2011-2016). Multilevel, multivariable Fine-Gray competing risk models clustered by cardiologists were used to determine the impact of cardiologists on the likelihood of 1-year AVR treatment. Within 1 year of diagnosis, 35.6% of patients with ssAS received an AVR; however, rates varied widely among managing cardiologists (0%, lowest quartile; 100%, highest quartile [median, 29.6%; 25th-75th percentiles, 13.3%-47.0%]). The odds of receiving AVR varied >2-fold depending on the cardiologist (median odds ratio for AVR, 2.25; 95% CI, 2.14-2.36). Compared with patients with ssAS of cardiologists with the highest treatment rates, those treated by cardiologists with the lowest AVR rates experienced significantly higher 1-year mortality (lowest quartile, adjusted hazard ratio, 1.22, 95% CI, 1.13-1.33). Conclusions Overall AVR rates for ssAS were low, highlighting a potential challenge for ssAS management in the United States. Cardiologist AVR use varied substantially; patients treated by cardiologists with lower AVR rates had higher mortality rates than those treated by cardiologists with higher AVR rates.
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Affiliation(s)
- J Matthew Brennan
- Duke Clinical Research Institute Duke University School of Medicine Durham NC
| | - Angela Lowenstern
- Duke Clinical Research Institute Duke University School of Medicine Durham NC
| | - Paige Sheridan
- Department of Family Medicine and Public Health University of California, San Diego School of Medicine San Diego CA.,Boston Consulting Group Boston MA
| | | | - Vinod H Thourani
- Department of Cardiovascular Surgery Piedmont Heart Institute Atlanta GA
| | | | - Tracy Y Wang
- Duke Clinical Research Institute Duke University School of Medicine Durham NC
| | | | | | | | - Martin B Leon
- Columbia University Irving Medical Center and New York Presbyterian Hospital New York NY
| | - Eric D Peterson
- Duke Clinical Research Institute Duke University School of Medicine Durham NC
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4
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Pizzorno M, Desilvestri M, Lippi L, Marchioni M, Audo A, de Sire A, Invernizzi M, Perrero L. Early cardiac rehabilitation: could it improve functional outcomes and reduce length of stay and sanitary costs in patients aged 75 years or older? A retrospective case-control study. Aging Clin Exp Res 2021; 33:957-964. [PMID: 32415667 DOI: 10.1007/s40520-020-01589-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/02/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is considered as a cornerstone in improving physical function in older people after cardiac procedures; however, its effects in patients aged more than 75 years are still debated. AIMS To assess the effectiveness of early CR in improving functional outcomes and reducing the length of stay (LOS) and sanitary costs in patients aged ≥ 75 years. METHODS We retrospectively analysed data from medical records of patients aged ≥ 75 years performed CR after cardiac procedures. Patients were divided into two groups according to the median timing lasting from the cardiac procedure and CR start: 'early rehabilitation' (< 8 days) and 'delayed rehabilitation' (≥ 8 days). Six-minutes walking test (6MWT), left ventricular ejection fraction (LVEF), LOS, and sanitary costs were assessed. RESULTS The 160 patients (mean aged 79.18 ± 3.13 years) included were divided into two groups: 'early rehabilitation' (n = 80) and 'delayed rehabilitation' (n = 80). Both groups showed a significant improvement (p < 0.0001) in 6MWT and LVEF but there were no differences between groups in all clinical outcomes. On the other hand, the 'early rehabilitation' group showed significantly lower LOS (25.8 ± 5.3 vs 34.1 ± 10.8 days; p < 0.0001) and sanitary costs (22,282.08 ± 3242.68 euros vs. 44,954.03 ± 22,160.11 euros; p < 0.0001). DISCUSSION Beginning CR in the first week seems to be effective in improving physical performance after cardiac procedures in patients aged ≥ 75 years, reducing LOS and sanitary costs. CONCLUSIONS Our findings suggest that early CR could be performed with positive effects on functional outcomes, leading to a reduction in LOS and sanitary costs in elderly.
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Affiliation(s)
- Marco Pizzorno
- Rehabilitation Unit, Rehabilitation Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Manuela Desilvestri
- Rehabilitation Unit, Rehabilitation Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Viale Piazza D'Armi 1, 28100, Novara, Italy
| | - Manuela Marchioni
- Rehabilitation Unit, Rehabilitation Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Andrea Audo
- Department of Cardiothoracic and Vascular Surgery, Cardiac Surgery, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Viale Piazza D'Armi 1, 28100, Novara, Italy.
- Rehabilitation Unit, 'Mons. L. Novarese' Hospital, Moncrivello, Vercelli, Italy.
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Viale Piazza D'Armi 1, 28100, Novara, Italy
| | - Luca Perrero
- Rehabilitation Unit, Rehabilitation Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Ahmed T, Safdar A. The Management Dilemma: Concomitant Acute Hip Fracture and Severe Asymptomatic Aortic Stenosis. Cureus 2020; 12:e7527. [PMID: 32377475 PMCID: PMC7198081 DOI: 10.7759/cureus.7527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Acute hip fractures (AHF) are common in elderly patients. A combination of age-related osteoporosis and increased fall risk makes this population group most susceptible to different fractures including acute fracture of the hip. AHF is a disabling condition that warrants immediate attention. It has a huge impact on the already compromised baseline functional status of elderly patients rendering them more susceptible to different morbidities and even mortality. Similarly, age-related degeneration of the aortic valve with resulting calcification also makes elderly patients prone to aortic stenosis (AS). Severe asymptomatic AS when diagnosed in these patients with AHF in the perioperative period makes the management options very challenging. Severity of AS usually translates into worse postoperative outcomes. The management rationale of concomitant presence of these two conditions is unclear. There is a lack of clear-cut recommendations and societal guidelines in such scenario.
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Affiliation(s)
- Talha Ahmed
- Internal Medicine, University of Maryland Medical Center, Baltimore, USA
| | - Ayesha Safdar
- Internal Medicine, Army Medical College, Rawalpindi, PAK
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6
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Roca F, Durand E, Eltchaninoff H, Chassagne P. Predictive Value for Outcome and Evolution of Geriatric Parameters after Transcatheter Aortic Valve Implantation. J Nutr Health Aging 2020; 24:598-605. [PMID: 32510112 DOI: 10.1007/s12603-020-1375-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify parameters of comprehensive geriatric assessment (CGA) CGA including ABCDEF score, a multidomain frailty assessment, associated with poor outcome after TAVI and to assess the evolution of CGA parameters at 6-months follow-up. DESIGN one-year monocentric prospective cohort study. SETTING Departments of geriatric medicine and cardiology in Rouen University Hospital, Normandy, France. PARTICIPANTS all patients over 70, selected for TAVI by a multidisciplinary "heart team". MEASUREMENTS 8-areas CGA was performed before TAVI and at 6-months follow-up. Poor outcome was defined as decrease in 1 BADL or unplanned readmission at 6 months or death within the first year after TAVI. Geriatric characteristics associated with poor outcome were assessed by logistic regression with surgical scores as bivariable. Geriatric characteristics were compared between baseline and 6-months follow-up. RESULTS 114 patients (mean age 85.8±5.3 years) were included. Mean EuroSCORE was 19.1±10.6%. Poor outcome occurred in 57(50.0%) patients. Loss of one BADL (OR:1.66, 95CI[1.11-2.48]), decrease in IADL (OR:1.41, 95CI[1.14-1.74]), in plasmatic albumin (OR:1.10, 95CI[1.01-1.20]), in MMSe (OR:1.13, 95CI[1.02-1.26]), low walking speed (OR:1.53, 95CI[1.01-2.33]) and ABCDEF score ≥2 (OR:1.63, 95CI[1.09-2.42]) were independently associated with poor outcome. In survivors with complete follow-up (n=80), most geriatric parameters were maintained 6 months after TAVI, but IADL decreased (5.6±1.9 to 4.9±2.2, p<0.001). MMSe increased in patients with previous cognitive impairments whereas it decreased in those without (p<0.001). CONCLUSION CGA parameters are independently associated with poor outcome after TAVI. These parameters, but IADL, are maintained at 6 months and course of the MMSe depends on previous cognitive status.
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Affiliation(s)
- F Roca
- Dr Roca Frédéric, Service de Médecine Gériatrique, CHU de Rouen, 76031 Rouen Cedex, France. Tel: +33 2 32 88 93 67, Fax: +33 2 32 88 06 01;
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7
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van Mourik MS, Janmaat YC, van Kesteren F, Vendrik J, Planken RN, Henstra MJ, Velu JF, Vlastra W, Zwinderman AH, Koch KT, de Winter RJ, Wykrzykowska JJ, Piek JJ, Henriques JPS, Lanting VR, Baan J, Latour C, Lindeboom R, Vis MM. CT determined psoas muscle area predicts mortality in women undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2019; 93:E248-E254. [PMID: 30208263 PMCID: PMC6585699 DOI: 10.1002/ccd.27823] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/15/2018] [Accepted: 07/14/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aim of this study was to assess the predictive value of PMA measurement for mortality. BACKGROUND Current surgical risk stratification have limited predictive value in the transcatheter aortic valve implantation (TAVI) population. In TAVI workup, a CT scan is routinely performed but body composition is not analyzed. Psoas muscle area (PMA) reflects a patient's global muscle mass and accordingly PMA might serve as a quantifiable frailty measure. METHODS Multi-slice computed tomography scans (between 2010 and 2016) of 583 consecutive TAVI patients were reviewed. Patients were divided into equal sex-specific tertiles (low, mid, and high) according to an indexed PMA. Hazard ratios (HR) and their confidence intervals (CI) were determined for cardiac and all-cause mortality after TAVI. RESULTS Low iPMA was associated with cardiac and all-cause mortality in females. One-year adjusted cardiac mortality HR in females for mid-iPMA and high-iPMA were 0.14 [95%CI, 0.05-0.45] and 0.40 [95%CI, 0.15-0.97], respectively. Similar effects were observed for 30-day and 2-years cardiac and all-cause mortality. In females, adding iPMA to surgical risk scores improved the predictive value for 1-year mortality. C-statistics changed from 0.63 [CI = 0.54-0.73] to 0.67 [CI: 0.58-0.75] for EuroSCORE II and from 0.67 [CI: 0.59-0.77] to 0.72 [CI: 0.63-0.80] for STS-PROM. CONCLUSIONS Particularly in females, low iPMA is independently associated with an higher all-cause and cardiac mortality. Prospective studies should confirm whether PMA or other body composition parameters should be extracted automatically from CT-scans to include in clinical decision making and outcome prediction for TAVI.
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Affiliation(s)
- Martijn S. van Mourik
- Amsterdam UMCUniversity of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Yvonne C. Janmaat
- ACHIEVE – Centre of Applied ResearchAmsterdam University of Applied SciencesAmsterdamThe Netherlands
| | - Floortje van Kesteren
- Amsterdam UMCUniversity of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
- Amsterdam UMC, University of Amsterdam, Department of RadiologyAmsterdamThe Netherlands
| | - Jeroen Vendrik
- Amsterdam UMCUniversity of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - R. Nils Planken
- Amsterdam UMC, University of Amsterdam, Department of RadiologyAmsterdamThe Netherlands
| | - Marieke J. Henstra
- Amsterdam UMC, University of Amsterdam, Department of GeriatricsAmsterdamThe Netherlands
| | - Juliëtte F. Velu
- Amsterdam UMCUniversity of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Wieneke Vlastra
- Amsterdam UMCUniversity of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Aeilko H. Zwinderman
- Department of Clinical Epidemiology, Biostatistics and BioinformaticsUniversity of AmsterdamAmsterdamThe Netherlands
| | - Karel T. Koch
- Amsterdam UMCUniversity of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Robbert J. de Winter
- Amsterdam UMCUniversity of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Joanna J. Wykrzykowska
- Amsterdam UMCUniversity of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Jan J. Piek
- Amsterdam UMCUniversity of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - José P. S. Henriques
- Amsterdam UMCUniversity of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Vincent R. Lanting
- Amsterdam UMCUniversity of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Jan Baan
- Amsterdam UMCUniversity of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Corine Latour
- ACHIEVE – Centre of Applied ResearchAmsterdam University of Applied SciencesAmsterdamThe Netherlands
| | - Robert Lindeboom
- Department of Clinical Epidemiology, Biostatistics and BioinformaticsUniversity of AmsterdamAmsterdamThe Netherlands
| | - M. Marije Vis
- Amsterdam UMCUniversity of Amsterdam, AMC Heartcenter, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
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8
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The Erasmus Frailty Score is associated with delirium and 1-year mortality after Transcatheter Aortic Valve Implantation in older patients. The TAVI Care & Cure program. Int J Cardiol 2019; 276:48-52. [DOI: 10.1016/j.ijcard.2018.10.093] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 09/14/2018] [Accepted: 10/26/2018] [Indexed: 12/16/2022]
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9
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Rostagno C, Ranalli C, Polidori G, Cartei A, Boccaccini A, Peris A. Outcome in elderly patients with aortic stenosis undergoing hip fracture surgery. Results may suggest a different postoperative strategy? Trauma Surg Acute Care Open 2019; 4:e000218. [PMID: 30729173 PMCID: PMC6340543 DOI: 10.1136/tsaco-2018-000218] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/24/2018] [Accepted: 11/28/2018] [Indexed: 11/18/2022] Open
Abstract
Background Five to ten percent of patients with hip fracture have severe aortic valve stenosis (AS). The aim of the present investigation was to evaluate the impact of AS on early and long-term outcome after surgery for hip fracture. Methods 145 patients with AS and 283 consecutive patients without AS (control group) aged >70 years referred to Azienda Ospadaliera Universitaria (AOU) Careggi for hip fracture were included in the study. The endpoints were incidence of postoperative myocardial infarction, 30-day and 1-year mortality, and a composite endpoint (30-day mortality + myocardial infarction). Results 66 patients had mild, 47 moderate and 32 severe AS according to the European Society of Cardiology guidelines. 30-day mortality was 6.2% in AS and 3.1% in controls. Postoperative non-fatal myocardial infarction and composite endpoint were more frequent in AS than in the control group (8.3% vs 1.1%, p<0.001 and 14.5% vs 4.2%, p<0.001, respectively). The risk was significantly higher for patients with severe AS (28.1%). 1-year mortality in patients with moderate/severe AS was 46% in comparison with 16% in mild AS or in the control group (p<0.001). Coronary disease, atrial fibrillation, age, and aortic gradient were independent predictors of mortality in AS. Discussion AS significantly affects postoperative outcome after surgery for hip fracture. Since not infrequently AS is incidentally diagnosed during hospitalization after trauma, which should be the management in these patients after hip surgery? How many might benefit from surgical valve replacement or transcatheter aortic valve replacement? A heart team evaluation may be suggested before discharge for most of these patients. Level of evidence IV.
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Affiliation(s)
- Carlo Rostagno
- Dipartimento Medicina Sperimentale e Clinica, Università di Firenze, Firenze, Italy.,SOD Medicina Interna e Postchirurgica, AOU Careggi, Firenze, Italy
| | - Claudia Ranalli
- SOD Medicina Interna e Postchirurgica, AOU Careggi, Firenze, Italy
| | | | | | | | - Adriano Peris
- Dipartimento neuromuscoloscheletrico, AOU Careggi, Firenze, Italy
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Ajam F, Patel S, Asgarian K, Sealove B, Dejene B, Apolito R, Neibart RM, Carson MP. Cannulation of the Femoral Arterial Bypass Cannula Allows Completion of TAVR in Unstable Patients. Ann Thorac Surg 2018; 107:e297-e299. [PMID: 30447190 DOI: 10.1016/j.athoracsur.2018.09.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 09/14/2018] [Accepted: 09/30/2018] [Indexed: 12/20/2022]
Abstract
When hemodynamic instability occurs during transcatheter aortic valve replacement, peripheral cardiopulmonary bypass is required. The pigtail catheter, initially placed through the femoral artery to direct placement of the valve, is exchanged over a wire for an arterial bypass cannula. Other than time-consuming arterial cut-down procedures in hypotensive patients, there are few techniques described to allow the operator to continue bypass and complete transcatheter aortic valve replacement. This report describes a method to reintroduce the pigtail catheter by puncturing the arterial bypass cannula. This technique allows the operator to support the patient, continue bypass, and successfully place the valve without aborting the procedure.
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Affiliation(s)
- Firas Ajam
- Division of General Internal Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Swapnil Patel
- Division of General Internal Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Koroush Asgarian
- Division of Thoracic Surgery, Hackensack Meridian School of Medicine at Seton Hall University, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Brett Sealove
- Division of Cardiology, Hackensack Meridian School of Medicine at Seton Hall University, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Brook Dejene
- Division of Thoracic Surgery, Hackensack Meridian School of Medicine at Seton Hall University, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Renato Apolito
- Division of Cardiology, Hackensack Meridian School of Medicine at Seton Hall University, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Richard M Neibart
- Division of Thoracic Surgery, Hackensack Meridian School of Medicine at Seton Hall University, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Michael P Carson
- Division of General Internal Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Jersey Shore University Medical Center, Neptune, New Jersey.
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11
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Interaction Between Frailty and Access Site in Older Adults Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:2185-2192. [DOI: 10.1016/j.jcin.2018.06.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 11/15/2022]
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12
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Thongprayoon C, Cheungpasitporn W, Kashani K. The impact of frailty on mortality after transcatheter aortic valve replacement. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:144. [PMID: 28462224 DOI: 10.21037/atm.2017.01.35] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Frailty is a notably common problem in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) evaluation. Studies have demonstrated significant associations between frailty and worse outcomes in patients undergoing TAVR including higher risks of disability and mortality and admissions to long-term care facility. While there are multiple methods to identify and measure frailty, there is a critical need for a precise definition of frailty and its standardized assessment protocol based on well-established tests covering all aspects of the frailty, as a syndrome. Incorporation of the available frailty evaluation into pre-operative risk assessments chances of morbidity or mortality following surgery can help enhancing performance and improve shared decision-making between physicians and their patients. In this review, we present the perspectives of the impact of frailty on mortality in patients undergoing TAVR.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kianoush Kashani
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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13
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Yaffee DW, Williams MR. Cardiovascular Surgery in the Elderly. Semin Thorac Cardiovasc Surg 2016; 28:741-747. [PMID: 28417859 DOI: 10.1053/j.semtcvs.2016.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2016] [Indexed: 11/11/2022]
Abstract
The elderly population is the fastest growing demographic in Western countries. As the population ages, the incidence of age-related comorbidities such as diabetes mellitus, chronic obstructive pulmonary disease, peripheral vascular disease, renal disease, cerebrovascular disease, and cardiovascular disease increases. With cardiovascular disease occurring in approximately one-quarter of the population over the age of 75 years and more than half of all cardiac procedures performed on this age group, the number of potential elderly surgical candidates is increasing. However, data suggest that old age is associated with increased morbidity and mortality following cardiac surgery. Over the past 2 decades, improvements in myocardial protection, extracorporeal circulation, anesthesia, and surgical techniques have significantly reduced the morbidity and mortality associated with cardiac surgery. Although most prospective studies exclude elderly patients, data from large retrospective studies and subgroup analyses suggest that cardiac surgery is a viable option for many elderly patients with cardiovascular disease, with good outcomes observed in reasonable-risk candidates; moreover, there are a growing number of available less-invasive options for them when surgical risk becomes prohibitive. In this article, we discuss the current state of cardiovascular surgery in the elderly as well as emerging technologies on the horizon.
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Affiliation(s)
- David W Yaffee
- Department of Cardiothoracic Surgery, NYU School of Medicine, New York, New York
| | - Mathew R Williams
- Department of Cardiothoracic Surgery, NYU School of Medicine, New York, New York.
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14
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Amofah HA, Broström A, Fridlund B, Bjorvatn B, Haaverstad R, Hufthammer KO, Kuiper KK, Ranhoff AH, Norekvål TM. Sleep in octogenarians during the postoperative phase after transcatheter or surgical aortic valve replacement. Eur J Cardiovasc Nurs 2015; 15:168-77. [PMID: 26635329 PMCID: PMC4804287 DOI: 10.1177/1474515115620992] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/15/2015] [Indexed: 12/14/2022]
Abstract
Background: Octogenarians with aortic stenosis are an increasing population of patients admitted for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Although adequate sleep is important after illness and surgery, it has scarcely been studied in the immediate postoperative phase. Aims: To determine and compare the nature of self-reported sleep and insomnia, and recorded sleep–wake patterns in octogenarians during the in-hospital postoperative phase after SAVR or TAVI. Methods: A prospective cohort design was used that included octogenarian patients undergoing SAVR or TAVI at a regional university hospital. Self-reports were used to document sleep and insomnia, and actigraphy was used to record sleep–wake patterns. Data were collected at baseline preoperatively, and then daily for the first five postoperative days. Results: SAVR patients experienced the most insomnia on postoperative nights later in recovery, while TAVI patients experienced the most insomnia on postoperative nights early in recovery. The median total sleep time, as measured by actigraphy, was 6.4 h, and the median sleep efficiency was 79% for the five postoperative nights, but no differences were found between SAVR and TAVI patients on this parameter. All patients slept more during daytime than at night, with SAVR patients having significantly more total sleep hours for all five days than TAVI patients (p < 0.01). Conclusion: Octogenarians with aortic stenosis had disturbed self-reported sleep, increased insomnia, and disturbed sleep–wake patterns postoperatively, resulting in more daytime sleep and inactivity. In patients undergoing SAVR or TAVI, sleep evolves differently during the in-hospital postoperative phase.
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Affiliation(s)
| | - Anders Broström
- Institute of Nursing, Faculty of Health and Social Science, Bergen University College, Norway School of Health Sciences, Jönköping University, Sweden Department of Clinical Neurophysiology, Linkoping University Hospital, Sweden
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Institute of Nursing, Faculty of Health and Social Science, Bergen University College, Norway School of Health Sciences, Jönköping University, Sweden
| | - Bjørn Bjorvatn
- Norwegian Competence Centre for Sleep Disorders, Bergen, Norway Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Rune Haaverstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Department of Clinical Science, University of Bergen, Norway
| | | | - Karel Kj Kuiper
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Anette Hylen Ranhoff
- Department of Clinical Science, University of Bergen, Norway Kavli Research Centre for Geriatrics and Dementia, Haraldsplass Hospital, Bergen, Norway
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Institute of Nursing, Faculty of Health and Social Science, Bergen University College, Norway Department of Clinical Science, University of Bergen, Norway
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15
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The Application of Frailty to the Modern Cardiac Risk Assessment: a Case-Based Review. CURRENT CARDIOVASCULAR RISK REPORTS 2015; 9. [PMID: 27668030 DOI: 10.1007/s12170-015-0476-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cardiac risk assessment in aging patients poses a significant challenge to the practicing clinician, particularly when evaluating the use of invasive procedures. Frailty is a valuable risk marker that has been associated with worse outcomes in patients with coronary artery disease, heart failure, and aortic stenosis. Integrating the available frailty studies into cardiac risk assessments can help improve shared decision-making between physicians and their patients. In this review, we provide an up-to-date, case-based appraisal of the available clinical trial data focusing on the impact of frailty in patients with cardiovascular disease.
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16
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Chivite D, Franco J, Formiga F. [Chronic heart failure in the elderly patient]. Rev Esp Geriatr Gerontol 2015; 50:237-246. [PMID: 25962334 DOI: 10.1016/j.regg.2015.03.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 03/18/2015] [Accepted: 03/24/2015] [Indexed: 06/04/2023]
Abstract
The prevalence and incidence of heart failure (HF) is increasing, especially in the elderly population, and is becoming a major geriatric problem. Elderly patients with HF usually show etiopathogenic, epidemiological, and even clinical characteristics significantly different from those present in younger patients. Their treatment, however, derives from clinical trials performed with only a few elderly subjects. Moreover, beyond the cardiovascular disease itself, it is essential to evaluate the patient as a whole, given the interrelationship between HF and the characteristic geriatric syndromes of the elderly patient. This review examines the peculiarities in the most prevalent "real world" HF patient.
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Affiliation(s)
- David Chivite
- Servicio de Medicina Interna, Programa de Geriatría, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
| | - Jhonatan Franco
- Servicio de Medicina Interna, Programa de Geriatría, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Francesc Formiga
- Servicio de Medicina Interna, Programa de Geriatría, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
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17
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18
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Finn M, Green P. The Influence of Frailty on Outcomes in Cardiovascular Disease. ACTA ACUST UNITED AC 2015; 68:653-6. [PMID: 26129717 DOI: 10.1016/j.rec.2015.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 04/28/2015] [Indexed: 01/11/2023]
Affiliation(s)
- Matthew Finn
- Department of Cardiology, Columbia University Medical Center, New York, United States.
| | - Philip Green
- Department of Cardiology, Columbia University Medical Center, New York, United States
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