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Saevik M, Beitnes JO, Aaberge L, Halvorsen PS. Safety and feasibility of dobutamine stress echocardiography in symptomatic high gradient aortic stenosis patients scheduled for transcatheter aortic valve implantation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:38-48. [PMID: 32914454 DOI: 10.1002/jcu.22915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/18/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE We aimed to study the safety and feasibility of low-dose dobutamine stress echocardiography in a symptomatic high gradient aortic stenosis population scheduled for transfemoral transcatheter aortic valve implantation (TAVI) and to quantify left ventricular (LV) flow reserve. METHODS Fifty patients underwent dobutamine stress echocardiography with 5 minutes increments of 5 μg/kg/min up to 20 μg/kg/min until the heart rate increased ≥20 beats/min from baseline or exceeded 100 beats/min. Other criteria for discontinuing the infusion were major adverse events: ventricular arrhythmia, persistent supraventricular arrhythmia, pulmonary edema, chest pain with significant ST-changes, or minor events: ST-changes, drop in systolic blood pressure >30 mmHg, mild chest pain, and/or dyspnea. LV flow reserve was defined as an increase in stroke volume ≥20% during the test. RESULTS Of 50 patients, 45 completed the test according to protocol. No patient had major adverse event. Five patients experienced minor side effects: mild chest pain/dyspnea in three, self-terminating atrial flutter in one, and decrease in blood pressure in one. Significant LV flow reserve was observed in 20 patients (40%). CONCLUSION Low-dose dobutamine stress test appeared safe and feasible patients with high gradient aortic stenosis, and showed LV flow reserve in a minority of them.
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Affiliation(s)
- Marte Saevik
- The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jan O Beitnes
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Lars Aaberge
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Per S Halvorsen
- The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Nicolas J, Claessen BE, Cao D, Sartori S, Baber U, Power D, Chiarito M, Goel R, Roumeliotis A, Chandiramani R, Chen S, Chandrasekhar J, Tchetche D, Petronio AS, Mehilli J, Lefèvre T, Presbitero P, Capranzano P, Iadanza A, Sardella G, Van Mieghem NM, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail G, Ferrer‐Gracia M, Naber C, Sharma S, Morice M, Dangas GD, Chieffo A, Mehran R. Preprocedural anemia in females undergoing transcatheter aortic valve implantation: Insights from the WIN‐TAVI registry. Catheter Cardiovasc Interv 2020; 97:E704-E715. [DOI: 10.1002/ccd.29276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/05/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Johny Nicolas
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Bimmer E. Claessen
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Davide Cao
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Samantha Sartori
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Usman Baber
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - David Power
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Mauro Chiarito
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
- Department of Cardiology Istituto Clinico Humanitas Milan Italy
| | - Ridhima Goel
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Anastasios Roumeliotis
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Rishi Chandiramani
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Siyan Chen
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Jaya Chandrasekhar
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Didier Tchetche
- Groupe CardioVasculaire Interventional Clinique Pasteur Toulouse France
| | | | - Julinda Mehilli
- Munich University Clinic Ludwig‐Maximilians University and German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance Munich Germany
| | - Thierry Lefèvre
- Institut Hospitalier Jacques Cartier Ramsay Générale de Santé Massy France
| | | | | | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese Policlinico Le Scotte Siena Italy
| | | | | | | | - Nicolas Dumonteil
- Department of Cardiology Rangueil University Hospital Toulouse France
| | | | | | - Ghada Mikhail
- Imperial College Healthcare NHS Trust Hammersmith Hospital London UK
| | | | - Christoph Naber
- Contilia Heart and Vascular Centre Elisabeth Krankenhaus Essen Germany
| | - Samin Sharma
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | | | - George D. Dangas
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | | | - Roxana Mehran
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
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The learning curve in transcatheter aortic valve implantation clinical studies: A systematic review. Int J Technol Assess Health Care 2020; 36:152-161. [DOI: 10.1017/s0266462320000100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BackgroundTranscatheter aortic-valve implantation (TAVI) has become an essential alternative to surgical aortic-valve replacement in the treatment of symptomatic severe aortic stenosis, and this procedure requires technical expertise. The aim of this study was to identify prospective studies on TAVI from the past 10 years, and then to analyze the quality of information reported about the learning curve.Materials and methodsA systematic review of articles published between 2007 and 2017 was performed using PubMed and the EMBASE database. Prospective studies regarding TAVI were included. The quality of information reported about the learning curve was evaluated using the following criteria: mention of the learning curve, the description of a roll-in phase, the involvement of a proctor, and the number of patients suggested to maintain skills.ResultsA total of sixty-eight studies met the selection criteria and were suitable for analysis. The learning curve was addressed in approximately half of the articles (n = 37, 54 percent). However, the roll-in period was mentioned by only eight studies (12 percent) and with very few details. Furthermore, a proctorship was disclosed in three articles (4 percent) whereas twenty-five studies (37 percent) included authors that were proctors for manufacturers of TAVI.ConclusionMany prospective studies on TAVI over the past 10 years mention learning curves as a core component of successful TAVI procedures. However, the quality of information reported about the learning curve is relatively poor, and uniform guidance on how to properly assess the learning curve is still missing.
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Grymyr OJHN, Beitnes JO, Eidet J, Tølløfsrud S, Fiane A, Skulstad H, Fosse E, Halvorsen PS. Detection of intraoperative myocardial dysfunction by accelerometer during aortic valve replacement. Interact Cardiovasc Thorac Surg 2017; 24:188-195. [PMID: 28364479 DOI: 10.1093/icvts/ivw326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/29/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Myocardial dysfunction may occur during weaning from cardiopulmonary bypass (CPB). Epicardial accelerometers have been shown to be useful in continuous monitoring of myocardial ischaemia during beating-heart surgery. We aimed to investigate whether an accelerometer can detect myocardial dysfunction during weaning from CPB. METHODS In 23 patients undergoing isolated aortic valve replacement (AVR), a three-axis accelerometer was attached to the left ventricle and 3D velocity was calculated from the signals. Peak early systolic velocity (Vsys) and velocity at aortic valve closure (Vavc) were measured. Measurements were undertaken during normothermia with 50% bypass flow and atrial pacing (90 beats/min) before aortic cross-clamping and after cross-clamp removal. Myocardial dysfunction was defined as Vsys < Vavc, and patients were classified as having normal function or dysfunction. Left ventricular (LV) stroke work via pulmonary artery catheter and systolic velocity by echocardiography were compared between groups and used as reference methods. RESULTS The accelerometer identified a substantial proportion of patients with myocardial dysfunction during weaning from CPB, 56% of patients compared with 11% before aortic cross-clamping. Patients classified with normal myocardial function during weaning significantly improved their LV stroke work and systolic velocity by echocardiography in response to AVR, whereas those classified with dysfunction did not. Accelerometer classification of normal function predicted an increase in echocardiographic systolic velocity [r = 0.63, regression coefficient 1.98, 95% CI (0.57, 3.40) (P < 0.01)]. CONCLUSIONS The accelerometer detected myocardial dysfunction during weaning from CPB in accordance with measures obtained by echocardiography and pulmonary artery catheter. Clinical Trials identifier NCT01926067. https://clinicaltrials.gov/.
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Affiliation(s)
- Ole-Johannes H N Grymyr
- The Intervention Centre, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - Jan O Beitnes
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Jo Eidet
- The Intervention Centre, Oslo University Hospital, Oslo, Norway.,Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - Stein Tølløfsrud
- Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - Arnt Fiane
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Helge Skulstad
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
| | - Erik Fosse
- The Intervention Centre, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Per S Halvorsen
- The Intervention Centre, Oslo University Hospital, Oslo, Norway.,Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
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Eidet J, Dahle G, Bugge JF, Bendz B, Rein KA, Aaberge L, Offstad JT, Fosse E, Aakhus S, Halvorsen PS. Long-term outcomes after transcatheter aortic valve implantation: the impact of intraoperative tissue Doppler echocardiography. Interact Cardiovasc Thorac Surg 2016; 23:403-9. [PMID: 27241050 DOI: 10.1093/icvts/ivw159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/20/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Transcatheter aortic valve implantation improves survival in patients with severe aortic stenosis who are ineligible for surgical valve replacement; however, not all patients benefit from the procedure. We endeavoured to identify these patients using intraoperative echocardiography and hypothesized that intraoperative left ventricular function in response to the acute afterload reduction during the procedure was related to long-term outcomes. METHODS We prospectively included 64 patients who were scheduled for transcatheter aortic valve implantation and divided them into responders and non-responders based on their left ventricular intraoperative responses to the acute afterload reduction after valve deployment. Responders were defined by increases of ≥20% in left ventricular longitudinal peak systolic velocities determined by tissue Doppler echocardiography. All patients were assessed for the following outcomes at 12 months: cardiac mortality, adverse cardiac events, quality of life, New York Heart Association class, N-terminal pro-brain natriuretic peptide (NT-proBNP) and echocardiography. RESULTS Thirty-five patients (55%) were classified as responders and 29 patients (45%) as non-responders. Compared with responders, non-responders had higher risks of death (28 vs 9%, respectively, P = 0.04) and cardiac events (66 vs 26%, respectively, P < 0.01) during the 12-month follow-up. Significant long-term improvements in quality of life, NT-proBNP and left ventricular function were observed only in the responders. Preoperative risk stratification, intraoperative handling, aortic gradient and valve area were similar between groups. CONCLUSIONS Intraoperative assessment of left ventricular function by tissue Doppler echocardiography predicted long-term outcomes after transcatheter aortic valve implantation. Our results suggest that a preoperative test of myocardial contractile reserve might improve risk stratification and patient selection prior to the procedure.
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Affiliation(s)
- Jo Eidet
- The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Gry Dahle
- Department of Cardiothoracic and Vascular Surgery, Oslo University Hospital, Oslo, Norway
| | - Jan F Bugge
- Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital, Oslo, Norway
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Kjell A Rein
- Department of Cardiothoracic and Vascular Surgery, Oslo University Hospital, Oslo, Norway
| | - Lars Aaberge
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Jon T Offstad
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Erik Fosse
- The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Svend Aakhus
- Department of Cardiology, Oslo University Hospital, Oslo, Norway Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Per S Halvorsen
- The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway
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Eidet J, Dahle G, Bugge JF, Bendz B, Rein KA, Aaberge L, Offstad JT, Fosse E, Aakhus S, Halvorsen PS. Intraoperative improvement in left ventricular peak systolic velocity predicts better short-term outcome after transcatheter aortic valve implantation. Interact Cardiovasc Thorac Surg 2015; 22:5-12. [PMID: 26467639 DOI: 10.1093/icvts/ivv277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/03/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Left ventricular function is expected to improve after transcatheter aortic valve implantation due to the acute reduction in afterload, but does not occur in all patients. We hypothesized that the immediate intraoperative response in systolic left ventricular longitudinal motion during the procedure could be a predictor of short-term outcome. METHODS Sixty-four patients treated with transcatheter aortic valve implantation for severe aortic stenosis were included. Transoesophageal 4- and 2-chamber echocardiograms were obtained immediately prior to and ∼15 min after valve implantation. Patients were defined as responders if their average left ventricular longitudinal peak systolic velocity increased by ≥20% from the preimplantation value and was related to the 3-month outcome. RESULTS Thirty-five patients were classified as responders, with an increase in the intraoperative longitudinal peak systolic velocity from an average of 2.2 ± 0.8 to 3.1 ± 1.1 cm/s (P < 0.001); the velocity was unchanged in the remaining 29 patients, who averaged 2.4 ± 1.1 cm/s. There were significantly fewer adverse cardiac events in the responder group at the 3-month follow-up (20 vs 45%, P = 0.03) and the New York Heart Association class was significantly better in the responders compared with non-responders. Responders had a significant reduction in N-terminal probrain natriuretic peptide levels [243 (113-361) vs 163 (64-273), P = 0.004] at the 3-month follow-up, whereas non-responders did not [469 (130-858) vs 289 (157-921), P = 0.48]. CONCLUSIONS An immediate improvement in the longitudinal peak systolic velocity during the transcatheter aortic valve implantation procedure predicted a better short-term outcome and may be useful in identifying patients who are at risk of a less favourable outcome after transcatheter aortic valve implantation.
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Affiliation(s)
- Jo Eidet
- The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Gry Dahle
- Department of Cardiothoracic and Vascular Surgery, Oslo University Hospital, Oslo, Norway
| | - Jan Frederik Bugge
- Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital, Oslo, Norway
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Kjell Arne Rein
- Department of Cardiothoracic and Vascular Surgery, Oslo University Hospital, Oslo, Norway
| | - Lars Aaberge
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | | | - Erik Fosse
- The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Svend Aakhus
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
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