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Lu J, Zambetti B, Plant J, Gupta A, Nagarsheth K, Toursavadkohi S. Simultaneous Endovascular Aortic Repair Expands Transcatheter Aortic Valve Replacement Eligibility to Patients With Hostile Aortic Pathology. Vasc Endovascular Surg 2024:15385744241292122. [PMID: 39392929 DOI: 10.1177/15385744241292122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2024]
Abstract
BACKGROUND In recent years, Transcatheter Aortic Valve Replacement (TAVR) has become a primary modality of therapy in moderate-high risk patients with symptomatic aortic stenosis. Although clinicians remain vigilant about screening for both aortic stenosis, many patients still, nevertheless, often present only when they are symptomatic. Unfortunately, when isolated TAVR is performed in the context of hostile aortic pathology, it has been reported that patients suffer from higher rates of complications such as rupture, dissection, or death post-operatively. OBJECTIVES To explore the utility of a simultaneous TAVR and endovascular aortic repair in addressing symptomatic aortic stenosis in challenging patients with hostile aortic pathology. METHODS Retrospective case series within a tertiary care hospital between May 2017 and December 2023. RESULTS A total of 11 patients underwent simultaneous endovascular aortic repair and TAVR. TAVR was performed first in 9/11 (82%) of the procedures while endovascular aortic repair was performed first in 2/11 procedures (18%). The median age was 84 years old (IQR = 77-86 years old). The median LOS was 3 days (IQR = 2-10 days). The median procedure time was 155 minutes (IQR = 111-202 minutes) and the median contrast amount was 100 CC (IQR = 65-139 CC). 2 patients (18%) experienced post-operative complications. Both of these patients required re-intervention. This cohort of patients did not experience any mortality at 30 days related to pertinent complications or adverse MACE events. All patients were transferred to the PACU and ultimately discharged home. CONCLUSIONS Extending TAVR eligibility to high-risk patients with hostile aortic pathology through the implementation of simultaneous endovascular aortic repair, performed via the same access site, is an effective strategy for management of symptomatic aortic stenosis in the context of extensive cardiovascular co-morbidities.
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Affiliation(s)
- Jeffrey Lu
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, MD, USA
| | - Benjamin Zambetti
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, MD, USA
| | - Joshua Plant
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, MD, USA
| | - Anuj Gupta
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, MD, USA
| | - Khanjan Nagarsheth
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, MD, USA
| | - Shahab Toursavadkohi
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, MD, USA
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2
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Juarez-Casso FM, Singh M, Lewis BR, Sandhu GS, Arghami A, Rowse PG, Bagameri G, Crestanello JA, Greason KL. Long-term Stroke and Mortality Risk in Nonagenarians After Transcatheter Aortic Valve Insertion. Ann Thorac Surg 2024:S0003-4975(24)00372-2. [PMID: 38763221 DOI: 10.1016/j.athoracsur.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 03/05/2024] [Accepted: 04/22/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Limited data exist on the long-term outcomes of transcatheter aortic valve insertion (TAVI) in nonagenarian patients. This study investigated the relationship between patient baseline comorbidity and frailty on the long-term outcome of the nonagenarian population. METHODS A retrospective analysis was conducted of 187 consecutive nonagenarian patients who underwent TAVI from 2009 to 2020. Multivariable models were used to analyze the association between baseline patient and frailty variables and mortality, stroke, and repeat hospitalization. Long-term survival was compared with an age- and sex-matched United States population. RESULTS The median Society of Thoracic Surgeons predicted risk of mortality was 10% (interquartile range, 7%-17%). Frailty was met in 72% of patients based on the 5-meter walk test, 13% based on the Kansas City Cardiomyopathy Questionnaire 12-item instrument score, 12% based on Katz Index of Independence in Activities of Daily Living, and 8% based on serum albumin levels. Procedure-related death occurred in 3 patients (2%) and stroke in 8 (4%). The median duration of follow-up was 3.4 years. Outcomes included death in 150 patients (80%), stroke in 15, and repeat hospitalization in 114. Multivariable analysis identified no association between any of the baseline patient variables with mortality, stroke, repeat hospitalization, or the combined outcomes (all P > .05). The 1- and 5-year survival rates in TAVI-treated nonagenarians were similar to age- and sex-matched controls (P = .27). CONCLUSIONS Long-term death or stroke is independent of The Society of Thoracic Surgeons predicted risk of mortality and frailty risk variables in this nonagenarian patient population who received TAVI. Furthermore, survival is similar to age- and sex-matched controls.
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Affiliation(s)
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Bradley R Lewis
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Gurpreet S Sandhu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Phillip G Rowse
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
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3
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Zou Q, Wei Z, Sun S. Complications in transcatheter aortic valve replacement: A comprehensive analysis and management strategies. Curr Probl Cardiol 2024; 49:102478. [PMID: 38437930 DOI: 10.1016/j.cpcardiol.2024.102478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 03/06/2024]
Abstract
Transcatheter Aortic Valve Replacement (TAVR) marks a significant advancement in treating aortic stenosis (AS), especially for patients with high surgical risks. This concise review outlines TAVR's development, its broader application to include lower-risk patients, and innovations in the device and procedural technology. Clinical trials, notably the PARTNER series, affirm TAVR's efficacy, showing it matches or surpasses surgical aortic valve replacement (SAVR) in mortality reduction, hemodynamic benefits, and symptom alleviation, including heart failure. However, TAVR entails complications such as paravalvular leakage (PVL), conduction disorders, and increased cerebrovascular event risks. We evaluate these issues, their prevalence, causative factors, and clinical consequences, emphasizing improvements in valve design and technique that have significantly lowered PVL rates. The role of aortic valve anatomy and calcification in PVL and conduction issues is analyzed, underlining the necessity for meticulous patient selection and procedural planning. Further, the review delves into cerebrovascular event risks, their origins, and preventative strategies, including cerebral protection devices and the judicious use of anticoagulant and antiplatelet therapies. TAVR presents a less invasive, promising alternative to SAVR, but requires careful complication management to optimize patient results. Ongoing innovation and research are vital for advancing TAVR's techniques, improving valve designs, and extending its reach, thereby enhancing AS patients' quality of life.
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Affiliation(s)
- Qi Zou
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Zhiliang Wei
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Shougang Sun
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, China.
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4
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Gerfer S, Großmann C, Gablac H, Elderia A, Wienemann H, Krasivskyi I, Mader N, Lee S, Mauri V, Djordjevic I, Adam M, Kuhn E, Baldus S, Eghbalzadeh K, Wahlers T. Low Left-Ventricular Ejection Fraction as a Predictor of Intraprocedural Cardiopulmonary Resuscitation in Patients Undergoing Transcatheter Aortic Valve Implantation. Life (Basel) 2024; 14:424. [PMID: 38672696 PMCID: PMC11051090 DOI: 10.3390/life14040424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has become an established alternative to surgical aortic valve replacement (AVR) for patients with moderate-to-high perioperative risk. Periprocedural TAVR complications decrease with growing expertise of implanters. Nevertheless, TAVR can still be accompanied by life-threatening adverse events such as intraprocedural cardiopulmonary resuscitation (CPR). This study analyzed the role of a reduced left-ventricular ejection fraction (LVEF) in intraprocedural complications during TAVR. Perioperative and postoperative outcomes from patients undergoing TAVR in a high-volume center (600 cases per year) were analyzed retrospectively with regard to their left-ventricular ejection fraction. Patients with a reduced left-ventricular ejection fraction (EF ≤ 40%) faced a significantly higher risk of perioperative adverse events. Within this cohort, patients were significantly more often in need of mechanical ventilation (35% vs. 19%). These patients also underwent CPR (17% vs. 5.8%), defibrillation due to ventricular fibrillation (13% vs. 5.4%), and heart-lung circulatory support (6.1% vs. 2.5%) more often. However, these intraprocedural adverse events showed no significant impact on postoperative outcomes regarding in-hospital mortality, stroke, or in-hospital stay. A reduced preprocedural LVEF is a risk factor for intraprocedural adverse events. With respect to this finding, the identified patient cohort should be treated with more caution to prevent intraprocedural incidents.
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Affiliation(s)
- Stephen Gerfer
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
| | - Clara Großmann
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
| | - Hannah Gablac
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
| | - Ahmed Elderia
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
| | - Hendrik Wienemann
- Clinic for Cardiology, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (V.M.)
| | - Ihor Krasivskyi
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
| | - Navid Mader
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
| | - Samuel Lee
- Clinic for Cardiology, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (V.M.)
| | - Victor Mauri
- Clinic for Cardiology, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (V.M.)
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
| | - Matti Adam
- Clinic for Cardiology, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (V.M.)
| | - Elmar Kuhn
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
| | - Stephan Baldus
- Clinic for Cardiology, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (V.M.)
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany (K.E.)
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5
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Lundahl C, Kragholm K, Tayal B, Karasoy D, Andersen NH, Strange JE, Olesen JB, Østergaard L, Fosbøl E, Torp-Pedersen C, Søgaard P, Terkelsen CJ, Nissen H, De Backer O, Freeman PM. Temporal Trends in Patient Characteristics and Outcomes of Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement: A Nationwide Study. Am J Cardiol 2024; 211:299-306. [PMID: 37984636 DOI: 10.1016/j.amjcard.2023.11.024] [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: 06/08/2023] [Revised: 11/05/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
With increased use of transcatheter aortic valve implantation (TAVI) in treatment of aortic stenosis, it is important to evaluate real life data trends in outcomes. This nationwide register-based study aimed to present an outlook on temporal trends in characteristics and outcomes, including mortality. First-time consecutive Danish patients who underwent TAVI from 2010 to 2019 were included in this study. The chi-square and Kruskal-Wallis tests were performed to assess the differences in the characteristics over time and Cochrane-Armitage trend tests were used to examine changes in complications and mortality. Between 2010 and 2019, 4,847 patients (54.6% men, median age 82 [quartile 1 to quartile 3: 77 to 85] years) underwent first-time TAVI. A statistically significant decrease over time was observed for preprocedural hypertension, ischemic heart disease, and heart failure, whereas preexisting chronic obstructive lung disease and preprocedural pacemaker remained stable. We observed a significant decrease in 30- and 90-day postoperative preprocedural pacemaker implantation from 2011 to 2017, with 15.1% and 15.9% in 2011 and 8.6% and 8.9% in 2017, respectively. The incidence of for 30- and 90-day heart failure significantly decreased from 19.3% and 20.3% to 8.5% and 9.1%, respectively. We observed significant changes for 30-day atrial fibrillation, whereas the changes over time for 90-day atrial fibrillation and 30- and 90-day stroke/transient ischemic attack remained insignificant. The all-cause mortality within 30- and 90 days significantly decreased over time from 6.7% and 9.2% in 2011 to 1.5% and 2.7% in 2019 and 2016, respectively. In conclusion, this national study provides general insight on the trends of complications and mortality of TAVI, demonstrating significant reductions over time.
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Affiliation(s)
- Camilla Lundahl
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jarl E Strange
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark; Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jonas B Olesen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Lauge Østergaard
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Emil Fosbøl
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology and Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christian J Terkelsen
- Department of Cardiology, Aarhus University Hospital, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - Henrik Nissen
- Department of Cardiology, Odense University Hospital, Denmark
| | - Ole De Backer
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Phillip M Freeman
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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6
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Gerfer S, Kuhn EW, Gablac H, Ivanov B, Djordjevic I, Mauri V, Adam M, Mader N, Baldus S, Eghbalzadeh K, Wahlers TCW. Outcomes and Characteristics of Patients with Intraprocedural Cardiopulmonary Resuscitation during TAVR. Thorac Cardiovasc Surg 2023; 71:101-106. [PMID: 35853463 DOI: 10.1055/s-0042-1750304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has become an established alternative to surgical aortic valve replacement (AVR) for higher risk patients. Periprocedural TAVR complications decreased with a growing expertise of implanters. Yet, TAVR can be accompanied by life-threatening adverse events such as intraprocedural cardiopulmonary resuscitation (CPR). This study retrospectively analyzed predictors and outcomes in a cohort of patients from a high-volume center undergoing periprocedural CPR during TAVR. METHODS A total of 729 patients undergoing TAVR, including 59 with intraprocedural CPR, were analyzed with respect to peri- and postprocedural outcomes. RESULTS Patients undergoing CPR showed a significantly lower left ventricular ejection fraction (LVEF) and lower baseline transvalvular mean and peak pressure gradients. The systolic blood pressure measured directly preoperatively was significantly lower in the CPR cohort. CPR patients were in a higher need for intraprocedural defibrillation, heart-lung circulatory support, and conversion to open heart surgery. Further, they showed a higher incidence of atrioventricular block grade III , valve malpositioning, and pericardial tamponade. The in-hospital mortality was significantly higher after intraprocedural CPR, accompanied by a higher incidence of disabling stroke, new pacemaker implantation, more red blood cell transfusion, and longer stay in intensive care unit. CONCLUSION Impaired preoperative LVEF and instable hemodynamics before valve deployment are independent risk factors for CPR and are associated with compromised outcomes. Heart rhythm disturbances, malpositioning of the prosthesis, and pericardial tamponade are main causes of the high mortality of 17% reported in the CPR group. Nevertheless, mechanical circulatory support and conversion to open heart surgery reduce mortality rates of CPR patients.
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Affiliation(s)
- Stephen Gerfer
- Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
| | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
| | - Hannah Gablac
- Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
| | - Borko Ivanov
- Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
| | - Victor Mauri
- Department of Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
| | - Thorsten C W Wahlers
- Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany
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7
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Tsao AL, Shapeton AD. Requiem for Routine Self-Expanding Transcatheter Aortic Valve Replacement Valves? A Commentary on the Comparative Analysis of Evolut PRO Versus Sapien Ultra Valves for Transfemoral Transcatheter Aortic Valve Implantation Registry. J Cardiothorac Vasc Anesth 2023; 37:849-851. [PMID: 36918340 DOI: 10.1053/j.jvca.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023]
Affiliation(s)
- Allison L Tsao
- VA Boston Healthcare System and Harvard Medical School, Boston, MA.
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8
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Venkatraman V, Ponder M, Gellad ZF, Lad SP, Christy E, Plichta R, Harrison JK, Hughes GC, Doberne J. Feasibility study of a novel digital health platform for patients undergoing transcatheter aortic valve replacement. J Card Surg 2022; 37:2017-2022. [DOI: 10.1111/jocs.16515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Vishal Venkatraman
- Department of Neurosurgery Duke University Medical Center Durham North Carolina USA
| | | | | | - Shivanand P. Lad
- Department of Neurosurgery Duke University Medical Center Durham North Carolina USA
| | - Edana Christy
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery Duke University Medical Center Durham North Carolina USA
| | - Ryan Plichta
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery Duke University Medical Center Durham North Carolina USA
| | - John Kevin Harrison
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery Duke University Medical Center Durham North Carolina USA
| | - George Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery Duke University Medical Center Durham North Carolina USA
| | - Julie Doberne
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery Duke University Medical Center Durham North Carolina USA
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9
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Campany ME, Bhandarkar AR, Bydon M, Donato BB, Sell-Dottin KA. Transcatheter aortic valve replacement outcomes in solid organ transplant recipients. J Card Surg 2022; 37:602-607. [PMID: 34985156 DOI: 10.1111/jocs.16202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Transcatheter aortic valve replacement (TAVR) has become the primary treatment for severe symptomatic aortic stenosis in patients >65 years with volumes exceeding surgical aortic valve replacements (SAVR) since 2019. As a less invasive procedure with lower complication rates, TAVR is preferable in most patient populations, particularly those with increased surgical risk. One such population is patients who have undergone solid organ transplant (SOT). We aimed to evaluate periprocedural outcomes and complication rates following TAVR in SOT recipients as compared to the general TAVR population. METHODS The 2016-2018 National Inpatient Sample (NIS) was queried by ICD-10 PCS codes to identify TAVR cases; hospitalizations were subsequently stratified by SOT history. Multivariate analyses were completed to evaluate complication rates, length of stay (LOS), and cost of stay (COS). RESULTS No significant difference was observed in mortality rates or post-procedural complications between SOT recipients (n = 223) and those without transplant history undergoing TAVR (n = 29,448) except for increased thromboembolic events captured in transplant patients (p < .001). There was no significant variation in LOS or COS between the two populations; female sex and Black or Hispanic race were predictors of increased inpatient time. CONCLUSIONS SOT recipients have no increased risk of mortality or periprocedural complications when undergoing TAVR. Though the rate of thromboembolic events was higher in SOT recipients, observation size was small (n = 27 TAVR, n = 4 TAVR + SOT) thus external validity is limited. Based on these data, transplant recipients experience no difference in outcomes following TAVR as compared to patients without a history of organ transplant.
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Affiliation(s)
- Megan E Campany
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | | | - Mohamad Bydon
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Britton B Donato
- Division of Cardiothoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
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10
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Cormican DS. The Puzzle of TAVR for Bicuspid AS: Still Missing a Piece? J Cardiothorac Vasc Anesth 2022; 36:1225-1227. [DOI: 10.1053/j.jvca.2021.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 12/28/2021] [Indexed: 11/11/2022]
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11
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Bodmer NJ, Fielding-Singh V, Vanneman MW. Transcatheter Aortic Valve Dissemination: The More the Merrier or Too Much of a Good Thing? J Cardiothorac Vasc Anesth 2021; 36:925-928. [PMID: 34974961 DOI: 10.1053/j.jvca.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Natalie J Bodmer
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Vikram Fielding-Singh
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Matthew W Vanneman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA.
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12
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Abbas S, Qayum I, Wahid R, Salman F, Khan H, Hassan F, Babar A, Inayat A. Acute Kidney Injury in Transcatheter Aortic Valve Replacement. Cureus 2021; 13:e15154. [PMID: 34168922 PMCID: PMC8214866 DOI: 10.7759/cureus.15154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction Transcatheter aortic valve replacement (TAVR) has been established as a standard of care for patients with severe aortic stenosis. We aim to study the predictors of acute kidney injury (AKI) after TAVR from a contemporary analysis using the National Inpatient Sample (NIS) database. Methods We performed a national analysis using the NIS database to evaluate predictors of acute kidney injury (AKI) after TAVR. Our study period was from 2015 to 2018, and we identified TAVR patients in all procedure fields. Patients aged less than 18 years were excluded from the study. Results We report data of 173,760 TAVR patients, of which 20,045 (11.5%) had AKI and 153,715 (88.4%) did not. There were three principal findings of our study. First, mortality was higher in patients with AKI compared to patients who did not have AKI (8% vs. 0.8%; p<0.01). Second, patients with chronic kidney disease, weight loss, liver disease, congestive heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, metastatic cancer, and peripheral vascular disease had higher adjusted odds of AKI. Third, length of stay and cost of stay were significantly higher in patients who had AKI during the index admission. Conclusion Patients with AKI had higher in-hospital mortality. We also report that at baseline, chronic kidney disease, weight loss, liver disease, congestive heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, metastatic cancer, and peripheral vascular disease were important predictors of AKI in patients after TAVR. Length of stay and cost of stay were higher with AKI, which result in higher burden on the health care system due to increased resource utilization.
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Affiliation(s)
- Sakina Abbas
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Ihtisham Qayum
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
| | - Rabiya Wahid
- Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Fnu Salman
- Medicine, St. Vincent Medical Center, Toledo, USA
| | - Henna Khan
- Internal Medicine, Khyber Girls Medical College, Peshawar, PAK
| | - Fatima Hassan
- Medicine, Fatima Jinnah Medical University, Lahore, PAK
| | - Anum Babar
- Medicine, Khyber Girls Medical College, Peshawar, PAK
| | - Arslan Inayat
- Internal Medicine, University at Buffalo, Catholic Health System, Buffalo, USA
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13
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Abstract
Transcatheter aortic valve replacement (TAVR) is a minimally invasive approach to treat symptomatic severe aortic stenosis. The patient populations that have been shown to benefit from this procedure continue to grow with time. Techniques and technology in TAVR persistently advance with a continued trend toward improved outcomes for patients. In this review, we highlight the advances in vascular access, TAVR valve design, progress in reducing procedural complications, and emerging evidence in the field.
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Affiliation(s)
- Morgan H Randall
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Anthony A Bavry
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA.
- North Florida/South Georgia, Veterans Health System, Gainesville, FL, USA.
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14
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Mas-Peiro S, Fichtlscherer S, Walther C, Vasa-Nicotera M. Current issues in transcatheter aortic valve replacement. J Thorac Dis 2020; 12:1665-1680. [PMID: 32395310 PMCID: PMC7212163 DOI: 10.21037/jtd.2020.01.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aortic stenosis is the most common valvular disease worldwide. With transcatheter aortic valve replacement (TAVR) being increasingly expanded to lower-risk populations, several challenging issues remain to be solved. The present review aims at discussing modern approaches to such issues as well as the current status of TAVR. TAVR has undergone several developments in the recent years: an increased use of transfemoral access, the development of prostheses in order to adapt to challenging anatomies, improved delivery systems with repositioning features, and outer skirts aiming at reducing paravalvular leak. The indication of TAVR is increasingly being expanded to patients with lower surgical risk. The main clinical trials supporting such expansion are reviewed and the latest data on low-risk patients are discussed. A number of challenges need still to be addressed and are also reviewed in this paper: the need for updated international guidelines including the latest evidence; a reduction of main complications such as permanent pacemaker implantation, paravalvular leak, and stroke (and its potential prevention by using anti-embolic protection devices); the appropriate role of TAVR in patients with concomitant cardiac ischemic disease; and durability of bio-prosthetic implanted valves. Finally, the future perspectives for TAVR use and next device developments are discussed.
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Affiliation(s)
- Silvia Mas-Peiro
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Stephan Fichtlscherer
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Claudia Walther
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Germany
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15
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Cormican D, McHugh S, Boisen M, Winter D, So CY, Villablanca PA, Ramakrishna H. The Low Risk Transcatheter Aortic Valve Replacement Trials-An Analysis. J Cardiothorac Vasc Anesth 2020; 34:3133-3138. [PMID: 32144060 DOI: 10.1053/j.jvca.2020.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel Cormican
- Department of Anesthesiology, Divisions of Cardiothoracic Anesthesiology and Critical Care Medicine, Allegheny Health Network, Pittsburgh, PA
| | - Stephen McHugh
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center Shadyside, Pittsburgh, PA
| | - Michael Boisen
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, University of Pittsburgh Medical Center Presbyterian, Pittsburgh, PA
| | - Daniel Winter
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Northwestern Medicine, Chicago, IL
| | - Chak-Yu So
- Department of Cardiology, Henry Ford Hospital, Detroit, MI; Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR
| | | | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MI.
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16
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Abstract
Initially, transcatheter aortic valve replacement (TAVR) was only used in patients with severe symptomatic aortic stenosis and prohibitive risk for surgical aortic valve replacement. Subsequently, TAVR was extended to patients with high and intermediate surgical risk. Recently, the results of randomized trials in low-surgical-risk patients showed superiority or noninferiority of TAVR versus surgical aortic valve replacement in this population. Procedural outcomes have been improved. Long-term durability of transcatheter heart valves remains to be confirmed. This article presents the evolution and current status of TAVR, with respect to the different types of devices and procedures as well as its outcomes.
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17
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Evans AS, Weiner MM, Shaefi S, Patel PA, Townsley MM, Kumaresan A, Feinman JW, Fritz AV, Martin AK, Steinberg TB, Renew JR, Gui JL, Radvansky B, Bhatt H, Subramani S, Sharma A, Gutsche JT, Augoustides JG, Ramakrishna H. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2019. J Cardiothorac Vasc Anesth 2019; 34:1-11. [PMID: 31759862 DOI: 10.1053/j.jvca.2019.10.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 12/26/2022]
Abstract
This highlights in our specialty for 2019 begin with the ongoing major developments in transcatheter valve interventions. Thereafter, the advances in left ventricular assist devices are reviewed. The recent focus on conduit selection and robotic options in coronary artery bypass surgery are then explored. Finally, this special articles closes with a discussion of pulmonary hypertension in noncardiac surgery, anesthetic technique in cardiac surgery, as well as postoperative pneumonia and its outcome consequences.
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Affiliation(s)
| | - Menachem M Weiner
- Department of Anesthesiology, Perioperative, and Pain Medicine Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine Beth Israel, Deaconess Medical Center, Boston, MA
| | - Prakash A Patel
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Abirami Kumaresan
- Department of Anesthesiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | - Jared W Feinman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - Ashley V Fritz
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Archer K Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Toby B Steinberg
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - J Ross Renew
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Jane L Gui
- Department of Anesthesiology, Perioperative, and Pain Medicine Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brian Radvansky
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - Himani Bhatt
- Department of Anesthesiology, Perioperative, and Pain Medicine Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Archit Sharma
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Jacob T Gutsche
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA.
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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