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Sazzad F, Ler AAL, Furqan MS, Tan LKZ, Leo HL, Kuntjoro I, Tay E, Kofidis T. Harnessing the power of artificial intelligence in predicting all-cause mortality in transcatheter aortic valve replacement: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1343210. [PMID: 38883982 PMCID: PMC11176615 DOI: 10.3389/fcvm.2024.1343210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Objectives In recent years, the use of artificial intelligence (AI) models to generate individualised risk assessments and predict patient outcomes post-Transcatheter Aortic Valve Implantation (TAVI) has been a topic of increasing relevance in literature. This study aims to evaluate the predictive accuracy of AI algorithms in forecasting post-TAVI mortality as compared to traditional risk scores. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Systematic Reviews (PRISMA) standard, a systematic review was carried out. We searched four databases in total-PubMed, Medline, Embase, and Cochrane-from 19 June 2023-24 June, 2023. Results From 2,239 identified records, 1,504 duplicates were removed, 735 manuscripts were screened, and 10 studies were included in our review. Our pooled analysis of 5 studies and 9,398 patients revealed a significantly higher mean area under curve (AUC) associated with AI mortality predictions than traditional score predictions (MD: -0.16, CI: -0.22 to -0.10, p < 0.00001). Subgroup analyses of 30-day mortality (MD: -0.08, CI: -0.13 to -0.03, p = 0.001) and 1-year mortality (MD: -0.18, CI: -0.27 to -0.10, p < 0.0001) also showed significantly higher mean AUC with AI predictions than traditional score predictions. Pooled mean AUC of all 10 studies and 22,933 patients was 0.79 [0.73, 0.85]. Conclusion AI models have a higher predictive accuracy as compared to traditional risk scores in predicting post-TAVI mortality. Overall, this review demonstrates the potential of AI in achieving personalised risk assessment in TAVI patients. Registration and protocol This systematic review and meta-analysis was registered under the International Prospective Register of Systematic Reviews (PROSPERO), under the registration name "All-Cause Mortality in Transcatheter Aortic Valve Replacement Assessed by Artificial Intelligence" and registration number CRD42023437705. A review protocol was not prepared. There were no amendments to the information provided at registration. Systematic Review Registration https://www.crd.york.ac.uk/, PROSPERO (CRD42023437705).
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Affiliation(s)
- Faizus Sazzad
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ashlynn Ai Li Ler
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mohammad Shaheryar Furqan
- Department of Biomedical Informatics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Linus Kai Zhe Tan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hwa Liang Leo
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore, Singapore
| | - Ivandito Kuntjoro
- Department of Cardiology, National University Heart Centre, Singapore, National University Hospital, Singapore, Singapore
| | - Edgar Tay
- Department of Cardiology, National University Heart Centre, Singapore, National University Hospital, Singapore, Singapore
- Asian Heart & Vascular Centre (AHVC), Mount Elizabeth Medical Centre, Singapore, Singapore
| | - Theo Kofidis
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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von Aspern K, Leontyev S, Etz CD, Haunschild J, Misfeld M, Borger MA. Iatrogenic Type A Aortic Dissection: Challenges and Frontiers-Contemporary Single Center Data and Clinical Perspective. AORTA (STAMFORD, CONN.) 2022; 10:201-209. [PMID: 36521814 PMCID: PMC9754867 DOI: 10.1055/s-0042-1756670] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 07/06/2022] [Indexed: 06/17/2023]
Abstract
Iatrogenic aortic dissection (IAD) is a rare but devastating complication in cardiac surgery and related procedures. Due to its rarity, published data on emergency surgery following IAD are limited. Herein, we discuss IAD occurring intra- and postoperatively, including those occurring during transcatheter aortic valve replacement and cardiac catheterization, and present benchmark data from our consecutive, single-center experience. We demonstrate changes in patient characteristics, surgical approaches, and outcomes over a 23-year period.
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Affiliation(s)
- Konstantin von Aspern
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Saxony, Germany
| | - Sergey Leontyev
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Saxony, Germany
| | - Christian D. Etz
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Saxony, Germany
| | - Josephina Haunschild
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Saxony, Germany
| | - Martin Misfeld
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Saxony, Germany
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Department of Cardiac Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, New South Wales, Australia
| | - Michael A. Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Saxony, Germany
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Toff WD, Hildick-Smith D, Kovac J, Mullen MJ, Wendler O, Mansouri A, Rombach I, Abrams KR, Conroy SP, Flather MD, Gray AM, MacCarthy P, Monaghan MJ, Prendergast B, Ray S, Young CP, Crossman DC, Cleland JGF, de Belder MA, Ludman PF, Jones S, Densem CG, Tsui S, Kuduvalli M, Mills JD, Banning AP, Sayeed R, Hasan R, Fraser DGW, Trivedi U, Davies SW, Duncan A, Curzen N, Ohri SK, Malkin CJ, Kaul P, Muir DF, Owens WA, Uren NG, Pessotto R, Kennon S, Awad WI, Khogali SS, Matuszewski M, Edwards RJ, Ramesh BC, Dalby M, Raja SG, Mariscalco G, Lloyd C, Cox ID, Redwood SR, Gunning MG, Ridley PD. Effect of Transcatheter Aortic Valve Implantation vs Surgical Aortic Valve Replacement on All-Cause Mortality in Patients With Aortic Stenosis: A Randomized Clinical Trial. JAMA 2022; 327:1875-1887. [PMID: 35579641 PMCID: PMC9115619 DOI: 10.1001/jama.2022.5776] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical aortic valve replacement and is the treatment of choice for patients at high operative risk. The role of TAVI in patients at lower risk is unclear. OBJECTIVE To determine whether TAVI is noninferior to surgery in patients at moderately increased operative risk. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial conducted at 34 UK centers, 913 patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk due to age or comorbidity were enrolled between April 2014 and April 2018 and followed up through April 2019. INTERVENTIONS TAVI using any valve with a CE mark (indicating conformity of the valve with all legal and safety requirements for sale throughout the European Economic Area) and any access route (n = 458) or surgical aortic valve replacement (surgery; n = 455). MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality at 1 year. The primary hypothesis was that TAVI was noninferior to surgery, with a noninferiority margin of 5% for the upper limit of the 1-sided 97.5% CI for the absolute between-group difference in mortality. There were 36 secondary outcomes (30 reported herein), including duration of hospital stay, major bleeding events, vascular complications, conduction disturbance requiring pacemaker implantation, and aortic regurgitation. RESULTS Among 913 patients randomized (median age, 81 years [IQR, 78 to 84 years]; 424 [46%] were female; median Society of Thoracic Surgeons mortality risk score, 2.6% [IQR, 2.0% to 3.4%]), 912 (99.9%) completed follow-up and were included in the noninferiority analysis. At 1 year, there were 21 deaths (4.6%) in the TAVI group and 30 deaths (6.6%) in the surgery group, with an adjusted absolute risk difference of -2.0% (1-sided 97.5% CI, -∞ to 1.2%; P < .001 for noninferiority). Of 30 prespecified secondary outcomes reported herein, 24 showed no significant difference at 1 year. TAVI was associated with significantly shorter postprocedural hospitalization (median of 3 days [IQR, 2 to 5 days] vs 8 days [IQR, 6 to 13 days] in the surgery group). At 1 year, there were significantly fewer major bleeding events after TAVI compared with surgery (7.2% vs 20.2%, respectively; adjusted hazard ratio [HR], 0.33 [95% CI, 0.24 to 0.45]) but significantly more vascular complications (10.3% vs 2.4%; adjusted HR, 4.42 [95% CI, 2.54 to 7.71]), conduction disturbances requiring pacemaker implantation (14.2% vs 7.3%; adjusted HR, 2.05 [95% CI, 1.43 to 2.94]), and mild (38.3% vs 11.7%) or moderate (2.3% vs 0.6%) aortic regurgitation (adjusted odds ratio for mild, moderate, or severe [no instance of severe reported] aortic regurgitation combined vs none, 4.89 [95% CI, 3.08 to 7.75]). CONCLUSIONS AND RELEVANCE Among patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk, TAVI was noninferior to surgery with respect to all-cause mortality at 1 year. TRIAL REGISTRATION isrctn.com Identifier: ISRCTN57819173.
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Affiliation(s)
| | - William D Toff
- Department of Cardiovascular Sciences, University of Leicester, Leicester, England
- National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, England
| | - Jan Kovac
- Department of Cardiovascular Sciences, University of Leicester, Leicester, England
- National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England
| | - Michael J Mullen
- Institute of Cardiovascular Science, University College London, London, England
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital NHS Foundation Trust, London, England
| | - Anita Mansouri
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Ines Rombach
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Keith R Abrams
- Centre for Health Economics, University of York, York, England
- Department of Statistics, University of Warwick, Coventry, England
- Department of Health Sciences, University of Leicester, Leicester, England
| | - Simon P Conroy
- Department of Health Sciences, University of Leicester, Leicester, England
| | - Marcus D Flather
- Norwich Medical School, University of East Anglia, Norwich, England
| | - Alastair M Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, England
| | - Mark J Monaghan
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, England
| | | | - Simon Ray
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, England
| | | | | | - John G F Cleland
- Robertson Centre for Biostatistics and Glasgow Clinical Trials Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Mark A de Belder
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, England
| | - Peter F Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, England
| | - Stephen Jones
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, England
| | - Cameron G Densem
- Department of Cardiology, Royal Papworth Hospital, Cambridge, England
| | - Steven Tsui
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, England
| | - Manoj Kuduvalli
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, England
| | - Joseph D Mills
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, England
| | - Adrian P Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Rana Sayeed
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Ragheb Hasan
- Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, England
| | - Douglas G W Fraser
- Department of Cardiovascular Medicine, University of Manchester, Manchester, England
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, England
| | - Simon W Davies
- Cardiac Department, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England
| | - Alison Duncan
- Cardiac Department, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England
| | - Nick Curzen
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, England
| | - Sunil K Ohri
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, England
| | | | - Pankaj Kaul
- Department of Cardiac Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | - Douglas F Muir
- Department of Cardiology, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, England
| | - W Andrew Owens
- Department of Cardiothoracic Surgery, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, England
| | - Neal G Uren
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Renzo Pessotto
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Simon Kennon
- Barts Heart Centre, Barts Health NHS Trust, London, England
| | - Wael I Awad
- Barts Heart Centre, Barts Health NHS Trust, London, England
| | - Saib S Khogali
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, England
| | | | - Richard J Edwards
- Cardiothoracic Department, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, England
| | | | - Miles Dalby
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England
| | - Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England
| | - Giovanni Mariscalco
- Department of Cardiovascular Sciences, University of Leicester, Leicester, England
- National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England
| | - Clinton Lloyd
- Department of Cardiothoracic Surgery, Derriford Hospital, Plymouth, England
| | - Ian D Cox
- Department of Cardiology, Derriford Hospital, Plymouth, England
| | - Simon R Redwood
- Cardiovascular Division, King's College London, British Heart Foundation Centre of Research Excellence, Rayne Institute, St Thomas' Hospital, London, England
| | - Mark G Gunning
- Cardiology Department, Royal Stoke University Hospital, Stoke-on-Trent, England
| | - Paul D Ridley
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, England
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4
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Swift SL, Puehler T, Misso K, Lang SH, Forbes C, Kleijnen J, Danner M, Kuhn C, Haneya A, Seoudy H, Cremer J, Frey N, Lutter G, Wolff R, Scheibler F, Wehkamp K, Frank D. Transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis: a systematic review and meta-analysis. BMJ Open 2021; 11:e054222. [PMID: 34873012 PMCID: PMC8650468 DOI: 10.1136/bmjopen-2021-054222] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patients undergoing surgery for severe aortic stenosis (SAS) can be treated with either transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). The choice of procedure depends on several factors, including the clinical judgement of the heart team and patient preferences, which are captured by actively informing and involving patients in a process of shared decision making (SDM). We synthesised the most up-to-date and accessible evidence on the benefits and risks that may be associated with TAVI versus SAVR to support SDM in this highly personalised decision-making process. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE (Ovid), Embase (Ovid) and the Cochrane Central Register of Controlled Trials (CENTRAL; Wiley) were searched from January 2000 to August 2020 with no language restrictions. Reference lists of included studies were searched to identify additional studies. ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) that compared TAVI versus SAVR in patients with SAS and reported on all-cause or cardiovascular mortality, length of stay in intensive care unit or hospital, valve durability, rehospitalisation/reintervention, stroke (any stroke or major/disabling stroke), myocardial infarction, major vascular complications, major bleeding, permanent pacemaker (PPM) implantation, new-onset or worsening atrial fibrillation (NOW-AF), endocarditis, acute kidney injury (AKI), recovery time or pain were included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers were involved in data extraction and risk of bias (ROB) assessment using the Cochrane tool (one reviewer extracted/assessed the data, and the second reviewer checked it). Dichotomous data were pooled using the Mantel-Haenszel method with random-effects to generate a risk ratio (RR) with 95% CI. Continuous data were pooled using the inverse-variance method with random-effects and expressed as a mean difference (MD) with 95% CI. Heterogeneity was assessed using the I2 statistic. RESULTS 8969 records were retrieved and nine RCTs (61 records) were ultimately included (n=8818 participants). Two RCTs recruited high-risk patients, two RCTs recruited intermediate-risk patients, two RCTs recruited low-risk patients, one RCT recruited high-risk (≥70 years) or any-risk (≥80 years) patients; and two RCTs recruited all-risk or 'operable' patients. While there was no overall change in the risk of dying from any cause (30 day: RR 0.89, 95% CI 0.65 to 1.22; ≤1 year: RR 0.90, 95% CI 0.79 to 1.03; 5 years: RR 1.09, 95% CI 0.98 to 1.22), cardiovascular mortality (30 day: RR 1.03, 95% CI 0.77 to 1.39; ≤1 year: RR 0.90, 95% CI 0.76 to 1.06; 2 years: RR 0.96, 95% CI 0.83 to 1.12), or any type of stroke (30 day: RR 0.83, 95% CI 0.61 to 1.14;≤1 year: RR 0.94, 95% CI 0.72 to 1.23; 5 years: RR 1.07, 95% CI 0.88 to 1.30), the risk of several clinical outcomes was significantly decreased (major bleeding, AKI, NOW-AF) or significantly increased (major vascular complications, PPM implantation) for TAVI vs SAVR. TAVI was associated with a significantly shorter hospital stay vs SAVR (MD -3.08 days, 95% CI -4.86 to -1.29; 4 RCTs, n=2758 participants). Subgroup analysis generally favoured TAVI patients receiving implantation via the transfemoral (TF) route (vs non-TF); receiving a balloon-expandable (vs self-expanding) valve; and those at low-intermediate risk (vs high risk). All RCTs were rated at high ROB, predominantly due to lack of blinding and selective reporting. CONCLUSIONS No overall change in the risk of death from any cause or cardiovascular mortality was identified but 95% CIs were often wide, indicating uncertainty. TAVI may reduce the risk of certain side effects while SAVR may reduce the risk of others. Most long-term (5-year) results are limited to older patients at high surgical risk (ie, early trials), therefore more data are required for low risk populations. Ultimately, neither surgical technique was considered dominant, and these results suggest that every patient with SAS should be individually engaged in SDM to make evidence-based, personalised decisions around their care based on the various benefits and risks associated with each treatment. PROSPERO REGISTRATION NUMBER CRD42019138171.
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Affiliation(s)
| | - Thomas Puehler
- Department of Cardiac and Vascular Surgery, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- German Centre for Cardiovascular Research, Kiel, Germany
| | - Kate Misso
- Kleijnen Systematic Reviews Ltd, York, UK
| | | | | | | | - Marion Danner
- National Competency Center for Shared Decision Making, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Christian Kuhn
- German Centre for Cardiovascular Research, Kiel, Germany
- Department of Cardiology and Angiology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Assad Haneya
- Department of Cardiac and Vascular Surgery, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Hatim Seoudy
- German Centre for Cardiovascular Research, Kiel, Germany
- Department of Cardiology and Angiology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiac and Vascular Surgery, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology, and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
| | - Georg Lutter
- Department of Cardiac and Vascular Surgery, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- German Centre for Cardiovascular Research, Kiel, Germany
| | | | - Fueloep Scheibler
- National Competency Center for Shared Decision Making, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Kai Wehkamp
- Department of Internal Medicine I, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Derk Frank
- German Centre for Cardiovascular Research, Kiel, Germany
- Department of Cardiology and Angiology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
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Next-Day Discharge vs Early Discharge After Transcatheter Aortic Valve Replacement: Systematic Review and Meta-Analysis. Curr Probl Cardiol 2021; 47:100998. [PMID: 34571105 DOI: 10.1016/j.cpcardiol.2021.100998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022]
Abstract
With the growing utilization of transcatheter aortic valve replacement (TAVR) as an alternative option to surgical valve replacement (SAVR) in patients considered to be suboptimal for surgery, there is a need to explore the possibility of next day discharge (NDD) and its potential outcomes. The aim of our study is to compare outcomes and complications following NDD vs the standard early discharge (ED) (less than 3 days). A comprehensive literature search was performed in PubMed, Embase, and Cochrane to identify relevant trials. Summary effects were calculated using a DerSimonian and Laird random effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. Studies comparing same-day or next-day discharge vs discharge within the next three days were included in our analysis. 6 studies with 2,672 patients were identified. The risk of bleeding and vascular complications was significantly lower in patients with NDD compared to ED (OR 0.10, P < 0.00001 and OR 0.22, P = 0.002 respectively). The incidence of permanent pacemaker (PPM) implants was significantly lower in patients who had NDD compared to ED (OR 0.21, P = 0.0005). The incidence of 30 day mortality, stroke, AKI and readmission rates was not different between the two groups. NDD after TAVR allows for reduction in hospital stay and can mitigate hospital costs without an increased risk of complications. Our analysis shows that complication rate is comparable to ED, NDD is a reasonable option for certain patients with severe aortic stenosis who undergo TAVR. Further studies are needed to elucidate whether higher risk patients who would benefit from an extended inpatient monitoring post TAVR.
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Krasniqi L, Kronby MP, Riber LPS. Long-term survival after Carpentier-Edwards Perimount aortic valve replacement in Western Denmark: a multi-centre observational study. J Cardiothorac Surg 2021; 16:130. [PMID: 33990211 PMCID: PMC8120717 DOI: 10.1186/s13019-021-01506-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background This study describes the long-term survival, risk of reoperation and clinical outcomes of patients undergoing solitary surgical aortic valve replacement (SAVR) with a Carpentier-Edwards Perimount (CE-P) bioprosthetic in Western Denmark. The renewed interest in SAVR is based on the questioning regarding the long-term survival since new aortic replacement technique such as transcatheter aortic-valve replacement (TAVR) probably have shorter durability, why assessment of long-term survival could be a key issue for patients. Methods From November 1999 to November 2013 a cohort of a total of 1604 patients with a median age of 73 years (IQR: 69–78) undergoing solitary SAVR with CE-P in Western Denmark was obtained November 2018 from the Western Danish Heart Registry (WDHR). The primary endpoint was long-term survival from all-cause mortality. Secondary endpoints were survival free from major adverse cardiovascular and cerebral events (MACCE), risk of reoperation, cause of late death, patient-prothesis mismatch, risk of AMI, stroke, pacemaker or ICD implantation and postoperative atrial fibrillation (POAF). Time-to-event analysis was performed with Kaplan-Meier curve, cumulative incidence function was performed with Nelson-Aalen cumulative hazard estimates. Cox regression was applied to detect risk factors for death and reoperation. Results In-hospital mortality was 2.7% and 30-day mortality at 3.4%. The 5-, 10- and 15-year survival from all-cause mortality was 77, 52 and 24%, respectively. Survival without MACCE was 80% after 10 years. Significant risk factors of mortality were small valves, smoking and EuroSCORE II ≥4%. The risk of reoperation was < 5% after 7.5 years and significant risk factors were valve prosthesis-patient mismatch and EuroSCORE II ≥4%. Conclusions Patients undergoing aortic valve replacement with a Carpentier-Edwards Perimount valve shows a very satisfying long-term survival. Future research should aim to investigate biological valves long-term durability for comparison of different SAVR to different TAVR in long perspective.
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Affiliation(s)
- Lytfi Krasniqi
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark. .,Faculty of Health Science, University of Southern Denmark, Odense, Denmark.
| | - Mads P Kronby
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.,Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Lars P S Riber
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.,Faculty of Health Science, University of Southern Denmark, Odense, Denmark
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7
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Weisman SV, Cheng EP, Girvin F, Toy D, Hossain R, Steinberger S, Escalon J, Legasto AC. Acute Thoracic Complications of Minimally Invasive Cardiac Procedures. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00919-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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8
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Gürbak İ, Güner A, Güler A, Şahin AA, Çelik Ö, Uzun F, Onan B, Ertürk M. Prognostic influence of objective nutritional indexes on mortality after surgical aortic valve replacement in elderly patients with severe aortic stenosis (from the nutrition-SAVR trial). J Card Surg 2021; 36:1872-1881. [PMID: 33586213 DOI: 10.1111/jocs.15434] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/21/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
AIM Several scoring systems, such as controlling nutritional status (CONUT) score, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI), have been previously described to show nutritional status. In the present study, we aimed to investigate the value of these scoring systems in predicting in-hospital and long-term mortality in patients undergoing surgical aortic valve replacement (SAVR). METHODS PNI, GNRI, and CONUT were determined using the receiver operator characteristics curve analysis in 150 consecutive elderly patients (age: 70 (66-74) years, male: 78) who underwent SAVR due to degenerative severe aortic stenosis (AS). Patients were divided into two groups according to cutoff values from these indexes. RESULTS During the 50 ± 31 months follow-up period, a total of 36 (24%) patients died. 30-day mortality, 1-year mortality, and total mortality were significantly higher in lower PNI, lower GNRI, and higher CONUT groups. PNI cutoff value was 49.2, GNRI cutoff value was 102.5, and CONUT cutoff value was 1.5. PNI ≤ 49.2, GNRI ≤ 102.5, and CONUT > 1.5 values were found to be independent predictors of total mortality even after risk adjustment. In addition, in the mortality group, PNI (53.7 ± 5.9 vs. 47.4 ± 6.3; p < .001) and GNRI (108 ± 10 vs. 99 ± 6.3); p < .001) were significantly lower, while CONUT score (1 [0-2] vs. 2 [0.2-3]; p < .001) was significantly higher. CONCLUSION Objective nutritional indexes including CONUT score, PNI, and GNRI are important prognostic factors and those indexes should be part of frailty assessment in patients with severe AS.
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Affiliation(s)
- İsmail Gürbak
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ahmet Güner
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Arda Güler
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ahmet A Şahin
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ömer Çelik
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Fatih Uzun
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Burak Onan
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Ertürk
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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9
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Yamashiro S, Kise Y, Inafuku H, Nagano T, Kuniyoshi Y. Prosthesis valve dislocation and acute ascending aortic dissection during transcatheter self-expandable aortic valve replacement. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.20.05100-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Jin L, He H, Yang F, Xu L, Guo G, Wang Y. Tough pNAGA hydrogel hybridized porcine pericardium for the pre-mounted TAVI valve with improved anti-tearing properties and hemocompatibility. ACTA ACUST UNITED AC 2020; 15:065013. [PMID: 32615546 DOI: 10.1088/1748-605x/aba239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The rate of adoption of transcatheter aortic valve implantation (TAVI) is increasing rapidly, due to the procedure being less invasive. However, TAVI still faces problems relating to durability, the potential incidence of thrombosis, and the inconvenience of storage in glutaraldehyde (Glut) solution. In this work, a tough hydrogel poly(N-acryloyl glycinamide) (pNAGA) is hybridized with Glut-crosslinked porcine pericardium (Glut-PP) via in situ polymerization and glycerolization, so as to obtain dry leafet material for the fabrication of a pre-mounted bioprosthetic heart valve (BHV). The tensile strength, anti-shearing, and anti-tearing properties of the valve are significantly improved by the process of hydrogel hybridization. Following a period of dry-state compression as a simulation for the crimping process of pre-mounted TAV, pNAGA/Glut-PP showed full recovery without structural damage when fully rehydrated. The introduction of pNAGA also improved the blood compatibility of the tissue, with less clot formation and fewer blood cells adhering to the surface of pNAGA/Glut-PP than is found with Glut-PP. Subcutaneous implantation in rats showed that pNAGA/Glut-PP induced a decreased inflammatory response compared with Glut-PP. These results indicate that the strategy for hybridization with hydrogel could be a potential method for preparing pre-mounted TAVs with an improved performance.
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11
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Matsuda Y, Nai Fovino L, Giacoppo D, Scotti A, Massussi M, Ueshima D, Sasano T, Fabris T, Tarantini G. Association between surgical risk and 30‐day stroke after transcatheter versus surgical aortic valve replacement: a systematic review and meta‐analysis. Catheter Cardiovasc Interv 2020; 97:E536-E543. [DOI: 10.1002/ccd.29105] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/07/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Yuji Matsuda
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
- Department of Cardiovascular Medicine Graduate School of General Medical and Dental Science, Tokyo Medical and Dental University Tokyo Japan
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Daniele Giacoppo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Andrea Scotti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Mauro Massussi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Daisuke Ueshima
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine Graduate School of General Medical and Dental Science, Tokyo Medical and Dental University Tokyo Japan
| | - Tommaso Fabris
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School Padua Italy
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12
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Lei X, Wei Z, Liu S, Liang F, Song B. The short-term and long-term outcomes of transcatheter or surgical aortic valve replacement in elderly patients: A protocol for a systematic review. Medicine (Baltimore) 2020; 99:e19307. [PMID: 32118752 PMCID: PMC7478717 DOI: 10.1097/md.0000000000019307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has become an essential alternate option for people suffering from aortic stenosis. However, the efficacy and safety of TAVR for elderly population (aged over 80 years) is still unclear. METHODS We plan to perform a systematic review and meta-analysis of clinical controlled trials and propensity-match cohort studies to evaluate the short- and long-term outcomes in elderly aortic stenosis patients who undergo a transcatheter or surgical aortic valve replacement. We will search PubMed, EMBASE, and Cochrane Library using a comprehensive strategy. The related conference proceedings and reference lists of the included studies will also be checked to identify additional studies. Two reviewers will screen retrieved records, extract information, and assess the risk of bias independently. STATA software will be used to conduct data synthesis. There is no requirement of ethical approval and informed consent. RESULTS This study will be submitted to a peer-reviewed journal for publication. CONCLUSION This is the first systematic assessment of TAVR for elderly patients with aortic stenosis. We hope it will provide a relatively comprehensive reference for clinical practice and future relevant clinical trials. ETHICS AND DISSEMINATION Ethics approval and patient consent are not required as this study is a systematic review and meta-analysis. PROSPERO REGISTRATION NUMBER CRD42019140857. STUDY PROTOCOL REGISTRY The protocol has been registered in PROSPERO, which is an International Prospective Register of Systematic Reviews. The registration number is CRD42019140857.
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Affiliation(s)
- Xiang Lei
- First Clinical Medical College, Lanzhou University
- Department of Cardiovascular Surgery, First Hospital of Lanzhou University, Lanzhou, China
| | - Zhili Wei
- First Clinical Medical College, Lanzhou University
| | - Shidong Liu
- First Clinical Medical College, Lanzhou University
- Department of Cardiovascular Surgery, First Hospital of Lanzhou University, Lanzhou, China
| | - Fuxiang Liang
- First Clinical Medical College, Lanzhou University
- Department of Cardiovascular Surgery, First Hospital of Lanzhou University, Lanzhou, China
| | - Bing Song
- Department of Cardiovascular Surgery, First Hospital of Lanzhou University, Lanzhou, China
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13
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Amrane H, Deeb GM, Popma JJ, Yakubov SJ, Gleason TG, Van Mieghem NM, Reardon MJ. Causes of death in intermediate-risk patients: The Randomized Surgical Replacement and Transcatheter Aortic Valve Implantation Trial. J Thorac Cardiovasc Surg 2018; 158:718-728.e3. [PMID: 30709668 DOI: 10.1016/j.jtcvs.2018.11.129] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/31/2018] [Accepted: 11/05/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Examine the causes and timing of death in the Surgical Replacement and Transcatheter Aortic Valve Implantation intermediate-risk randomized trial for transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). METHODS Causes of death were adjudicated by an independent clinical event committee and by post-hoc hierarchical classification. Causes of death were evaluated and characteristics and procedural parameters compared between patients who died and survivors for 3 time periods: early (0-30 days), recovery (31-120 days), and late (121-365 days). RESULTS All-cause mortality at 1 year was 6.5% after TAVR and 6.7% after SAVR. There were no differences in mortality rates between TAVR and SAVR for any of the 3 time periods. Early mortality was primarily due to technical, procedure-related problems in TAVR and due to complications in SAVR. For TAVR and SAVR, most deaths during recovery were caused by complications. Other causes, including comorbid conditions, accounted for most late deaths. CONCLUSIONS Mortality rates were similar for patients treated with TAVR or SAVR at any time period including at 1 year. Early cause of death was more commonly technical failure after TAVR and due to complications after SAVR. Recovery phase cause of death was dominated by complications from TAVR and SAVR. Late cause of death appeared to be independent of the procedure in both groups.
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Affiliation(s)
- Hafid Amrane
- Department of Cardiac and Thoracic Surgery, Medisch Centrum Leeuwarden, The Netherlands
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan Hospitals, Ann Arbor, Mich
| | - Jeffrey J Popma
- Department of Interventional Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Steven J Yakubov
- Department of Interventional Cardiology; Riverside Methodist-Ohio Health, Columbus, Ohio
| | - Thomas G Gleason
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Eramus Medical Center, Rotterdam, The Netherlands
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex.
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14
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Pineda AM, Kevin Harrison J, Kleiman NS, Reardon MJ, Conte JV, O'Hair DP, Chetcuti SJ, Huang J, Yakubov SJ, Popma JJ, Beohar N. Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement. Catheter Cardiovasc Interv 2018; 93:740-748. [DOI: 10.1002/ccd.27928] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 09/24/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Andres M. Pineda
- Division of CardiologyUniversity of Florida College of Medicine‐Jacksonville Jacksonville Florida
| | - J. Kevin Harrison
- Department of MedicineDuke University Medical Center Durham North Carolina
| | - Neal S. Kleiman
- Department of CardiologyHouston Methodist DeBakey Heart and Vascular Center Houston Texas
| | - Michael J. Reardon
- Department of Cardiothoracic SurgeryHouston Methodist DeBakey Heart and Vascular Center Houston Texas
| | - John V. Conte
- Division of Cardiac SurgeryJohns Hopkins University Baltimore Maryland
| | - Daniel P. O'Hair
- Department of Cardiothoracic SurgeryAurora Healthcare Milwaukee Wisconsin
| | - Stanley J. Chetcuti
- Department of Internal Medicine, Division of CardiologyUniversity of Michigan Ann Arbor Michigan
| | - Jian Huang
- Coronary and Structural Heart Clinical Department Mounds View Minnesota
| | | | - Jeffrey J. Popma
- Department of Internal Medicine, Cardiovascular DivisionBeth Israel Deaconess Medical Center Boston Massachusetts
| | - Nirat Beohar
- Division of Cardiology at Mount Sinai Medical Center, Columbia University Miami Beach Florida
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15
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Musumeci L, Jacques N, Hego A, Nchimi A, Lancellotti P, Oury C. Prosthetic Aortic Valves: Challenges and Solutions. Front Cardiovasc Med 2018; 5:46. [PMID: 29868612 PMCID: PMC5961329 DOI: 10.3389/fcvm.2018.00046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/30/2018] [Indexed: 01/04/2023] Open
Abstract
Aortic Valve Disease (AVD) is the most common Valvular Heart Disease (VHD), affecting millions of people worldwide. Severe AVD is treated in most cases with prosthetic aortic valve replacement, which involves the substitution of the native aortic valve with a prosthetic one. In this review we will discuss the different types of prosthetic aortic valves available for implantation and the challenges faced by patients, medical doctors, researchers and manufacturers, as well as the approaches that are taken to overcome them.
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Affiliation(s)
- Lucia Musumeci
- Laboratory of Thrombosis and Hemostasis and Valvular Heart Disease, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
| | - Nicolas Jacques
- Laboratory of Thrombosis and Hemostasis and Valvular Heart Disease, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
| | - Alexandre Hego
- Laboratory of Thrombosis and Hemostasis and Valvular Heart Disease, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
| | - Alain Nchimi
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium
| | - Patrizio Lancellotti
- Laboratory of Thrombosis and Hemostasis and Valvular Heart Disease, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium.,Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Cécile Oury
- Laboratory of Thrombosis and Hemostasis and Valvular Heart Disease, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
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