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Aurigemma C, Busco M, Bianchini F, Bianchini E, Di Brango C, Marchetta M, Bruno P, Nesta M, Romagnoli E, Burzotta F, Trani C. Clinical impact of multiple resheathing during transcatheter aortic valve implantation with Evolut self-expanding valves. Int J Cardiol 2024; 410:132218. [PMID: 38815673 DOI: 10.1016/j.ijcard.2024.132218] [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: 10/25/2023] [Revised: 05/02/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The possibility to resheath some transcatheter heart valves (THV) facilitates the optimization of self-expandable devices implantation. However, resheating manoeuvres (expecially when repeated) increase the interaction between the transcatheter prosthesis and the patient's tissues potentially causing side-effects. AIMS To assess the clinical outcomes of resheathing at midterm follow-up with a focus on the safety of multiple resheathing. METHODS This retrospective observational study included all consecutive patients who underwent TAVI with a self-expandable supra-annular THV between December 2018 and December 2022. Primary endpoint was a composite of cardiovascular (CV) mortality, neurological events, non-fatal acute myocardial infarction and CV rehospitalizations. All clinical endpoints were assessed according to VARC-3 criteria. RESULTS 469 TAVI procedures with self-expandable supra-annular THV were included in the study. The attempt to resheath and the resheath manoeuvres number was prospectively recorded into an electronic database. Resheating was attempted in 253 (53.9%) cases; 1, 2 and ≥ 3 resheathing were performed in respectively 122 (26.0%), 63 (13.4%) and 68 (14.5%) procedures. At a median follow-up of 640 days (interquartile range 340-1033 days), the incidence of the primary endpoint did not differ between 0 vs. ≥1 (22.7 vs. 26.1%, LogRank p = 0.584) and < 3 vs. ≥3 resheathing groups (24.2 vs. 26.5% LogRank p = 0.963). Furthermore, no significant differences in the primary endpoint were observed between 0, 1-2 and ≥ 3 resheathing (p = 0.84). CONCLUSIONS Our study found that resheathing of self-expandable THVs during TAVI did not result in worse clinical outcomes compared with no resheathing at mid-term follow-up. These results are independent from the number of resheathing, underling the safety of multiple resheathing in terms of peri-procedural and mid-term outcome. CONDENSED ABSTRACT In this retrospective observational study of 469 patients undergoing transcatheter aortic valve implantation (TAVI) for symptomatic severe aortic stenosis with self-expanding valves, we investigated the influence of resheathing on mid-term clinical outcomes. Specifically, we focused on the safety of multiple resheathing procedures. Our findings revealed no significant impact of resheathing on medium-term outcomes. The primary endpoint, a composite of cardiovascular mortality, neurological events, non-fatal acute myocardial infarction, and cardiovascular rehospitalizations, did not show statistically significant differences between no resheathing, single resheathing and multiple resheathing groups. Our study suggests that resheathing, even when performed multiple times, does not appear to significantly affect clinical outcomes at mid-term follow-up.
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Affiliation(s)
- Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Busco
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Bianchini
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emiliano Bianchini
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Di Brango
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michele Marchetta
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marialisa Nesta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Carlo Trani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
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Rivera FB, Cha SW, Redula SC, Liston MBO, Ong EP, Bantayan NRB, Kaur G, Volgman AS, Mamas MA. Sex differences in transcatheter aortic valve replacement outcomes among patients with bicuspid aortic stenosis. Heart Lung 2024; 67:144-151. [PMID: 38762962 DOI: 10.1016/j.hrtlng.2024.05.003] [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: 10/17/2023] [Revised: 01/22/2024] [Accepted: 05/06/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Despite comprising almost half of all patients undergoing valvular repair, data on transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (BAS) are limited. OBJECTIVE We aimed to evaluate whether there are any sex differences in trends and outcomes of TAVR in this population. METHODS We utilized the National Inpatient Sample from 2012 to 2020 to identify admissions with BAS who underwent TAVR and analyzed trends and outcomes. Our primary outcome was in-hospital mortality and secondary outcomes were in-hospital complications. We used two models to adjust for demographics (A) and interventions (B). RESULTS Between 2012 to 2020, there were 76,540 hospitalizations for BAS patients who underwent AVR, among which 6,010 (7.9 %) underwent TAVR. There was an overall increasing trend in number of TAVR cases with a decreasing trend in mortality (2013: 8.7 %, 2020: 1.3 %). TAVR was performed more in males (61.1% vs 38.9 %). Despite the worse baseline characteristics in males, in-hospital mortality (2.4% vs. 1.5 %; OR: 1.584; 95 % CI: 0.621-4.038; p = 0.335) and secondary outcomes were similar across both sexes, even after adjusting for demographics and interventions. CONCLUSION TAVR in BAS has grown rapidly in the last decade. Males comprised the majority and had more comorbidities, but mortality and complications were similar in both sexes. Despite the increasing number of cases, a decreasing trend in mortality was observed for both sexes ultimately approaching that of SAVR, suggesting that TAVR may be a safe alternative among eligible males and females with bicuspid AS.
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Affiliation(s)
| | | | | | | | - Erika P Ong
- University of the Philippines Manila, Manila City, Philippines
| | | | - Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke-on-Trent, UK
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3
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Gómez-Herrero J, Fernandez-Cordón C, Gonzalez JC, García-Gómez M, Turrión SB, Serrador A, Gutiérrez H, Campo A, Cortés C, Sevilla T, Aristizabal C, Ruiz J, Campillo S, Baladrón C, Carrasco-Moraleja M, Román JAS, Amat-Santos IJ. TAV-in-TAV in patients with prosthesis embolization: Impact of commissural alignment and global outcomes. Int J Cardiol 2024; 410:132179. [PMID: 38761972 DOI: 10.1016/j.ijcard.2024.132179] [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: 03/30/2024] [Revised: 05/02/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Optimal strategies to manage embolization of transcatheter aortic valve implantation (TAVI) devices are unclear; valve-in-valve (ViV) is often used. We aimed to describe through one-single center experience its rate, causes, consequences, and management as well as the rate and relevance of commissural alignment (CA) in this context. METHODS We identified across 1038 TAVI cases, those cases requiring ViV for the management of first device embolization. CA (absence or mild misalignment) after first and second device was assessed by CT or fluoroscopy. RESULTS A total of 23 cases (2.2%) were identified, 52.3% embolized towards the aorta and 47.7% towards the ventricle. Suboptimal implant height (38%) and embolization at the time of post-dilation (23%) were the most frequent mechanisms together with greater rate of bicuspid valve (p < 0.001) and a trend to greater annular eccentricity. Procedural and 1-year death occurred in 13% and 34%, respectively (vs. 1.1% and 7.8% in the global cohort, p < 0.001). CA was present in 76.9% of the prostheses initially implanted but was only spontaneously achieved in 30.8% of the second ViV device. Adequate CA of both prostheses was identified in only two cases (8.7%). There were no cases of coronary obstruction. CONCLUSIONS TAVI device embolization mechanisms can often be predicted and prevented. Mortality following bail-out ViV is higher than in regular TAVI procedures but 2/3 of these patients survived beyond 1-year follow-up. In them, valve degeneration or coronary re-access might be particularly challenging since CA was rarely achieved with both devices suggesting that greater efforts should be made in this regard.
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Affiliation(s)
| | | | | | | | | | - Ana Serrador
- Cardiology Department, University Clinic Hospital, Valladolid, Spain; Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | | | - Alberto Campo
- Cardiology Department, University Clinic Hospital, Valladolid, Spain
| | - Carlos Cortés
- Cardiology Department, University Clinic Hospital, Valladolid, Spain
| | - Teresa Sevilla
- Cardiology Department, University Clinic Hospital, Valladolid, Spain; Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | | | - Julio Ruiz
- Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - Sofía Campillo
- Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - Carlos Baladrón
- Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - Manuel Carrasco-Moraleja
- Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - J Alberto San Román
- Cardiology Department, University Clinic Hospital, Valladolid, Spain; Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain
| | - Ignacio J Amat-Santos
- Cardiology Department, University Clinic Hospital, Valladolid, Spain; Enfermedades Cardiovasculares - Centro de Investigación biomédica en red (CIBERCV), Madrid, Spain.
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Fukuhara S, Kim KM, Yang B, Romano M, Ailawadi G, Patel HJ, Deeb GM. Reoperation following transcatheter aortic valve replacement: Insights from 10 years' experience. J Thorac Cardiovasc Surg 2024; 168:488-497.e3. [PMID: 37164056 DOI: 10.1016/j.jtcvs.2023.04.029] [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: 03/07/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Use of transcatheter aortic valve replacement (TAVR) has demonstrated dramatic growth in the past decade. This study aims to investigate implications of post-TAVR reoperation from our 10-year experience. METHODS Between 2011 and 2022, 66 post-TAVR patients underwent a reoperation, consisting of 42 (63.6%) patients with native TAVR and 24 (36.4%) patients with valve-in-valve TAVR (VIV-TAVR) after surgical aortic valve replacement. RESULTS The aggregate proportion of patients belonging to the low-/intermediate-risk group at the time of TAVR exceeded that of the high-/extreme-risk cohort in 2021. The native TAVR group received a larger TAVR valve, whereas more frequent low-risk status at the time of TAVR than the VIV-TAVR group. Concurrent procedures were highly common during reoperation and isolated surgical aortic valve replacement represented only 18.2% of the entire cohort. The native TAVR group demonstrated significantly higher TAVR explant difficulty index score (2.0 vs 1.0 points; P < .001) and operative mortality (14.2% vs 0%; P = .079) compared with the VIV-TAVR group. The 8-year cumulative incidence of reoperation was 1.9% and 14.1% (subdistribution hazard ratio, 8.0; 95% CI, 4.1-15.9; P < .001) in the native and VIV-TAVR group, respectively. Furthermore, cumulative incidence of valve reintervention, combining reoperations and redo TAVRs, was 3.3% and 19.0% (subdistribution hazard ratio, 6.2; 95% CI, 3.6-10.9; P < .001). CONCLUSIONS Low-/intermediate-risk patients are emerging as the predominant group necessitating reoperations. Native TAVR was associated with lower postimplant reintervention rates, albeit with higher reoperative technical difficulty and mortality. Conversely, VIV-TAVR was associated with higher reintervention, but demonstrated lower technical difficulty and mortality for reoperation.
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Affiliation(s)
- Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
| | - Karen M Kim
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Bo Yang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Matthew Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
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5
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McHugh S, Allaham H, Chahal D, Gupta A. Coronary Artery Revascularization in Patients Undergoing Transcatheter Aortic Valve Replacement. Cardiol Clin 2024; 42:333-338. [PMID: 38910018 DOI: 10.1016/j.ccl.2024.03.001] [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] [Indexed: 06/25/2024]
Abstract
Patients with concomitant severe aortic stenosis and significant coronary artery disease present a diagnostic and therapeutic challenge in clinical practice. There are no clear-cut guidelines as to the timing of revascularization in these patients who are referred for transcatheter aortic valve replacement (TAVR). This article aims to show that in patients without high-grade proximal coronary artery disease, revascularization after TAVR is safe, feasible, and practical. Additionally, the use of preoperative TAVR computed tomographic angiography might be used in both intermediate and high-risk patients rather than invasive coronary angiography to assess for significant proximal coronary artery disease to help guide the timing of revascularization.
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Affiliation(s)
| | | | - Diljon Chahal
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Anuj Gupta
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Fallahtafti P, Soleimani H, Ebrahimi P, Ghaseminejad‐Raeini A, Karimi E, Shirinezhad A, Sabri M, Mehrani M, Taheri H, Siegel R, Shah N, Nanna M, Hakim D, Hosseini K. Comparative Analysis of PCI Strategies in Aortic Stenosis Patients Undergoing TAVI: A Systematic Review and Network Meta-Analysis. Clin Cardiol 2024; 47:e24324. [PMID: 39054901 PMCID: PMC11272956 DOI: 10.1002/clc.24324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has been increasingly used in patients with severe aortic stenosis (AS). Since coronary artery disease (CAD) is common among these patients, it is crucial to choose the best method and timing of revascularization. This study aims to compare different timing strategies of percutaneous coronary intervention (PCI) in patients with severe AS undergoing TAVI to clarify whether PCI timing affects the patients' outcomes or not. METHODS A frequentist network meta-analysis was conducted comparing three different revascularization strategies in patients with CAD undergoing TAVI. The 30-day all-cause mortality, in-hospital mortality, all-cause mortality at 1 year, 30-day rates of myocardial infarction (MI), stroke, and major bleeding, and the need for pacemaker implantation at 6 months were analyzed in this study. RESULTS Our meta-analysis revealed that PCI during TAVI had higher 30-day mortality (RR = 2.46, 95% CI = 1.40-4.32) and in-hospital mortality (RR = 1.70, 95% CI = [1.08-2.69]) compared to no PCI. Post-TAVI PCI was associated with higher 1-year mortality compared to other strategies. While no significant differences in major bleeding or stroke were observed, PCI during TAVI versus no PCI (RR = 3.63, 95% CI = 1.27-10.43) showed a higher rate of 30-day MI. CONCLUSION Our findings suggest that among patients with severe AS and CAD undergoing TAVI, PCI concomitantly with TAVI seems to be associated with worse 30-day outcomes compared with no PCI. PCI after TAVI demonstrated an increased risk of 1-year mortality compared to alternative strategies. Choosing a timing strategy should be individualized based on patient characteristics and procedural considerations.
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Affiliation(s)
- Parisa Fallahtafti
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Hamidreza Soleimani
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Pouya Ebrahimi
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | | | - Elaheh Karimi
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
- School of MedicineTehran University of Medical SciencesTehranIran
| | | | - Mahshad Sabri
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Mehdi Mehrani
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
| | - Homa Taheri
- Smidt Heart InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Robert Siegel
- Smidt Heart InstituteCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Neeraj Shah
- Independence Health estmoreland HospitalGreensburgPennsylvaniaUSA
| | - Michael Nanna
- Section of Cardiovascular MedicineYale University School of MedicineNew HavenCTUSA
| | - Diaa Hakim
- Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Disease Research InstituteTehran University of Medical SciencesTehranIran
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7
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Imamura T, Ushijima R, Sobajima M, Fukuda N, Ueno H, Kinugawa K. Prognostic impact of insomnia in patients receiving trans-catheter aortic valve replacement. J Cardiol 2024; 84:113-118. [PMID: 38580176 DOI: 10.1016/j.jjcc.2024.03.009] [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: 02/05/2024] [Revised: 02/27/2024] [Accepted: 03/14/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND The presence of insomnia exhibits a profound association with diverse cardiovascular pathologies. However, its prognostic implications in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis remain ambiguous. METHODS This retrospective study enrolled patients who underwent TAVR for severe aortic stenosis at a prominent academic center from 2015 to 2022. The impact of insomnia, operationally defined as the prescription of soporific agents, on the two-year composite primary outcome comprising all-cause mortality and hospital readmissions was scrutinized. RESULTS A cohort of 345 patients (median age 85 years, 99 males) was encompassed in the analysis. All subjects underwent successful TAVR and subsequent discharge. The presence of insomnia (N = 91) emerged as an independent predictor of the two-year composite endpoint, with an adjusted hazard ratio of 1.66 (95 % confidence interval 1.08-2.57, p = 0.022), significantly delineating the two-year cumulative incidence of the primary endpoint (40 % versus 30 %, p = 0.035). CONCLUSION Approximately one-fourth of TAVR candidates manifested symptoms of insomnia, a condition autonomously correlated with heightened mortality and morbidity following the TAVR procedure. The optimal strategy for addressing insomnia in TAVR candidates constitutes a paramount consideration for future interventions.
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Affiliation(s)
- Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
| | - Ryuichi Ushijima
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Mitsuo Sobajima
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Nobuyuki Fukuda
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Hiroshi Ueno
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
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Li R, Luo Q, Huddleston SJ. African Americans have worse outcomes after transcatheter and surgical aortic valve replacement: A national inpatient sample analysis from 2015 to 2020. J Cardiol 2024; 84:105-112. [PMID: 38373538 DOI: 10.1016/j.jjcc.2024.02.003] [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: 11/20/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Racial disparities in transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are controversial among African Americans (AA). This study investigated racial disparities comparing AA and Caucasians undergoing aortic valve replacement. METHODS Patients who underwent SAVR and TAVR for aortic stenosis were identified in National Inpatient Sample from Q4 2015-2020. In-hospital perioperative outcomes, length of stay, days from admission to operation, and total hospital charge, were compared between AA and Caucasians using multivariable analysis, adjusting for sex, age, socioeconomic status, comorbidity, and hospital characteristics. RESULTS In TAVR, 51,394 (84.41 %) were Caucasians and 2433 (4.00 %) were AA. In SAVR, there were 50,080 (78.52 %) Caucasians and 3565 (5.59 %) AA. Compared to Caucasians, AA underwent TAVR had a higher risk of complications such as major adverse cardiovascular events (MACE) [adjusted odds ratio (aOR) = 1.335, p = 0.02)], respiratory complications (aOR = 1.363, p = 0.01), acute kidney injury (AKI) (aOR = 1.468, p < 0.01), pulmonary embolism (aOR = 4.65, p = 0.05), hemorrhage/hematoma (aOR = 1.202, p < 0.01), or superficial wound complication (aOR = 1.414, p = 0.04). AA who underwent SAVR had higher risks of morality (aOR = 1.184, p < 0.05) and surgical complications including MACE (aOR = 1.263, p < 0.01), pericardial complications (aOR = 1.563, p < 0.01), cardiogenic shock (aOR = 1.578, p < 0.01), respiratory complications (aOR = 1.261, p < 0.01), AKI (aOR = 1.642, p < 0.01), venous thromboembolism (aOR = 1.613, p < 0.01), hemorrhage/hematoma (aOR = 1.129, p < 0.01), infection (aOR = 1.234, p < 0.01), superficial wound complications (aOR = 1.756, p < 0.01), vascular complications (aOR = 1.592, p < 0.01), and diaphragmatic paralysis (aOR = 2.181, p = 0.02). In both TAVR and SAVR, AA had longer waiting times from admission to operation (p < 0.01), longer hospital stays (p < 0.01), and higher hospital charges (p < 0.01). CONCLUSION AA were underrepresented, especially in TAVR. AA experienced higher in-hospital mortality post-SAVR, but not after TAVR. Furthermore, AA had more complications for both TAVR and SAVR. These findings underscore the pronounced disparities among AA in aortic valve replacement.
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Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Qianyun Luo
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Stephen J Huddleston
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
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9
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Di Pietro G, Improta R, De Filippo O, Bruno F, Birtolo LI, Tocci M, Fabris T, Saade W, Colantonio R, Celli P, Sardella G, Esposito G, Tarantini G, Mancone M, D'Ascenzo F. Transcatheter Aortic Valve Replacement in Low Surgical Risk Patients: An Updated Metanalysis of Extended Follow-Up Randomized Controlled Trials. Am J Cardiol 2024; 224:56-64. [PMID: 38729335 DOI: 10.1016/j.amjcard.2024.05.005] [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: 02/08/2024] [Revised: 04/03/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
The long-term safety and effectiveness of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR) in low surgical risk has not been evaluated in a pooled analysis. An electronic database search was conducted for randomized controlled trials with a maximal 5 years clinical and echocardiographic follow-up including low surgical risk patients who underwent TAVR or SAVR. We calculated odds ratio (OR) and 95% confidence intervals (CIs) using a random-effects model. Subgroups analysis was performed for permanent pacemaker implantation and paravalvular leaks. Three randomized controlled trials were included with a total of 2,611 low surgical risk patients (Society of Thoracic Surgeons score <4%). Compared with SAVR, the TAVR group had similar rates of all-cause mortality (OR 0.94,95% CI 0.65 to 1.37, p = 0.75) and disabling stroke (OR 0.84, 95% CI 0.52 to 1.36, p = 0.48). No significant differences were registered in the TAVR group in terms of major cardiovascular events (OR 0.96, 95% CI 0.67 to 1.38, p = 0.83), myocardial infarction (OR 0.69, 95% CI 0.34 to 1.40, p = 0.31), valve thrombosis (OR 3.11, 95% CI 0.29 to 33.47, p = 0.35), endocarditis (OR 0.71,95% CI 0.35 to 1.48, p = 0.36), aortic valve reintervention (OR 0.93, 95% CI 0.52 to 1.66, p = 0.80), and rehospitalization (OR 0.80, 95% CI 0.52 to 1.02, p = 0.07) compared with SAVR. However, TAVR patients had a higher risk of paravalvular leaks (OR 8.21, 95% CI 4.18 to 16.14, p <0.00001), but lower rates of new-onset atrial fibrillation (OR 0.27,95% CI 0.17 to 0.30, p <0.0001). The rates of permanent pacemaker implantation were comparable from 1 year up to a maximum of 5 years (OR 1.32, 95% CI 0.88 to 1.97, p = 0.18). Lastly, TAVR had a greater effective orifice area (0.10 cm2/m2, 95% CI 0.05 to 0.15, p = 0.0001), but similar transvalvular mean gradients (0.60, 95% CI 3.94 to 2.73, p = 0.72). In conclusion, TAVR patients had similar long-term outcomes compared with SAVR, except for an elevated risk of paravalvular leaks in the TAVR group and increased rates of atrial fibrillation in the SAVR cohort.
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Affiliation(s)
- Gianluca Di Pietro
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy; Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
| | - Riccardo Improta
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy; Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
| | - Ovidio De Filippo
- Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
| | - Francesco Bruno
- Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Marco Tocci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Tommaso Fabris
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Wael Saade
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Riccardo Colantonio
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Paola Celli
- Department of General and Specialistic Surgery "Paride Stefanini", "Sapienza" University of Rome, Rome, Italy
| | - Gennaro Sardella
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy.
| | - Fabrizio D'Ascenzo
- Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
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Etiwy M, Flannery LD, Li SX, Morrison FJ, Kim J, Tanguturi VK, Fraccaro C, Coylewright M, Turchin A, Elmariah S, Wasfy JH. Examining lack of referrals to heart valve specialists as mechanisms of potential underutilization of aortic valve replacement. Am Heart J 2024; 274:54-64. [PMID: 38621577 DOI: 10.1016/j.ahj.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/29/2024] [Accepted: 04/11/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Recent studies suggest that aortic valve replacement (AVR) remains underutilized. AIMS Investigate the potential role of non-referral to heart valve specialists (HVS) on AVR utilization. METHODS Patients with severe aortic stenosis (AS) between 2015 and 2018, who met class I indication for intervention, were identified. Baseline data and process-related parameters were collected to analyze referral predictors and evaluate outcomes. RESULTS Among 981 patients meeting criteria AVR, 790 patients (80.5%) were assessed by HVS within six months of index TTE. Factors linked to reduced referral included increasing age (OR: 0.95; 95% CI: 0.94-0.97; P < .001), unmarried status (OR: 0.59; 95% CI: 0.43-0.83; P = .002) and inpatient TTE (OR: 0.27; 95% CI: 0.19-0.38; P < .001). Conversely, higher hematocrit (OR: 1.13; 95% CI: 1.09-1.16; P < .001) and eGFR (OR: 1.01; 95% CI: 1.00-1.02; P = .003), mean aortic valve gradient (OR: 1.03; 95% CI: 1.01-1.04; P < .001) and preserved LVEF (OR: 1.59; 95% CI: 1.02-2.48; P = .04), were associated with increased referral likelihood. Moreover, patients assessed by HVS referral as a time-dependent covariate had a significantly lower two-year mortality risk than those who were not (aHR: 0.30; 95% CI: 0.23-0.39; P < .001). CONCLUSION A substantial proportion of severe AS patients meeting indications for AVR are not evaluated by HVS and experience markedly increased mortality. Further research is warranted to assess the efficacy of care delivery mechanisms, such as e-consults, and telemedicine, to improve access to HVS expertise.
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Affiliation(s)
- Muhammad Etiwy
- Department of Medicine, Division of Hospital Medicine, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH; Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laura D Flannery
- Department of Medicine, Division of Cardiology, OhioHealth Doctors Hospital, Columbus, OH
| | - Shawn X Li
- Department of Medicine, Division of Cardiology, The University of California San Francisco, CA
| | - Fritha J Morrison
- Department of Medicine, Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joonghee Kim
- Department of Medicine, Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Varsha K Tanguturi
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Megan Coylewright
- Erlanger Health System, University of Tennessee-Chattanooga, Chattanooga, TN
| | - Alexander Turchin
- Department of Medicine, Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sammy Elmariah
- Department of Medicine, Division of Cardiology, The University of California San Francisco, CA,.
| | - Jason H Wasfy
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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11
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Hyung K An J, Faridmoayer E, Haefner L, Salami AC, Sharath SE, Kougias P. Trends and predictors of inflation-adjusted costs in transcatheter and surgical aortic valve replacement in a nationally representative sample. Surgery 2024; 176:289-294. [PMID: 38772777 DOI: 10.1016/j.surg.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/05/2024] [Accepted: 04/13/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Transcatheter aortic valve replacement has become an accepted alternative to surgical aortic valve replacement. We examined the trends and predictors in inflation-adjusted costs of transcatheter aortic valve replacement and surgical aortic valve replacement. METHODS National Inpatient Sample identified patients who underwent aortic valve replacement for severe aortic stenosis by International Classification of Diseases, Ninth and Tenth Revisions, codes. Hospitalization costs were inflation-adjusted using the Federal Reserve's consumer price index to reflect current valuation. Outcomes of interest were unadjusted trend in annual cost for each procedure and predictors of in-patient cost. Generalized linear models with a log link function identified predictors of adjusted costs. Interaction terms determined where cost predictors were different by operation type. RESULTS Between 2011 and 2019, the mean annual inflation-adjusted cost of surgical aortic valve replacement increased from $62,853 to $63,743, in contrast to decreasing cost of transcatheter aortic valve replacement from $64,913 to $56,042 ($1,854 per year; P = .004). Significant independent predictors of patient-level cost included operation type (transcatheter aortic valve replacement associated with $9,625 increase; P < .001), incidence of in-hospital mortality ($28,836 increase; P < .001), elective status ($2,410 decrease; P < .001), Elixhauser Index ($995 increase; P < .001), and postoperative length of stay ($2,014 per day increase; P < .001). Compared to discharges with Medicare, discharges with private insurance and Medicaid paid $736 less (P = .004) and $1,863 less (P = .01), respectively. Increasing hospital volume was a significant predictor of decreasing patient level cost (P < .001). CONCLUSION Annual cost of transcatheter aortic valve replacement has decreased significantly and has been a more cost-effective modality compared to surgical aortic valve replacement since 2017. Predictors of patient-level costs allow for mindful preparation of healthcare systems for aortic valve replacement.
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Affiliation(s)
- Ju Hyung K An
- Department of Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY. https://twitter.com/kja485
| | - Erfan Faridmoayer
- Department of Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY. https://twitter.com/ErfanFarid
| | - Lindsay Haefner
- Department of Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY
| | - Aitua C Salami
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN. https://twitter.com/ACSalami
| | - Sherene E Sharath
- Department of Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY.
| | - Panos Kougias
- Department of Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY. https://twitter.com/KougiasP
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12
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Radico F, Biancari F, D’Ascenzo F, Saia F, Luzi G, Bedogni F, Amat-Santos IJ, De Marzo V, Dimagli A, Mäkikallio T, Stabile E, Blasco-Turrión S, Testa L, Barbanti M, Tamburino C, Porto I, Fabiocchi F, Conrotto F, Pelliccia F, Costa G, Stefanini GG, Macchione A, La Torre M, Bendandi F, Juvonen T, Pasceri V, Wańha W, Benedetto U, Miraldi F, Dobrev D, Zimarino M. Red blood cell transfusion and mortality after transcatheter aortic valve implantation via transapical approach: A propensity-matched comparison from the TRITAVI registry. IJC HEART & VASCULATURE 2024; 53:101460. [PMID: 39070183 PMCID: PMC11278079 DOI: 10.1016/j.ijcha.2024.101460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/07/2024] [Accepted: 06/21/2024] [Indexed: 07/30/2024]
Abstract
Objective Bleeding is frequent during transcatheter aortic valve implantation (TAVI), especially when performed through a transapical approach (TA), and is associated with a worse prognosis. The present study aims to test the implication of red blood cell (RBC) transfusion and the optimal transfusion strategy in this context. Methods Among 11,265 participants in the multicenter TRITAVI (Transfusion Requirements in Transcatheter Aortic Valve Implantation) registry, 548 patients (4.9%) who received TA-TAVI at 19 European centers were included. One-to-one propensity score matching was performed to reduce treatment selection bias and potential confounding among transfused versus non-transfused patients. The primary endpoint of the study was the 30-day occurrence of all-cause mortality. Results 209 patients (38 %) received RBC transfusions. The primary endpoint occurred in 47 (8.6 %) patients. Propensity score matching identified 188 pairs of patients with and without RBC transfusion. In the propensity score-matched analysis, RBC transfusion was associated with increased 30-day mortality (HR 3.35, 95 % CI 1.51 - 7.39; p = 0.002). At multivariable cox regression analysis, RBC transfusion was an independent predictor of 30-day mortality (HR 3.07, 95 % CI 1.01-9.41, p = 0.048), as well as baseline ejection fraction (HR 0.96, 95 % CI 0.92-0.99, p = 0.043), and acute kidney injury (HR 3.95, 95 % CI 1.11-14.05, p = 0.034). Conclusions RBC transfusion is an independent predictor of short-term mortality in patients undergoing TA-TAVI, regardless of major bleeding.Clinical trial registration: https://www.clinicaltrials.gov Unique identifier: NCT03740425.
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Affiliation(s)
- Francesco Radico
- Department of Cardiology, ASL2 Abruzzo and Department of Neuroscience, Imaging and Clinical Sciences, ’G. D’Annunzio’ University of Chieti-Pescara, Italy
| | - Fausto Biancari
- Department of Medicine, South Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Fabrizio D’Ascenzo
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Francesco Saia
- Department of Cardiothoracic Vascular, University Hospital, Bologna, Italy
| | - Giampaolo Luzi
- Cardiovascular Department, Azienda Ospedaliera Regionale “San Carlo”, Potenza, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Ignacio J. Amat-Santos
- CIBERCV, Interventional Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Vincenzo De Marzo
- Department of Cardiology, ASL2 Abruzzo and Department of Neuroscience, Imaging and Clinical Sciences, ’G. D’Annunzio’ University of Chieti-Pescara, Italy
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties University of Genoa Italy
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, the United States of America
| | - Timo Mäkikallio
- Department of Medicine, South Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Eugenio Stabile
- Cardiovascular Department, Azienda Ospedaliera Regionale “San Carlo”, Potenza, Italy
| | - Sara Blasco-Turrión
- CIBERCV, Interventional Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
| | - Italo Porto
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties University of Genoa Italy
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa Italy
| | - Franco Fabiocchi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Galeazzi-Sant’Ambrogio Hospital, I.R.C.C.S. Milan, Italy
| | - Federico Conrotto
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | | | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico - San Marco”, Catania, Italy
| | | | - Andrea Macchione
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa Italy
| | - Michele La Torre
- Department of Cardiothoracic Vascular, University Hospital, Bologna, Italy
| | - Francesco Bendandi
- Department of Cardiothoracic Vascular, University Hospital, Bologna, Italy
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | | | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Umberto Benedetto
- Department of Cardiac Surgery, University “G. d’Annunzio”, Chieti, Italy
| | - Fabio Miraldi
- Department of Cardiovascular Sciences, University Sapienza, Rome, Italy
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
- Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
- Department of Integrative Physiology, Baylor College of Medicine, Houston, TX, the United States of America
| | - Marco Zimarino
- Department of Cardiology, ASL2 Abruzzo and Department of Neuroscience, Imaging and Clinical Sciences, ’G. D’Annunzio’ University of Chieti-Pescara, Italy
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13
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Lee SH, Yoon SJ, Sun BJ, Kim HM, Kim HY, Lee S, Shim CY, Kim EK, Cho DH, Park JB, Seo JS, Son JW, Kim IC, Lee SH, Heo R, Lee HJ, Park JH, Song JM, Lee SC, Kim H, Kang DH, Ha JW, Kim KH. 2023 Korean Society of Echocardiography position paper for diagnosis and management of valvular heart disease, part I: aortic valve disease. J Cardiovasc Imaging 2024; 32:11. [PMID: 39061115 PMCID: PMC11282617 DOI: 10.1186/s44348-024-00019-0] [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: 09/06/2023] [Accepted: 11/24/2023] [Indexed: 07/28/2024] Open
Abstract
This manuscript represents the official position of the Korean Society of Echocardiography on valvular heart diseases. This position paper focuses on the clinical management of valvular heart diseases with reference to the guidelines recently published by the American College of Cardiology/American Heart Association and the European Society of Cardiology. The committee tried to reflect the recently published results on the topic of valvular heart diseases and Korean data by a systematic literature search based on validity and relevance. In part I of this article, we will review and discuss the current position of aortic valve disease in Korea.
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Affiliation(s)
- Sun Hwa Lee
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Se-Jung Yoon
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Byung Joo Sun
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyue Mee Kim
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hyung Yoon Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Sahmin Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong-Sook Seo
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jung-Woo Son
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - In-Cheol Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Sang-Hyun Lee
- Division of Cardiology, Pusan National Yangsan Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National Yangsan Hospital, Busan, Republic of Korea
| | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
- Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jong-Min Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyungseop Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
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14
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Spadaccio C, Nenna A, Pisani A, Laskawski G, Nappi F, Moon MR, Biancari F, Jassar AS, Greason KL, Shrestha ML, Bonaros N, Rose D. Sutureless Valves, a "Wireless" Option for Patients With Aortic Valve Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 84:382-407. [PMID: 39019533 DOI: 10.1016/j.jacc.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/21/2024] [Accepted: 05/03/2024] [Indexed: 07/19/2024]
Abstract
Transcatheter technologies triggered the recent revision of the guidelines that progressively widened the indications for the treatment of aortic stenosis. On the surgical realm, a technology avoiding the need for sutures to anchor the prosthesis to the aortic annulus has been developed with the aim to reduce the duration of cardiopulmonary bypass and simplify the process of valve implantation. In addition to a transcatheter aortic valve replacement (TAVR)-like stent that exerts a radial force, these so-called "rapid deployment valves" or "sutureless valves" for aortic valve replacement also have cuffs to improve sealing and reduce the risk of paravalvular leak. Despite promising, the actual advantage of sutureless valves over traditional surgical procedures (surgical aortic valve replacement) or TAVR is still debated. This review summarizes the current comparative evidence reporting outcomes of "sutureless valves" for aortic valve replacement to TAVR and surgical aortic valve replacement in the treatment of aortic valve stenosis.
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Affiliation(s)
- Cristiano Spadaccio
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom; Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Antonio Nenna
- Cardiovascular Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Angelo Pisani
- Cardiac Surgery, Hôpital Bichat - Claude-Bernard, Paris, France
| | - Grzegorz Laskawski
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom
| | - Francesco Nappi
- Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Marc R Moon
- Cardiothoracic Surgery, Baylor College of Medicine/Texas Heart Institute, Houston, Texas, USA
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital/University of Helsinki, Helsinki, Finland
| | - Arminder S Jassar
- Cardiac Surgery, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
| | - Kevin L Greason
- Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Malakh L Shrestha
- Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA; Cardiothoracic Surgery, Hannover Medical School, Hannover, Germany
| | - Nikolaos Bonaros
- Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - David Rose
- Cardiothoracic Surgery, Lancashire Cardiac Centre/Blackpool Teaching Hospital, Blackpool, United Kingdom
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15
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Bapat VN, Fukui M, Zaid S, Okada A, Jilaihawi H, Rogers T, Khalique O, Cavalcante JL, Landes U, Sathananthan J, Tarantini G, Tang GHL, Blackman DJ, De Backer O, Mack MJ, Leon MB. A Guide to Transcatheter Aortic Valve Design and Systematic Planning for a Redo-TAV (TAV-in-TAV) Procedure. JACC Cardiovasc Interv 2024; 17:1631-1651. [PMID: 39048251 DOI: 10.1016/j.jcin.2024.04.047] [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: 03/05/2024] [Revised: 04/27/2024] [Accepted: 04/30/2024] [Indexed: 07/27/2024]
Abstract
Transcatheter aortic valve replacement (TAVR) has become more common than surgical aortic valve replacement since 2016, with over 200,000 procedures globally each year. As patients increasingly outlive their TAVR devices, managing these cases is a growing concern. Treatment options include surgical removal of the old TAVR device (transcatheter aortic valve [TAV] explant) or implantation of a new transcatheter aortic valve (redo TAV). Redo TAV is complex because of the unique designs of TAV devices; compatibility issues; and the need for individualized planning based on factors such as implant depth, shape, and coronary artery relationships. This review serves as a comprehensive guide for redo TAV, detailing the design characteristics of TAV devices, device compatibility, standardized terminology, and a structured approach for computed tomography analysis. It aims to facilitate decision making, risk identification, and achieving optimal outcomes in redo TAV procedures.
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Affiliation(s)
- Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
| | - Miho Fukui
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Syed Zaid
- Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas, USA
| | - Atsushi Okada
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Hasan Jilaihawi
- Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, California, USA
| | - Toby Rogers
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Omar Khalique
- Division of Cardiovascular Imaging at St. Francis Hospital, New York, New York, USA
| | - João L Cavalcante
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Uri Landes
- Edith Wolfson Medical Center, Cardiology Department, Tel-Aviv University, Holon, Israel
| | | | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | | | - Ole De Backer
- The Heart Center, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Martin B Leon
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
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16
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Ungar A, Rivasi G, Testa GD, Boureau AS, Mattace-Raso F, Martínez-Sellés M, Bo M, Petrovic M, Werner N, Benetos A. Geriatricians' role in the management of aortic stenosis in frail older patients: a decade later. Eur Geriatr Med 2024:10.1007/s41999-024-01015-9. [PMID: 39037643 DOI: 10.1007/s41999-024-01015-9] [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] [Accepted: 06/25/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Increasing evidence supports the implementation of geriatric assessment in the workup of older patients with aortic stenosis (AS). In 2012, an online European survey revealed that geriatricians were rarely involved in the assessment of candidates for transcatheter aortic valve implantation (TAVI). After a "call to action" for early involvement of geriatricians in AS evaluation, the survey was repeated in 2022. Our aim was to investigate whether geriatricians' role changed in the last decade. METHODS Online survey conducted between December 16th, 2021, and December 15th, 2022. All members of the European Geriatric Medicine Society were invited to participate. The survey included 26 questions regarding geriatricians' experience with AS and TAVI. RESULTS Among 193 respondents (79.8% geriatricians), 73 (38%) reported to be involved in AS evaluation at least once a week. During 2 years prior to the survey, 43 (22.3%) had referred > 50% of their patients with severe AS for TAVI. Age influenced TAVI referral in a considerable proportion of respondents (36.8%). TAVI candidates were mainly referred to specialised cardiac centres with multidisciplinary teams (91.8%), including (47.2%) or not including (44.6%) a geriatrician. A total of 38.9% of respondents reported to be part of a multidisciplinary heart team. Geriatricians were less frequently involved (37%) than cardiologists (89.6%) and surgeons (53.4%) in pre-procedural TAVI management. Cardiologists were more frequently involved (85.5%) than geriatricians (33.7%) and surgeons (26.9%) in post-procedural management. CONCLUSIONS Geriatricians' involvement in AS management and multidisciplinary heart teams remains scarce. More efforts should be devoted to implement geriatricians' role in AS decision-making.
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Affiliation(s)
- Andrea Ungar
- Geriatrics and Intensive Care Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Giulia Rivasi
- Geriatrics and Intensive Care Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Giuseppe Dario Testa
- Geriatrics and Intensive Care Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Anne Sophie Boureau
- Nantes Université, CHU Nantes, Pole de Gérontologie Clinique, 44000, Nantes, France
| | - Francesco Mattace-Raso
- Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Mario Bo
- Section of Geriatric, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Molinette, Turin, Italy
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Nikos Werner
- Heart Center Trier, Department of Internal Medicine III, Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany
| | - Athanase Benetos
- Geriatric Department and Federation Hospital-University On Cardiovascular Aging (FHU-CARTAGE), University Hospital of Nancy, Université de Lorraine, Vandoeuvre-Lès-Nancy, France
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17
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Bacco LD, D’Alonzo M, Eusanio MD, Rosati F, Solinas M, Baudo M, Folliguet T, Benussi S, Fischlein T, Muneretto C. Sutureless Aortic Valve Replacement vs. Transcatheter Aortic Valve Implantation in Patients with Small Aortic Annulus: Clinical and Hemodynamic Outcomes from a Multi-Institutional Study. Braz J Cardiovasc Surg 2024; 39:e20230155. [PMID: 39038084 PMCID: PMC11259373 DOI: 10.21470/1678-9741-2023-0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/21/2023] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVE This study aimed to compare hemodynamic performances and clinical outcomes of patients with small aortic annulus (SAA) who underwent aortic valve replacement by means of sutureless aortic valve replacement (SUAVR) or transcatheter aortic valve implantation (TAVI). METHODS From 2015 to 2020, 622 consecutive patients with SAA underwent either SUAVR or TAVI. Through a 1:1 propensity score matching analysis, two homogeneous groups of 146 patients were formed. Primary endpoint: all cause-death at 36 months. Secondary endpoints: incidence of moderate to severe patient-prosthesis mismatch (PPM) and incidence of major adverse cardiovascular and cerebrovascular events (MACCEs). RESULTS All-cause death at three years was higher in the TAVI group (SUAVR 12.2% vs. TAVI 21.0%, P=0.058). Perioperatively, comparable hemodynamic performances were recorded in terms of indexed effective orifice area (SUAVR 1.12 ± 0.23 cm2/m2 vs. TAVI 1.17 ± 0.28 cm2/m2, P=0.265), mean transvalvular gradients (SUAVR 12.9 ± 5.3 mmHg vs. TAVI 12.2 ± 6.2 mmHg, P=0.332), and moderate-to-severe PPM (SUAVR 4.1% vs. TAVI 8.9%, P=0.096). TAVI group showed a higher cumulative incidence of MACCEs at 36 months (SUAVR 18.1% vs. TAVI 32.6%, P<0.001). Pacemaker implantation (PMI) and perivalvular leak ≥ 2 were significantly higher in TAVI group and identified as independent predictors of mortality (PMI: hazard ratio [HR] 3.05, 95% confidence interval [CI] 1.34-6.94, P=0.008; PPM: HR 2.72, 95% CI 1.25-5.94, P=0.012). CONCLUSION In patients with SAA, SUAVR and TAVI showed comparable hemodynamic performances. Moreover, all-cause death and incidence of MACCEs at follow-up were significantly higher in TAVI group.
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Affiliation(s)
- Lorenzo Di Bacco
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia,
University of Brescia, Brescia, Italy
| | - Michele D’Alonzo
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia,
University of Brescia, Brescia, Italy
| | - Marco Di Eusanio
- Cardiovascular Surgery Department, Ospedali Riuniti, Ancona, Italy
| | - Fabrizio Rosati
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia,
University of Brescia, Brescia, Italy
| | - Marco Solinas
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital,
Massa, Italy
| | - Massimo Baudo
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia,
University of Brescia, Brescia, Italy
| | - Thierry Folliguet
- Cardiac surgery, Centre Hospitalier Universitaire Mondor,
Créteil, France
| | - Stefano Benussi
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia,
University of Brescia, Brescia, Italy
| | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg, Nuremberg,
Germany
| | - Claudio Muneretto
- Department of Cardiac Surgery, ASST Spedali Civili di Brescia,
University of Brescia, Brescia, Italy
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18
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Bonnet M, Maxo L, Lohse T, Mangin L, Courand PY, Ricard C, Bouali A, Boussel L, Aktaa S, Ali N, Gerelli S, Lantelme P, Harbaoui B. Association Between Aortic Wall Thrombus and Thromboembolic Events After Transfemoral Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2024; 17:1680-1690. [PMID: 39048255 DOI: 10.1016/j.jcin.2024.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/05/2024] [Accepted: 05/21/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Thromboembolic events, particularly strokes, remain a major complication of transcatheter aortic valve replacement (TAVR). Embolic protection devices have failed to show significant clinical benefit in large randomized clinical trials. Aortic wall thrombus (AWT) is often observed on multidetector computed tomography during TAVR work-up, but its prognostic significance is uncertain. OBJECTIVES This study sought to evaluate the association between the presence of AWT and the incidence of thromboembolic outcomes in patients undergoing transfemoral (TF) TAVR for severe aortic stenosis. METHODS This was a prospective cohort study of consecutive patients who underwent TF TAVR for severe aortic stenosis between January 2011 and April 2022. A dedicated scale (range: 0-10) was qualitatively used to assess AWT. The primary outcome was a composite of procedural thromboembolic events defined as ischemic stroke, blue toe syndrome, bowel ischemia, or other solid organ infarction. The secondary endpoints were ischemic strokes and procedural death. RESULTS Of the 641 patients included, severe AWT (score ≥8) was identified in 73 (11.4%). The presence of severe AWT was strongly associated with an increase in the primary outcome (OR: 8.48; 95% CI: 3.36-21.40; P < 0.001). This relationship persisted following multivariable analysis, which adjusted for comorbidities and procedural characteristics. The presence of severe AWT was also found to be associated with an increased incidence of stroke and procedural death (OR: 5.66; 95% CI: 2.00-15.30; P = 0.002 and OR: 4.66; 95% CI: 1.80-11.30; P = 0.002, respectively). CONCLUSIONS The presence of severe AWT on preprocedural multidetector computed tomography is strongly associated with thromboembolic complications including stroke and mortality after TF TAVR.
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Affiliation(s)
- Marc Bonnet
- Cardiology Department, (Institut de Cardiologie) Hospital Croix-Rousse and Hospital Lyon Sud, Hospices Civils de Lyon, Lyon, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France; Cardiology Department, Hospital Annecy-Genevois, Metz-Tessy, France
| | - Ludovic Maxo
- Cardiology Department, (Institut de Cardiologie) Hospital Croix-Rousse and Hospital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Thomas Lohse
- Cardiology Department, (Institut de Cardiologie) Hospital Croix-Rousse and Hospital Lyon Sud, Hospices Civils de Lyon, Lyon, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France
| | - Lionel Mangin
- Cardiology Department, Hospital Annecy-Genevois, Metz-Tessy, France
| | - Pierre-Yves Courand
- Cardiology Department, (Institut de Cardiologie) Hospital Croix-Rousse and Hospital Lyon Sud, Hospices Civils de Lyon, Lyon, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France
| | - Cécile Ricard
- Cardiology Department, Hospital Annecy-Genevois, Metz-Tessy, France
| | - Anissa Bouali
- Cardiology Department, (Institut de Cardiologie) Hospital Croix-Rousse and Hospital Lyon Sud, Hospices Civils de Lyon, Lyon, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France
| | - Loïc Boussel
- University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France; Radiology Department, Hospital Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Suleman Aktaa
- Cardiology Department, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, United Kingdom
| | - Noman Ali
- Cardiology Department, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, United Kingdom
| | - Sébastien Gerelli
- Cardiac Surgery Department, Hospital Annecy-Genevois, Metz-Tessy, France
| | - Pierre Lantelme
- Cardiology Department, (Institut de Cardiologie) Hospital Croix-Rousse and Hospital Lyon Sud, Hospices Civils de Lyon, Lyon, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France
| | - Brahim Harbaoui
- Cardiology Department, (Institut de Cardiologie) Hospital Croix-Rousse and Hospital Lyon Sud, Hospices Civils de Lyon, Lyon, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France.
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19
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Hung Y, Lin C, Lin CS, Lee CC, Fang WH, Lee CC, Wang CH, Tsai DJ. Artificial Intelligence-Enabled Electrocardiography Predicts Future Pacemaker Implantation and Adverse Cardiovascular Events. J Med Syst 2024; 48:67. [PMID: 39028354 DOI: 10.1007/s10916-024-02088-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
Medical advances prolonging life have led to more permanent pacemaker implants. When pacemaker implantation (PMI) is commonly caused by sick sinus syndrome or conduction disorders, predicting PMI is challenging, as patients often experience related symptoms. This study was designed to create a deep learning model (DLM) for predicting future PMI from ECG data and assess its ability to predict future cardiovascular events. In this study, a DLM was trained on a dataset of 158,471 ECGs from 42,903 academic medical center patients, with additional validation involving 25,640 medical center patients and 26,538 community hospital patients. Primary analysis focused on predicting PMI within 90 days, while all-cause mortality, cardiovascular disease (CVD) mortality, and the development of various cardiovascular conditions were addressed with secondary analysis. The study's raw ECG DLM achieved area under the curve (AUC) values of 0.870, 0.878, and 0.883 for PMI prediction within 30, 60, and 90 days, respectively, along with sensitivities exceeding 82.0% and specificities over 81.9% in the internal validation. Significant ECG features included the PR interval, corrected QT interval, heart rate, QRS duration, P-wave axis, T-wave axis, and QRS complex axis. The AI-predicted PMI group had higher risks of PMI after 90 days (hazard ratio [HR]: 7.49, 95% CI: 5.40-10.39), all-cause mortality (HR: 1.91, 95% CI: 1.74-2.10), CVD mortality (HR: 3.53, 95% CI: 2.73-4.57), and new-onset adverse cardiovascular events. External validation confirmed the model's accuracy. Through ECG analyses, our AI DLM can alert clinicians and patients to the possibility of future PMI and related mortality and cardiovascular risks, aiding in timely patient intervention.
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Affiliation(s)
- Yuan Hung
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taipei, Taiwan, R.O.C
| | - Chin Lin
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Medical Technology Education Center, School of Medicine, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chin-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taipei, Taiwan, R.O.C
| | - Chiao-Chin Lee
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taipei, Taiwan, R.O.C
| | - Wen-Hui Fang
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chia-Cheng Lee
- Medical Informatics Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chih-Hung Wang
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Dung-Jang Tsai
- Artificial Intelligence of Things Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C..
- Medical Technology Education Center, School of Medicine, National Defense Medical Center, Taipei, Taiwan, R.O.C..
- Department of Statistics and Information Science, Fu Jen Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist, New Taipei City, 242062, Taiwan, R.O.C..
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20
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Ellfors E, Dismorr M, Rück A, Settergren M, Sartipy U, Glaser N. Predicted prosthesis-patient mismatch and long-term clinical outcomes after transcatheter aortic valve replacement: a SWEDEHEART study. Am Heart J 2024:S0002-8703(24)00175-3. [PMID: 39032585 DOI: 10.1016/j.ahj.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/07/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND The impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) is uncertain. This study was performed to investigate the risk of all-cause mortality, heart failure hospitalization, and aortic valve reintervention in patients with and without predicted PPM after TAVR. METHODS This nationwide, population-based cohort study included all patients who underwent transfemoral primary TAVR in Sweden from 2008 to 2022 in the SWEDEHEART register. PPM was defined according to published effective orifice areas for each valve model and size. The patients were divided into those with and without PPM. Additional baseline characteristics and outcome data were obtained from other national health data registers. Regression standardization was used to adjust for intergroup differences. RESULTS Of 8485 patients, 7879 (93%) had no PPM and 606 (7%) had PPM. The crude cumulative incidence of all-cause mortality at 1, 5, and 10 years in patients with versus without PPM was 7% versus 9%, 40% versus 44%, and 80% versus 85%, respectively. After regression standardization, there was no between-group difference in long-term mortality, and the absolute difference at 10 years was 1.5% (95% confidence interval, -2.9%-6.0%). The mean follow-up was 3.0 years (maximum, 14 years). There was no difference in the risk of heart failure hospitalization or aortic valve reintervention. CONCLUSIONS The risk of all-cause mortality, heart failure hospitalization, or aortic valve reintervention was not higher in patients with than without predicted PPM following TAVR. Furthermore, PPM was present in only 7% of patients, and severe PPM was almost nonexistent.
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Affiliation(s)
- Emma Ellfors
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Michael Dismorr
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Rück
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Settergren
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Natalie Glaser
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Brunetti E, Lucà F, Presta R, Marchionni N, Boccanelli A, Ungar A, Rao CM, Ingianni N, Lettino M, Del Sindaco D, Murrone A, Riccio C, Colivicchi F, Grimaldi M, Gulizia MM, Oliva F, Bo M, Parrini I. A Comprehensive Geriatric Workup and Frailty Assessment in Older Patients with Severe Aortic Stenosis. J Clin Med 2024; 13:4169. [PMID: 39064209 PMCID: PMC11278149 DOI: 10.3390/jcm13144169] [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: 05/09/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Aortic stenosis (AS) represents a notable paradigm for cardiovascular (CV) and geriatric disorders owing to comorbidity. Transcatheter aortic valve replacement (TAVR) was initially considered a therapeutic strategy in elderly individuals deemed unsuitable for or at high risk of surgical valve replacement. The progressive improvement in TAVR technology has led to the need to refine older patients' stratification, progressively incorporating the concept of frailty and other geriatric vulnerabilities. Recognizing the intricate nature of the aging process, reliance exclusively on chronological age for stratification resulted in an initial but inadequate tool to assess both CV and non-CV risks effectively. A comprehensive geriatric evaluation should be performed before TAVR procedures, taking into account both physical and cognitive capabilities and post-procedural outcomes through a multidisciplinary framework. This review adopts a multidisciplinary perspective to delve into the diagnosis and holistic management of AS in elderly populations in order to facilitate decision-making, thereby optimizing outcomes centered around patient well-being.
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Affiliation(s)
- Enrico Brunetti
- Geriatric Unit, Department of Medical Sciences, University of Turin, Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy (R.P.); (M.B.)
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. Brambilla 3, 50134 Florence, Italy
| | - Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano di Reggio, 89124 Reggio Calabria, Italy
| | - Roberto Presta
- Geriatric Unit, Department of Medical Sciences, University of Turin, Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy (R.P.); (M.B.)
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. Brambilla 3, 50134 Florence, Italy
| | | | - Andrea Ungar
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. Brambilla 3, 50134 Florence, Italy
| | | | | | - Maddalena Lettino
- Department for Cardiac, Thoracic and Vascular Diseases, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | | | - Adriano Murrone
- S.C. Cardiologia-UTIC, Ospedali di Città di Castello e di Gubbio-Gualdo Tadino, AUSL Umbria 1, 06127 Perugia, Italy
| | - Carmine Riccio
- Division of Clinical Cardiology, A.O.R.N. ‘Sant’Anna e San Sebastiano’, 81100 Caserta, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Massimo Grimaldi
- Cardiology Department, Miulli Hospital, Acquaviva delle Fonti, 70021 Bari, Italy
| | | | - Fabrizio Oliva
- Cardiovascular Department “A. De Gasperis”, ASST Niguarda Hospital, 20162 Milano, Italy
| | - Mario Bo
- Geriatric Unit, Department of Medical Sciences, University of Turin, Hospital Città della Salute e della Scienza di Torino, 10126 Turin, Italy (R.P.); (M.B.)
| | - Iris Parrini
- Department of Cardiology, Mauriziano Hospital, 10128 Turin, Italy
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22
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Leung Wai Sang S, Weissman C, Parker J, Timek T, Willekes C, Fanning J. Contemporary outcomes of surgical aortic valve replacement in patients referred for a transcatheter approach. Int J Cardiol 2024; 407:132004. [PMID: 38561110 DOI: 10.1016/j.ijcard.2024.132004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES The purpose of this study is to examine which patients referred to our structural valve clinic for potential transcatheter aortic valve replacement (TAVR) are receiving surgical aortic valve replacement (SAVR) whether due to unsuitable anatomy for TAVR versus other reasons. METHODS Individuals referred for TAVR from January 2019 to March 2022, who ultimately underwent SAVR were examined, retrospectively. Patients were divided into 2 surgical groups: TAVR was technically unsuitable (SAVR-TU) and those in which TAVR was technically feasible (SAVR-TF). RESULTS 215 patients referred for TAVR underwent SAVR with 61 (28.4%) patients in the SAVR-TU group and 154 (71.6%) in the SAVR-TF group. The SAVR-TU group were more commonly female (52.5% vs 23.4%, p < 0.0001), had a higher incidence of stroke at baseline (9.8% vs 2.0%, p = 0.017) were frailer (5-m gait 5.2 s vs 4.7 s, p = 0.0035), and had a higher Society of Thoracic Surgery risk score (2.2 vs 1.7, p = 0.04). In the SAVR-TU group, unsuitability for TAVR was due to inadequate aortic root anatomy (86.9%), and poor peripheral access (6.6%). In the SAVR-TF group, the most common reasons for SAVR referral were concomitant coronary artery disease (42.9%), bicuspid aortic valve disease (16.9%), and concomitant aortic aneurysm (10.4%). Overall, in-hospital mortality was 1.4% with no difference between both groups. One-year survival was 96.7%. CONCLUSION Despite a higher trend of aortic stenosis being treated with TAVR, higher risk patients unsuitable for TAVR can have SAVR with excellent outcomes. Moreover, patients with AS and concomitant other pathology should be evaluated for cardiac surgery.
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Affiliation(s)
- Stephane Leung Wai Sang
- Meijer Heart and Vascular Institute, Division of Cardiothoracic Surgery, Corewell Health West, Grand Rapids, MI, United States of America; College of Human Medicine, Michigan State University, Grand Rapids, MI, United States of America.
| | - Caleb Weissman
- College of Human Medicine, Michigan State University, Grand Rapids, MI, United States of America
| | - Jessica Parker
- Meijer Heart and Vascular Institute, Division of Cardiothoracic Surgery, Corewell Health West, Grand Rapids, MI, United States of America
| | - Tomasz Timek
- Meijer Heart and Vascular Institute, Division of Cardiothoracic Surgery, Corewell Health West, Grand Rapids, MI, United States of America; College of Human Medicine, Michigan State University, Grand Rapids, MI, United States of America
| | - Charles Willekes
- Meijer Heart and Vascular Institute, Division of Cardiothoracic Surgery, Corewell Health West, Grand Rapids, MI, United States of America; College of Human Medicine, Michigan State University, Grand Rapids, MI, United States of America
| | - Justin Fanning
- Meijer Heart and Vascular Institute, Division of Cardiothoracic Surgery, Corewell Health West, Grand Rapids, MI, United States of America; College of Human Medicine, Michigan State University, Grand Rapids, MI, United States of America
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23
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Thompson CR. Transcaval transcatheter aortic valve replacement: Worthy of consideration! Can J Cardiol 2024:S0828-282X(24)00559-2. [PMID: 39002944 DOI: 10.1016/j.cjca.2024.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 06/24/2024] [Indexed: 07/15/2024] Open
Affiliation(s)
- Christopher R Thompson
- The Division of Cardiology, Department of Medicine, St. Paul's Hospital and the University of British Columbia, Room 2350 -1081 Burrard Street, Vancouver, British Columbia V6Z 1YZ
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24
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Di Bacco L, D’Alonzo M, Baudo M, Montisci A, Di Eusanio M, Folliguet T, Solinas M, Miceli A, Fischlein T, Rosati F, Muneretto C. Reliability of EuroSCORE II on Prediction of Thirty-Day Mortality and Long-Term Results in Patients Treated with Sutureless Valves. J Clin Med 2024; 13:3986. [PMID: 38999550 PMCID: PMC11242606 DOI: 10.3390/jcm13133986] [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: 05/09/2024] [Revised: 06/19/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Background: EuroSCORE II (ES2) is a reliable tool for preoperative cardiac surgery mortality risk prediction; however, a patient's age, a surgical procedure's weight and the new devices available may cause its accuracy to drift. We sought to investigate ES2 performance related to the surgical risk and late mortality estimation in patients who underwent aortic valve replacement (AVR) with sutureless valves. Methods: Between 2012 and 2021, a total of 1126 patients with isolated aortic stenosis who underwent surgical AVR by means of sutureless valves were retrospectively collected from six European centers. Patients were stratified into three groups according to the EuroSCORE II risk classes (ES2 < 4%, ES2 4-8% and ES2 > 8%). The accuracy of ES2 in estimating mortality risk was assessed using the standardized mortality ratio (O/E ratio), ROC curves (AUC) and Hosmer-Lemeshow (HL) test for goodness-of-fit. Results: The overall observed mortality was 3.0% (predicted mortality ES2: 5.39%) with an observed/expected (O/E) ratio of 0.64 (confidential interval (CI): 0.49-0.89). In our population, ES2 showed a moderate discriminating power (AUC 0.65, 95%CI 0.56-0.72, p < 0.001; HL p = 0.798). Good accuracy was found in patients with ES2 < 4% (O/E ratio 0.54, 95%CI 0.23-1.20, AUC 0.75, p < 0.001, HL p = 0.999) and for patients with an age < 75 years (O/E ratio 0.98, 95%CI 0.45-1.96, AUC 0.76, p = 0.004, HL p = 0.762). Moderate discrimination was observed for ES2 in the estimation of long-term risk of mortality (AUC 0.64, 95%CI: 0.60-0.68, p < 0.001). Conclusions: EuroSCORE II showed good accuracy in patients with an age < 75 years and patients with ES2 < 4%, while overestimating risk in the other subgroups. A recalibration of the model should be taken into account based on the complexity of actual patients and impact of new technologies.
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Affiliation(s)
- Lorenzo Di Bacco
- Unit of Cardiac Surgery, Univesity of Brescia, 25123 Brescia, Italy; (L.D.B.); (A.M.); (F.R.); (C.M.)
| | - Michele D’Alonzo
- Unit of Cardiac Surgery, Univesity of Brescia, 25123 Brescia, Italy; (L.D.B.); (A.M.); (F.R.); (C.M.)
| | - Massimo Baudo
- Cardiothoracic Surgery, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA;
| | - Andrea Montisci
- Unit of Cardiac Surgery, Univesity of Brescia, 25123 Brescia, Italy; (L.D.B.); (A.M.); (F.R.); (C.M.)
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, 60121 Ancona, Italy;
| | - Thierry Folliguet
- Unit of Cardiac Surgery, Henri Mondor Hospital, 94010 Creteil, France;
| | - Marco Solinas
- Monasterio Foundation Heart Hospital, 54100 Massa, Italy;
| | - Antonio Miceli
- Department of Minimally Invasive Cardiac Surgery, Sant’Ambrogio Hospital, 20122 Milan, Italy;
| | - Theodor Fischlein
- Department of Cardiac Surgery, Paracelsus Medical University, 90419 Nuremberg, Germany;
| | - Fabrizio Rosati
- Unit of Cardiac Surgery, Univesity of Brescia, 25123 Brescia, Italy; (L.D.B.); (A.M.); (F.R.); (C.M.)
| | - Claudio Muneretto
- Unit of Cardiac Surgery, Univesity of Brescia, 25123 Brescia, Italy; (L.D.B.); (A.M.); (F.R.); (C.M.)
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Shimamura K, Miyagawa S. Treatment Strategy for Severe Aortic Stenosis With Moderate/Severe Mitral Regurgitation. Circ J 2024:CJ-24-0413. [PMID: 38972725 DOI: 10.1253/circj.cj-24-0413] [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: 07/09/2024]
Affiliation(s)
- Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
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Polizzi G, Campos K, Coulter SA. Mitral regurgitation carries greater prognostic significance than mitral stenosis in patients undergoing transcatheter aortic valve replacement. J Cardiovasc Med (Hagerstown) 2024; 25:529-538. [PMID: 38829939 DOI: 10.2459/jcm.0000000000001629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
AIMS This study assessed the outcomes of concomitant mitral valve disease and severe aortic stenosis in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS Echocardiographic data of 813 patients with severe aortic stenosis undergoing transfemoral TAVR were collected, and clinical outcomes were analyzed for individuals with mitral stenosis and mitral regurgitation. RESULTS The final cohort includes 788 patients with severe calcific aortic stenosis. Among single parameters of mitral stenosis, a smaller baseline mitral valve area (MVA) by the continuity equation and higher postprocedural mean mitral gradients (MMG) were associated with an increased risk of death at 1 year (P-values 0.02 and <0.01, respectively), but no correlation with outcomes was demonstrated after multivariate adjustment for major prognosticators. Mitral stenosis (based on MVA + MMG) was not associated with complications or mortality. Mitral regurgitation was present in 94.6% of the population at baseline and regressed by at least one grade post-TAVR in 28% of the patients. The improvement in mitral regurgitation was associated with a greater prosthetic effective orifice area (P-value 0.03). Significant (at least moderate) residual mitral regurgitation was correlated with short-term complications and shown to be an independent predictor of 1-year mortality (P-value 0.02, odds ratio (OR) 5.37, confidence interval 1.34-21.5). CONCLUSION Mitral regurgitation has a greater impact on TAVR patients than mitral stenosis as assessed by functional methods.
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Affiliation(s)
- Giovanni Polizzi
- Department of Cardiology, The Texas Heart Institute, Houston, TX, USA
| | - Karla Campos
- Center for Women's Heart and Vascular Health, The Texas Heart Institute, Houston, TX, USA
| | - Stephanie Alyse Coulter
- Department of Cardiology, The Texas Heart Institute, Houston, TX, USA
- Center for Women's Heart and Vascular Health, The Texas Heart Institute, Houston, TX, USA
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Montonati C, Pellegrini D, d'Atri DO, Pellicano M, Briguglia D, Giannini F, De Blasio G, Guagliumi G, Tespili M, Ielasi A. A novel balloon-expandable transcatheter aortic valve bioprosthesis: Myval and Myval Octacor. Expert Rev Cardiovasc Ther 2024; 22:325-337. [PMID: 38970466 DOI: 10.1080/14779072.2024.2375345] [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: 02/28/2024] [Accepted: 06/28/2024] [Indexed: 07/08/2024]
Abstract
INTRODUCTION Over the past two decades, transcatheter aortic valve replacement (TAVR) has expanded its application across all surgical risk levels, including low-risk patients, where, due to longer life expectancy, reducing common pitfalls of TAVR is essential. To address these needs, many technological advancements have been developed. Myval and the new generation Myval Octacor (Meril Life Sciences Pvt. Ltd) are novel balloon-expandable (BE) transcatheter heart valve (THV) systems designed for the treatment of severe aortic stenosis. AREAS COVERED This review aims to illustrate the design features of these novel THVs and the main evidence from available studies. Furthermore, we provide evidence of these THVs' performance in challenging scenarios such as extra-large aortic annuli, bicuspid aortic valves, and valve-in-valve/valve-in-ring procedures. EXPERT OPINION Myval and Myval Octacor have demonstrated comparable early safety and clinical efficacy to the leading contemporary THVs, exhibiting remarkably low rates of moderate to severe paravalvular leak (PVL) and permanent pacemaker implantation (PPI). The wide range of sizes offered by the Myval family may minimize the risk of under-/oversizing, potentially explaining the lower rates of the aforementioned phenomena. Moreover, the presence of both internal skirt and external reinforced cuff may also explain the low rate of moderate to severe PVL.
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Affiliation(s)
- Carolina Montonati
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Dario Pellegrini
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Daniele Oreste d'Atri
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
- Cardiothoracic Department, Università Vita-Salute San Raffaele, Milan, Italy
| | - Mariano Pellicano
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Daniele Briguglia
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Francesco Giannini
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Giuseppe De Blasio
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Giulio Guagliumi
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Maurizio Tespili
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Alfonso Ielasi
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
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Simonato M, Dvir D, Nanna MG. Editorial commentary: Chronic kidney disease and aortic valve replacement: Let's filter the evidence! Trends Cardiovasc Med 2024; 34:325-326. [PMID: 37437823 DOI: 10.1016/j.tcm.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023]
Affiliation(s)
| | - Danny Dvir
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States
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Jacquemyn X, Van den Eynde J, Iwens Q, Billiau J, Jabagi H, Serna-Gallegos D, Chu D, Sultan I, Sá MP. Transcatheter aortic valve implantation versus surgical aortic valve replacement in chronic kidney disease: Meta-analysis of reconstructed time-to-event data. Trends Cardiovasc Med 2024; 34:317-324. [PMID: 37169208 DOI: 10.1016/j.tcm.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/07/2023] [Accepted: 04/30/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Patients with advanced chronic kidney disease (CKD) are a challenging and understudied population. Specifically, the late outcomes following surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) in patients with CKD remains uncertain. OBJECTIVES To compare overall mortality risk in patients with moderate-to-severe CKD following TAVI versus SAVR. METHODS Study-level meta-analysis of reconstructed time-to-event data from Kaplan-Meier curves of studies published by August 2022. RESULTS Nine studies met our inclusion criteria. Patients who underwent TAVI had a higher 5-year mortality compared with patients undergoing SAVR in the overall population (HR 1.56, 95% CI 1.44-1.69, P < 0.001) and in populations with similar risk scores (HR 1.15, 95% CI 1.01-1.31, P = 0.035). The landmark analysis revealed a lower risk of 30-day mortality with TAVI (HR 0.62, 95% CI 0.41-0.94, P = 0.023), followed by similar risk until 7.5 months (HR 1, 95% CI 0.78-1.27, P = 0.978). In contrast, the landmark analysis beyond 7.5 months yielded a reversal of the HR in favor of SAVR (TAVI with HR 1.27, 95% CI 1.08-1.49 P = 0.003). CONCLUSIONS In patients with CKD, TAVI provides an initial survival benefit over SAVR. However, in the long run, a significant survival benefit of SAVR over TAVI was observed. Our findings highlight the need for randomized controlled trials to investigate outcomes in this special population.
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Affiliation(s)
- Xander Jacquemyn
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Faculty of Medicine, KU Leuven, Leuven, Belgium.
| | - Jef Van den Eynde
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Faculty of Medicine, KU Leuven, Leuven, Belgium
| | | | | | - Habib Jabagi
- Department of Cardiothoracic Surgery, Valley Heart and Vascular Institute, Ridgewood, NJ, United States
| | - Derek Serna-Gallegos
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Danny Chu
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Michel Pompeu Sá
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Shawon MSR, Ryan JB, Jorm L. Incidence and Predictors of Readmissions to Non-Index Hospitals After Transcatheter Aortic Valve Implantation in the Contemporary Era in New South Wales, Australia. Heart Lung Circ 2024; 33:1027-1035. [PMID: 38580581 DOI: 10.1016/j.hlc.2024.02.012] [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: 10/21/2023] [Revised: 02/05/2024] [Accepted: 02/19/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND In Australia, transcatheter aortic valve implantation (TAVI) is only performed in a limited number of specialised metropolitan centres, many of which are private hospitals, making it likely that TAVI patients who require readmission will present to another (non-index) hospital. It is important to understand the impact of non-index readmission on patient outcomes and healthcare resource utilisation. METHOD We analysed linked hospital and death records for residents of New South Wales, Australia, aged ≥18 years, who had an emergency readmission within 90 days following a TAVI procedure in 2013-2022. Mixed-effect, multi-level logistic regression models were used to evaluate predictors of non-index readmission, and associations between non-index readmission and readmission length of stay, 90-day mortality, and 1-year mortality. RESULTS Of 4,198 patients (mean age, 82.7 years; 40.6% female) discharged alive following TAVI, 933 (22.2%) were readmitted within 90 days of discharge. Over three-quarters (76.0%) of those readmitted returned to a non-index hospital, with no significant difference in readmission principal diagnosis between index hospital and non-index hospital readmissions. Among readmitted patients, independent predictors of non-index readmission included: residence in regional or remote areas, lower socio-economic status, having a pre-procedure transfer, and a private index hospital. Readmission length of stay (median, 4 days), 90-day mortality (adjusted odds ratio [OR] 1.04, 95% confidence interval [CI] 0.56-1.96) and 1-year mortality (adjusted OR 1.01, 95% CI 0.64-1.58) were similar between index and non-index readmissions. CONCLUSIONS Non-index readmission following TAVI was highly prevalent but not associated with increased mortality or healthcare utilisation. Our results are reassuring for TAVI patients in regional and remote areas with limited access to return to index TAVI hospitals.
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Affiliation(s)
| | - Jonathon B Ryan
- Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
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Kempton H, Hall R, Hungerford SL, Hayward CS, Muller DWM. Frailty and transcatheter valve intervention: A narrative review. Catheter Cardiovasc Interv 2024; 104:155-166. [PMID: 38819861 DOI: 10.1002/ccd.31076] [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: 09/05/2023] [Revised: 03/27/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024]
Abstract
Frailty is a common clinical syndrome that portends poor peri-procedural outcomes and increased mortality following transcatheter valve interventions. We reviewed frailty assessment tools in transcatheter intervention cohorts to recommend a pathway for preprocedural frailty assessment in patients referred for transcatheter valve procedures, and evaluated current evidence for frailty interventions and their efficacy in transcatheter intervention. We recommend the use of a frailty screening instrument to identify patients as frail, with subsequent referral for comprehensive geriatric assessment in these patients, to assist in selecting appropriate patients and then optimizing them for transcatheter valve interventions. Interventions to reduce preprocedural frailty are not well defined, however, data from limited cohort studies support exercise-based interventions to increase functional capacity and reduce frailty in parallel with preprocedural medical optimization.
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Affiliation(s)
- Hannah Kempton
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Faculty of Health and Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Rachael Hall
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Sara L Hungerford
- Faculty of Health and Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Christopher S Hayward
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Faculty of Health and Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
| | - David W M Muller
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Faculty of Health and Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
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Sá MP, Jacquemyn X, Sultan I. Editorial commentary: Transcatheter aortic valve implantation in bicuspid aortic valve stenosis. Trends Cardiovasc Med 2024; 34:314-316. [PMID: 37156328 DOI: 10.1016/j.tcm.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Xander Jacquemyn
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Auer J, Krotka P, Reichardt B, Traxler D, Wendt R, Mildner M, Ankersmit HJ, Graf A. Selection for transcatheter versus surgical aortic valve replacement and mid-term survival: results of the AUTHEARTVISIT study. Eur J Cardiothorac Surg 2024; 66:ezae214. [PMID: 38867365 PMCID: PMC11220406 DOI: 10.1093/ejcts/ezae214] [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: 03/12/2024] [Revised: 04/29/2024] [Accepted: 06/11/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVES Limited data are available from randomized trials comparing outcomes between transcatheter aortic valve replacement (TAVR) and surgery in patients with different risks and with follow-up of at least 4 years or longer. In this large, population-based cohort study, long-term mortality and morbidity were investigated in patients undergoing aortic valve replacement (AVR) for severe aortic stenosis using a surgically implanted bioprosthesis (surgical/biological aortic valve replacement; sB-AVR) or TAVR. METHODS Individual data from the Austrian Insurance Funds from 2010 through 2020 were analysed. The primary outcome was all-cause mortality, assessed in the overall and propensity score-matched populations. Secondary outcomes included reoperation and cardiovascular events. RESULTS From January 2010 through December 2020, a total of 18 882 patients underwent sB-AVR (n = 11 749; 62.2%) or TAVR (n = 7133; 37.8%); median follow-up was 5.8 (95% CI 5.7-5.9) years (maximum 12.3 years). The risk of all-cause mortality was higher with TAVR compared with sB-AVR: hazard ratio 1.552, 95% confidence interval (CI) 1.469-1.640, P < 0.001; propensity score-matched hazard ratio 1.510, 1.403-1.625, P < 0.001. Estimated median survival was 8.8 years (95% CI 8.6-9.1) with sB-AVR versus 5 years (4.9-5.2) with TAVR. Estimated 5-year survival probability was 0.664 (0.664-0.686) with sB-AVR versus 0.409 (0.378-0.444) with TAVR overall, and 0.690 (0.674-0.707) and 0.560 (0.540-0.582), respectively, with propensity score matching. Separate subgroup analyses for patients aged 65-75 years and >75 years indicated a significant survival benefit in patients selected for sB-AVR in both groups. Other predictors of mortality were age, sex, previous heart failure, diabetes and chronic kidney disease. CONCLUSIONS In this retrospective national population-based study, selection for TAVR was significantly associated with higher all-cause mortality compared with sB-AVR in patients ≥65 years with severe, symptomatic aortic stenosis in the >2-year follow-up.
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Affiliation(s)
- Johann Auer
- Department of Internal Medicine I with Cardiology and Intensive Care, St Josef Hospital Braunau, Braunau am Inn, Austria
| | - Pavla Krotka
- Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | | | - Denise Traxler
- Clinic of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
- Laboratory for Cardiac and Thoracic Diagnosis, Regeneration and Applied Immunology, Vienna, Austria
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - Ralph Wendt
- Department of Nephrology, Hospital St Georg Leipzig, Leipzig, Germany
| | - Michael Mildner
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Hendrik Jan Ankersmit
- Clinic of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
- Laboratory for Cardiac and Thoracic Diagnosis, Regeneration and Applied Immunology, Vienna, Austria
| | - Alexandra Graf
- Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
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Hatab T, Zaid S, Thakkar SJ, Bou Chaaya RG, Goel SS, Reardon MJ. Infection of Transcatheter Valvular Devices. Curr Cardiol Rep 2024; 26:767-775. [PMID: 38806975 DOI: 10.1007/s11886-024-02076-9] [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] [Accepted: 05/15/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW This review explores the epidemiology, clinical traits, and diagnosis of Transcatheter Aortic Valve Replacement-Associated Infective Endocarditis (TAVR-IE) and mitral transcatheter edge-to-edge repair infective endocarditis (TEER-IE), focusing on a multimodal imaging approach. It addresses the rising prevalence of TAVR and TEER, emphasizing the need to understand long-term complications and clinical consequences, which poses significant challenges despite advancements in valve technology. RECENT FINDINGS Studies report a variable incidence of TAVR-IE and TEER-IE influenced by diverse patient risk profiles and procedural factors. Younger age, male gender, and certain comorbidities emerge as patient-related risk factors. Procedure-related factors include intervention location, valve type, and technical aspects. Microbiologically, Staphylococcus aureus, Viridans Group Streptococcus, and Enterococcus are frequently encountered pathogens. TAVR-IE and TEER-IE diagnosis involves a multimodal imaging approach due to limitations in echocardiography. Blood cultures and imaging aid identification, with Fluorescence in situ hybridization is showing promise. Treatment encompasses medical management with antibiotics and, when necessary, surgical intervention. The management approach requires a multidisciplinary "Endocarditis Team." This review underscores the need for continued research to refine risk prediction, enhance diagnostic accuracy, and optimize management strategies for TAVR-IE, considering the evolving landscape of transcatheter interventions.
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Affiliation(s)
- Taha Hatab
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA
| | - Syed Zaid
- Baylor School of Medicine and the Michael E DeBakey VAMC, Houston, TX, USA
| | - Samarthkumar J Thakkar
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA
| | - Rody G Bou Chaaya
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA
| | - Michael J Reardon
- Division of Cardiothoracic Surgery, Houston Methodist DeBakey Heart & Vascular Center, Allison Family Distinguished Chair of Cardiovascular Research, 6550 Fannin Street, Office 1401, Houston, TX, 77030, USA.
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Ilonze OJ. Editorial commentary: Screening for aortic stenosis in at risk older patients - A new paradigm in valvular heart disease care? Trends Cardiovasc Med 2024; 34:302-303. [PMID: 37137400 DOI: 10.1016/j.tcm.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/05/2023]
Affiliation(s)
- Onyedika J Ilonze
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, 1801 N Senate Blvd Suite 2000, Indiana University, Indianapolis, IN, USA.
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Amin S, Baron SJ, Galper BZ. Aortic valve replacement today: Outcomes, costs, and opportunities for improvement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 64:78-86. [PMID: 38388246 DOI: 10.1016/j.carrev.2024.02.004] [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: 08/24/2023] [Revised: 01/19/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
The introduction of transcatheter aortic valve replacement (TAVR) just two decades ago has transformed the treatment of severe symptomatic aortic stenosis. TAVR has not only extended the option of aortic valve replacement to patients deemed ineligible for surgery, it has also demonstrated similar or better short- and intermediate-term clinical outcomes compared with surgical aortic valve replacement (SAVR) in patients at all levels of surgical risk. These benefits have been achieved with similar or lower costs compared with SAVR, at least in the first 1-2 years for intermediate- and low-risk patients. Longer-term data will further inform clinical and shared decision-making. SUMMARY FOR ANNOTATED TABLE OF CONTENTS: In just over two decades, transcatheter aortic valve replacement has emerged as a frontline approach for appropriately selected patients with severe aortic stenosis. A growing body of evidence documents similar or better clinical outcomes and cost-effectiveness for transcatheter compared with surgical aortic valve replacement. Whether the mode is transcatheter or surgical, aortic valve replacement remains underutilized in patients with clear indications for intervention.
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Affiliation(s)
- Sameer Amin
- L.A. Care Health Plan, 1055 W. 7th St, 10th Floor, Los Angeles, CA 90017, United States
| | - Suzanne J Baron
- Interventional Cardiovascular Research, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States; Outcomes Research, Baim Institute for Clinical Research, 930 W. Commonwealth Ave., Boston, MA 02215, United States
| | - Benjamin Z Galper
- Structural Heart Disease Program, Mid-Atlantic Permanente Medical Group, 8008 Westpark Dr., McLean, VA 22102, United States; Cardiac Catheterization Laboratory, Virginia Hospital Center, 1701 N. George Mason Dr., Arlington, VA 22205, United States.
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He A, Wilkins B, Lan NSR, Othman F, Sehly A, Bhat V, Jaltotage B, Dwivedi G, Leipsic J, Ihdayhid AR. Cardiac computed tomography post-transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr 2024; 18:319-326. [PMID: 38782668 DOI: 10.1016/j.jcct.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/25/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024]
Abstract
Transcatheter aortic valve replacement (TAVR) is performed to treat aortic stenosis and is increasingly being utilised in the low-to-intermediate-risk population. Currently, attention has shifted towards long-term outcomes, complications and lifelong maintenance of the bioprosthesis. Some patients with TAVR in-situ may develop significant coronary artery disease over time requiring invasive coronary angiography, which may be problematic with the TAVR bioprosthesis in close proximity to the coronary ostia. In addition, younger patients may require a second transcatheter heart valve (THV) to 'replace' their in-situ THV because of gradual structural valve degeneration. Implantation of a second THV carries a risk of coronary obstruction, thereby requiring comprehensive pre-procedural planning. Unlike in the pre-TAVR period, cardiac CT angiography in the post-TAVR period is not well established. However, post-TAVR cardiac CT is being increasingly utilised to evaluate mechanisms for structural valve degeneration and complications, including leaflet thrombosis. Post-TAVR CT is also expected to have a significant role in risk-stratifying and planning future invasive procedures including coronary angiography and valve-in-valve interventions. Overall, there is emerging evidence for post-TAVR CT to be eventually incorporated into long-term TAVR monitoring and lifelong planning.
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Affiliation(s)
- Albert He
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Department of Cardiology, Dunedin Public Hospital, Dunedin, New Zealand
| | - Ben Wilkins
- Department of Cardiology, Dunedin Public Hospital, Dunedin, New Zealand
| | - Nick S R Lan
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Harry Perkins Institute of Medical Research, Perth, Australia; Medical School, University of Western Australia, Perth, Australia
| | - Farrah Othman
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
| | - Amro Sehly
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
| | - Vikas Bhat
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
| | | | - Girish Dwivedi
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Harry Perkins Institute of Medical Research, Perth, Australia; Medical School, University of Western Australia, Perth, Australia
| | - Jonathon Leipsic
- Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Abdul Rahman Ihdayhid
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Harry Perkins Institute of Medical Research, Perth, Australia; Medical School, Curtin University, Perth, Australia.
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Ueyama HA, Miyamoto Y, Hashimoto K, Watanabe A, Kolte D, Latib A, Kuno T, Tsugawa Y. Comparison of Patient Outcomes Between Leadless vs Transvenous Pacemakers Following Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2024:S1936-8798(24)00812-4. [PMID: 39023453 DOI: 10.1016/j.jcin.2024.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/23/2024] [Accepted: 05/21/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Evidence is limited regarding the effectiveness of leadless pacemaker implantation for conduction disturbance following transcatheter aortic valve replacement (TAVR). OBJECTIVES This study sought to examine the national trends in the use of leadless pacemaker implantation following TAVR and compare its performance with transvenous pacemakers. METHODS Medicare fee-for-service beneficiaries aged ≥65 years who underwent leadless or transvenous pacemakers following TAVR between 2017 and 2020 were included. Outcomes included in-hospital overall complications as well as midterm (up to 2 years) all-cause death, heart failure hospitalization, infective endocarditis, and device-related complications. Propensity score overlap weighting analysis was used. RESULTS A total of 10,338 patients (730 leadless vs 9,608 transvenous) were included. Between 2017 and 2020, there was a 3.5-fold increase in the proportion of leadless pacemakers implanted following TAVR. Leadless pacemaker recipients had more comorbidities, including atrial fibrillation and end-stage renal disease. After adjusting for potential confounders, patients with leadless pacemakers experienced a lower rate of in-hospital overall complications compared with patients who received transvenous pacemakers (7.2% vs 10.1%; P = 0.014). In the midterm, we found no significant differences in all-cause death (adjusted HR: 1.13; 95% CI: 0.96-1.32; P = 0.15), heart failure hospitalization (subdistribution HR: 0.89; 95% CI: 0.74-1.08; P = 0.24), or infective endocarditis (subdistribution HR: 0.98; 95% CI: 0.44-2.17; P = 0.95) between the 2 groups, but leadless pacemakers were associated with a lower risk of device-related complications (subdistribution HR: 0.37; 95% CI: 0.21-0.64; P < 0.001). CONCLUSIONS Leadless pacemakers are increasingly being used for conduction disturbance following TAVR and were associated with a lower rate of in-hospital complications and midterm device-related complications compared to transvenous pacemakers without a difference in midterm mortality.
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Affiliation(s)
- Hiroki A Ueyama
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yoshihisa Miyamoto
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
| | - Kenji Hashimoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Atsuyuki Watanabe
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and West, New York, New York, USA
| | - Dhaval Kolte
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA; Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA; Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California, USA
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Kang JJ, Fialka NM, El-Andari R, Watkins A, Hong Y, Mathew A, Bozso SJ, Nagendran J. Surgical vs transcatheter aortic valve replacement in bicuspid aortic valve stenosis: A systematic review and meta-analysis. Trends Cardiovasc Med 2024; 34:304-313. [PMID: 37121526 DOI: 10.1016/j.tcm.2023.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/02/2023]
Abstract
This systematic review and meta-analysis aim to provide a comprehensive analysis of the literature directly comparing the outcomes of surgical aortic valve replacement (SAVR) and TAVR in patients with BAV stenosis. Medline, PubMed, and Scopus were systematically searched for articles published between 2000 and 2023, 1862 studies were screened, and 6 retrospective studies met the inclusion criteria. We included 6550 patients in the final analyses: 3,292 and 3,258 in the SAVR and TAVR groups, respectively. Both groups have similar rates of in-hospital mortality (odds ratio (OR) 1.11; 95% CI 0.59-2.10; p = 0.75) and stroke (OR 1.25; 95% CI 0.85-1.86; p = 0.26. Patients who underwent SAVR experienced lower rates of permanent pacemaker implantation (OR 0.54; 95% CI 0.35-0.83; p = 0.005) and paravalvular leak (OR 0.47; 95% CI 0.26-0.86; p = 0.02). On the other hand, patients who underwent TAVR displayed lower rates of acute kidney injury (OR 1.81; 95% CI 1.15-2.84; p = 0.010), major bleeding (OR 3.76; 95% CI 2.18-6.49; p < 0.00001), and pulmonary complications (OR 7.68; 95% CI 1.21-48.84; p = 0.03). Despite the early mortality data suggesting that TAVR may be a reasonable strategy for patients with bicuspid AS with low to intermediate surgical risk, the increased risk of PPI and PVL is concerning. A prospective, randomized, controlled trial reporting long-term outcomes with pre-defined subgroup analyses based on BAV morphology is paramount. In the interim, caution should be exercised in the widespread adoption of TAVR in lower surgical-risk patients.
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Affiliation(s)
- Jimmy Jh Kang
- Division of Cardiac Surgery, Department of Surgery, Minimally Invasive and Transcatheter Valve Surgery, Mazankowski Alberta Heart Institute, University of Alberta, 4-108A Li Ka Shing Health Research Center, 8602 - 112 Street, Edmonton, Alberta T6G 2E1, Canada
| | - Nicholas M Fialka
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ryaan El-Andari
- Division of Cardiac Surgery, Department of Surgery, Minimally Invasive and Transcatheter Valve Surgery, Mazankowski Alberta Heart Institute, University of Alberta, 4-108A Li Ka Shing Health Research Center, 8602 - 112 Street, Edmonton, Alberta T6G 2E1, Canada
| | - Abeline Watkins
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Yongzhe Hong
- Division of Cardiac Surgery, Department of Surgery, Minimally Invasive and Transcatheter Valve Surgery, Mazankowski Alberta Heart Institute, University of Alberta, 4-108A Li Ka Shing Health Research Center, 8602 - 112 Street, Edmonton, Alberta T6G 2E1, Canada
| | - Anoop Mathew
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sabin J Bozso
- Division of Cardiac Surgery, Department of Surgery, Minimally Invasive and Transcatheter Valve Surgery, Mazankowski Alberta Heart Institute, University of Alberta, 4-108A Li Ka Shing Health Research Center, 8602 - 112 Street, Edmonton, Alberta T6G 2E1, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, Department of Surgery, Minimally Invasive and Transcatheter Valve Surgery, Mazankowski Alberta Heart Institute, University of Alberta, 4-108A Li Ka Shing Health Research Center, 8602 - 112 Street, Edmonton, Alberta T6G 2E1, Canada.
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Fang W, Yuan X, Hu J, Ma W, Ren H, Wang Y, Zhou H, Li Y. Visualization of transcatheter aortic valve implantation from the perspective of bibliometric analysis. Heliyon 2024; 10:e33061. [PMID: 38988542 PMCID: PMC11234103 DOI: 10.1016/j.heliyon.2024.e33061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 06/13/2024] [Accepted: 06/13/2024] [Indexed: 07/12/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) was originally devised as a treatment for patients with aortic stenosis (AS). It has since emerged as a beneficial alternative to surgical aortic valve replacement (SAVR), extending its reach to a broader array of patients. Our objective was to illustrate the developmental trends and focus areas in TAVI research. We sourced a total of 11,480 research papers on TAVI, published between 1994 and 2022, from the Web of Science Core Collection (WoSCC) database. We conducted a bibliometric analysis of these publications, generating cooperation maps, performing co-citation analysis of journals and references, and carrying out a cluster analysis of keywords. Our findings indicate that TAVI research grapples with numerous clinical challenges. We created knowledge maps that highlight contributing countries/institutions, authors, journals with high publication and citation rates, and notable references in this domain. North America and Europe have been at the forefront of research within the TAVI field. The institutions and authors from these regions exert significant influence in this area of study. Beginning in 2009, China has progressively expanded its research on TAVI over the past two decades. We anticipate that future research will increasingly focus on three key areas: implementation scope, lifelong management, outcomes and predicting the risk of TAVI. Research on TAVI is flourishing. Cooperation among different countries and institutions in this field must be strengthened in the future, especially for developing counties.
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Affiliation(s)
- Wei Fang
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, 710000, China
| | - Xiaojie Yuan
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi'an, 710000, China
| | - Jianqiang Hu
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, 710000, China
| | - Wenshuai Ma
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, 710000, China
| | - He Ren
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, 710000, China
| | - Yuemei Wang
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi'an, 710000, China
| | - Haijia Zhou
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, 710000, China
| | - Yan Li
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an, 710000, China
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Rooijakkers MJP, El Messaoudi S, Stens NA, van Wely MH, Habets J, Brink M, Rodwell L, Giese D, van der Geest RJ, van Royen N, Nijveldt R. Assessment of paravalvular regurgitation after transcatheter aortic valve replacement using 2D multi-velocity encoding and 4D flow cardiac magnetic resonance. Eur Heart J Cardiovasc Imaging 2024; 25:929-936. [PMID: 38306632 PMCID: PMC11210991 DOI: 10.1093/ehjci/jeae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/26/2024] [Indexed: 02/04/2024] Open
Abstract
AIMS To compare the novel 2D multi-velocity encoding (venc) and 4D flow acquisitions with the standard 2D flow acquisition for the assessment of paravalvular regurgitation (PVR) after transcatheter aortic valve replacement (TAVR) using cardiac magnetic resonance (CMR)-derived regurgitant fraction (RF). METHODS AND RESULTS In this prospective study, patients underwent CMR 1 month after TAVR for the assessment of PVR, for which 2D multi-venc and 4D flow were used, in addition to standard 2D flow. Scatterplots and Bland-Altman plots were used to assess correlation and visualize agreement between techniques. Reproducibility of measurements was assessed with intraclass correlation coefficients. The study included 21 patients (mean age ± SD 80 ± 5 years, 9 men). The mean RF was 11.7 ± 10.0% when standard 2D flow was used, 10.6 ± 7.0% when 2D multi-venc flow was used, and 9.6 ± 7.3% when 4D flow was used. There was a very strong correlation between the RFs assessed with 2D multi-venc and standard 2D flow (r = 0.88, P < 0.001), and a strong correlation between the RFs assessed with 4D flow and standard 2D flow (r = 0.74, P < 0.001). Bland-Altman plots revealed no substantial bias between the RFs (2D multi-venc: 1.3%; 4D flow: 0.3%). Intra-observer and inter-observer reproducibility for 2D multi-venc flow were 0.98 and 0.97, respectively, and 0.92 and 0.90 for 4D flow, respectively. CONCLUSION Two-dimensional multi-venc and 4D flow produce an accurate quantification of PVR after TAVR. The fast acquisition of the 2D multi-venc sequence and the free-breathing acquisition with retrospective plane selection of the 4D flow sequence provide useful advantages in clinical practice, especially in the frail TAVR population.
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Affiliation(s)
- Maxim J P Rooijakkers
- Department of Cardiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Saloua El Messaoudi
- Department of Cardiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Niels A Stens
- Department of Cardiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Department of Medical BioSciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marleen H van Wely
- Department of Cardiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Jesse Habets
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Radiology and Nuclear Medicine, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Monique Brink
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Laura Rodwell
- Department of Health Sciences, Section Biostatistics, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Daniel Giese
- Magnetic Resonance, Siemens Healthcare GmbH, Erlangen, Germany
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Rob J van der Geest
- Department of Medical Imaging, Leiden University Medical Centre, Leiden, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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Barbieri F, Pfeifer BE, Senoner T, Dobner S, Spitaler P, Semsroth S, Lambert T, Zweiker D, Neururer SB, Scherr D, Schmidt A, Feuchtner GM, Hoppe UC, Adukauskaite A, Reinthaler M, Landmesser U, Müller S, Steinwender C, Dichtl W. A Neuronal Network-Based Score Predicting Survival in Patients Undergoing Aortic Valve Intervention: The ABC-AS Score. J Clin Med 2024; 13:3691. [PMID: 38999259 PMCID: PMC11242068 DOI: 10.3390/jcm13133691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/18/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Despite being the most commonly performed valvular intervention, risk prediction for aortic valve replacement in patients with severe aortic stenosis by currently used risk scores remains challenging. The study aim was to develop a biomarker-based risk score by means of a neuronal network. Methods: In this multicenter study, 3595 patients were divided into test and validation cohorts (70% to 30%) by random allocation. Input variables to develop the ABC-AS score were age, the cardiac biomarker high-sensitivity troponin T, and a patient history of cardiac decompensation. The validation cohort was used to verify the scores' value and for comparison with the Society of Thoracic Surgery Predictive Risk of Operative Mortality score. Results: Receiver operating curves demonstrated an improvement in prediction by using the ABC-AS score compared to the Society of Thoracic Surgery Predictive Risk of Operative Mortality (STS prom) score. Although the difference in predicting cardiovascular mortality was most notable at 30-day follow-up (area under the curve of 0.922 versus 0.678), ABC-AS also performed better in overall follow-up (0.839 versus 0.699). Furthermore, univariate analysis of ABC-AS tertiles yielded highly significant differences for all-cause (p < 0.0001) and cardiovascular mortality (p < 0.0001). Head-to-head comparison between both risk scores in a multivariable cox regression model underlined the potential of the ABC-AS score (HR per z-unit 2.633 (95% CI 2.156-3.216), p < 0.0001), while the STS prom score failed to reach statistical significance (p = 0.226). Conclusions: The newly developed ABC-AS score is an improved risk stratification tool to predict cardiovascular outcomes for patients undergoing aortic valve intervention.
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Affiliation(s)
- Fabian Barbieri
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité, 12203 Berlin, Germany
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Bernhard Erich Pfeifer
- Institute of Clinical Epidemiology, Tirol Kliniken, 6020 Innsbruck, Austria
- Division for Digital Medicine and Telehealth, University for Health Sciences, Medical Informatics and Technology (UMIT), 6060 Hall in Tirol, Austria
| | - Thomas Senoner
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Stephan Dobner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Department of Cardiology and Intensive Care, Clinic Ottakring, 1160 Vienna, Austria
| | - Philipp Spitaler
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Severin Semsroth
- University Clinic of Heart Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Thomas Lambert
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, 4021 Linz, Austria
| | - David Zweiker
- Department of Cardiology and Intensive Care, Clinic Ottakring, 1160 Vienna, Austria
- Department of Internal Medicine, Division of Cardiology, Medical University Graz, 8010 Graz, Austria
| | - Sabrina Barbara Neururer
- Institute of Clinical Epidemiology, Tirol Kliniken, 6020 Innsbruck, Austria
- Division for Digital Medicine and Telehealth, University for Health Sciences, Medical Informatics and Technology (UMIT), 6060 Hall in Tirol, Austria
| | - Daniel Scherr
- Department of Internal Medicine, Division of Cardiology, Medical University Graz, 8010 Graz, Austria
| | - Albrecht Schmidt
- Department of Internal Medicine, Division of Cardiology, Medical University Graz, 8010 Graz, Austria
| | - Gudrun Maria Feuchtner
- University Clinic of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Uta Charlotte Hoppe
- University Clinic of Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Agne Adukauskaite
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Markus Reinthaler
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité, 12203 Berlin, Germany
- Institute of Active Polymers and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Hereon, 14513 Teltow, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité, 12203 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Berlin Institute of Health (BIH), 10178 Berlin, Germany
| | - Silvana Müller
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, 4021 Linz, Austria
| | - Wolfgang Dichtl
- Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria
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Decotto S, Villar GF, Knorre ME, Bergier M, Orellano A, Vega BS, Busnelli G, Rossi E, Castillo SD, Falconi M, Oberti P, Kotowicz V, Pizarro R. Surgical aortic valve replacement in patients with reduced ejection fraction. Prevalence and follow-up. Curr Probl Cardiol 2024; 49:102725. [PMID: 38925204 DOI: 10.1016/j.cpcardiol.2024.102725] [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: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Limited information exists on the prevalence and outcomes of patients undergoing surgical aortic valve replacement (SAVR) for aortic stenosis (AS) with reduced left ventricular ejection fraction (LVEF). This study aims to describe the number of AS patients undergoing SAVR with LVEF less than 55 % and quantify LVEF improvement at follow-up. MATERIAL AND METHODS We analyzed patients undergoing SAVR with LVEF less than 55 % and the number of patients that improved the LVEF at 6 months. We defined 'improved LVEF' as a 10 % increase of LVEF compared to baseline. RESULTS Out of 685 patients, 11.4 % (n = 78) had SAVR with LVEF <55 %. The median pre-surgery LVEF was 45 % [IQR 37-51]. In-hospital mortality was 5.1 % (n = 4). Follow-up data for 69 patients showed 50.7 % (n = 35) had improved LVEF. CONCLUSIONS In our cohort, 10 % of severe AS patients underwent SAVR with LVEF <55 %, with half showing LVEF improvement at follow-up.
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Affiliation(s)
- Santiago Decotto
- Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
| | | | | | - Mariano Bergier
- Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
| | | | - Brian Soria Vega
- Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
| | - Guido Busnelli
- Cardiovascular Surgery Department, Hospital Italiano de Buenos Aires, Argentina
| | - Emiliano Rossi
- Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
| | | | - Mariano Falconi
- Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
| | - Pablo Oberti
- Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
| | - Vadim Kotowicz
- Cardiovascular Surgery Department, Hospital Italiano de Buenos Aires, Argentina
| | - Rodolfo Pizarro
- Cardiology Department, Hospital Italiano de Buenos Aires, Argentina
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Baumbach A, van Royen N, Amat-Santos IJ, Hudec M, Bunc M, Ijsselmuiden A, Laanmets P, Unic D, Merkely B, Hermanides RS, Ninios V, Protasiewicz M, Rensing BJWM, Martin PL, Feres F, De Sousa Almeida M, van Belle E, Linke A, Ielasi A, Montorfano M, Webster M, Toutouzas K, Teiger E, Bedogni F, Voskuil M, Pan M, Angerås O, Kim WK, Rothe J, Kristić I, Peral V, Garg S, Elzomor H, Tobe A, Morice MC, Onuma Y, Soliman O, Serruys PW. LANDMARK comparison of early outcomes of newer-generation Myval transcatheter heart valve series with contemporary valves (Sapien and Evolut) in real-world individuals with severe symptomatic native aortic stenosis: a randomised non-inferiority trial. Lancet 2024; 403:2695-2708. [PMID: 38795719 DOI: 10.1016/s0140-6736(24)00821-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Transcatheter aortic valve implantation is an established, guideline-endorsed treatment for severe aortic stenosis. Precise sizing of the balloon-expandable Myval transcatheter heart valve (THV) series with the aortic annulus is facilitated by increasing its diameter in 1·5 mm increments, compared with the usual 3 mm increments in valve size. The LANDMARK trial aimed to show non-inferiority of the Myval THV series compared with the contemporary THVs Sapien Series (Edwards Lifesciences, Irvine, CA, USA) or Evolut Series (Medtronic, Minneapolis, MN, USA). METHODS In this prospective, multinational, randomised, open-label, non-inferiority trial across 31 hospitals in 16 countries (Germany, France, Sweden, the Netherlands, Italy, Spain, New Zealand, Portugal, Greece, Hungary, Poland, Slovakia, Slovenia, Croatia, Estonia, and Brazil), 768 participants with severe symptomatic native aortic stenosis were randomly assigned (1:1) to the Myval THV or a contemporary THV. Eligibility was primarily decided by the heart team in accordance with 2021 European Society of Cardiology guidelines. As per the criteria of the third Valve Academic Research Consortium, the primary endpoint at 30 days was a composite of all-cause mortality, all stroke, bleeding (types 3 and 4), acute kidney injury (stages 2-4), major vascular complications, moderate or severe prosthetic valve regurgitation, and conduction system disturbances resulting in a permanent pacemaker implantation. Non-inferiority of the study device was tested in the intention-to-treat population using a non-inferiority margin of 10·44% and assuming an event rate of 26·10%. This trial is registered with ClinicalTrials.gov, NCT04275726, and EudraCT, 2020-000137-40, and is closed to new participants. FINDINGS Between Jan 6, 2021, and Dec 5, 2023, 768 participants with severe symptomatic native aortic stenosis were randomly assigned, 384 to the Myval THV and 384 to a contemporary THV. 369 (48%) participants had their sex recorded as female, and 399 (52%) as male. The mean age of participants was 80·0 years (SD 5·7) for those treated with the Myval THV and 80·4 years (5·4) for those treated with a contemporary THV. Median Society of Thoracic Surgeons scores were the same in both groups (Myval 2·6% [IQR 1·7-4·0] vs contemporary 2·6% [1·7-4·0]). The primary endpoint showed non-inferiority of the Myval (25%) compared with contemporary THV (27%), with a risk difference of -2·3% (one-sided upper 95% CI 3·8, pnon-inferiority<0·0001). No significant difference was seen in individual components of the primary composite endpoint. INTERPRETATION In individuals with severe symptomatic native aortic stenosis, the Myval THV met its primary endpoint at 30 days. FUNDING Meril Life Sciences.
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Affiliation(s)
- Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK; Cleveland Clinic, London, UK
| | - Niels van Royen
- Department of Cardiology, Radboud University Hospital, Nijmegen, Netherlands
| | - Ignacio J Amat-Santos
- CIVERCV, Centro de Investigación Biomédica en red - Enfermedades Cardiovasculares, University Clinical Hospital of Valladolid, Valladolid, Spain; Department of Cardiology, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Martin Hudec
- Department of Acute Cardiology, Middle-Slovak Institute Of Cardiovascular Diseases, Banska Bystrica, Slovakia
| | - Matjaz Bunc
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Alexander Ijsselmuiden
- Department of Cardiology, Amphia Hospital, Breda, Netherlands; Department of Interventional Cardiology, Maastricht University Medical Center, Maastricht, Netherlands; Zuyderland Hospital, Limburg, Netherlands
| | - Peep Laanmets
- Department of Invasive Cardiology, North Estonia Medical Centre, Tallinn, Estonia
| | - Daniel Unic
- Department of Cardiac and Transplant Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Bela Merkely
- Heart and Vascular Centre, Semmelweis University Heart and Vascular Centre, Budapest, Hungary
| | | | - Vlasis Ninios
- Department of Cardiology, European Interbalkan Medical Center, Thessaloniki, Greece
| | - Marcin Protasiewicz
- Department of Cardiology, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland
| | | | - Pedro L Martin
- Department of Interventional Cardiology, University Hospital of Gran Canaria Dr Negrín, Las Palmas, Spain
| | - Fausto Feres
- Department of Invasive Cardiology, Instituto Dante Pazzanese, Sao Paulo, Brazil
| | | | - Eric van Belle
- Department of Interventional Cardiology, Lille University, Lille, France
| | - Axel Linke
- Department of Internal Medicine and Cardiology, University Clinic, Heart Center Dresden, University of Technology Dresden, Dresden, Germany
| | - Alfonso Ielasi
- Department of Interventional Cardiology, IRCCS Galeazzi Sant'Ambrogio Hospital, Milan, Italy
| | - Matteo Montorfano
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mark Webster
- Department of Cardiology, Auckland City Hospital, Auckland, New Zealand
| | | | - Emmanuel Teiger
- Department of Medico-surgical Cardiovascular and Anaesthesiology, Henri-Mondor University Hospital, Creteil, France
| | - Francesco Bedogni
- Department of Clinical Cardiology, San Donato Hospital, Milan, Italy
| | - Michiel Voskuil
- Department of Interventional Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Manuel Pan
- Department of Cardiology, University Hospital Reina Sofía, University of Córdoba, Córdoba, Spain
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical and Molecular Medicine, Gothenburg University, Gothenburg, Sweden
| | - Won-Keun Kim
- Department of Cardiology and Angiology, University of Giessen and Marburg, Giessen, Germany; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Jürgen Rothe
- Department of Cardiology and Angiology, University Heart Center Freiburg Bad Krozingen, University Medical Center Freiburg, Freiburg, Germany; Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ivica Kristić
- Department of Cardiology, University Hospital of Split, Split, Croatia
| | - Vicente Peral
- Department of Cardiology, Son Espases University Hospital, Palma, Spain
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Hesham Elzomor
- Department of Cardiology, School of Medicine, University of Galway, Galway, Ireland
| | - Akihiro Tobe
- Department of Cardiology, School of Medicine, University of Galway, Galway, Ireland
| | | | - Yoshinobu Onuma
- Department of Cardiology, School of Medicine, University of Galway, Galway, Ireland
| | - Osama Soliman
- Department of Cardiology, School of Medicine, University of Galway, Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, School of Medicine, University of Galway, Galway, Ireland.
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Miyoshi H, Kamiya S, Ikeda T, Narasaki S, Kondo T, Syourin D, Sumii A, Kido K, Otsuki S, Kato T, Nakamura R, Tsutsumi YM. Impact of proficiency in the transcatheter aortic valve implantation procedure on clinical outcomes: a single center retrospective study. BMC Anesthesiol 2024; 24:209. [PMID: 38907200 PMCID: PMC11191309 DOI: 10.1186/s12871-024-02594-7] [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: 03/31/2024] [Accepted: 06/10/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND We used transcatheter aortic valve implantation (TAVI) procedure time to investigate the association between surgical team maturity and outcome. METHODS Among patients who underwent TAVI between October 2015 and November 2019, those who had Sapien™ implanted with the transfemoral artery approach were included in the analysis. We used TAVI procedure time and surgery number to draw a learning curve. Then, we divided the patients into two groups before and after the number of cases where the sigmoid curve reaches a plateau. We compared the two groups regarding the surveyed factors and investigated the correlation between the TAVI procedure time and survey factors. RESULTS Ninety-nine of 149 patients were analysed. The sigmoid curve had an inflection point in 23.2 cases and reached a plateau in 43.0 cases. Patients in the Late group had a shorter operating time, less contrast media, less radiation exposure, and less myocardial escape enzymes than the Early group. Surgical procedure time showed the strongest correlation with the surgical case number. CONCLUSION The number of cases required for surgeon proficiency for isolated Sapien™ valve implantation was 43. This number may serve as a guideline for switching the anesthesia management of TAVI from general to local anesthesia.
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Affiliation(s)
- Hirotsugu Miyoshi
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
| | - Satoshi Kamiya
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Tsuyoshi Ikeda
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Soshi Narasaki
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Takashi Kondo
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Daiki Syourin
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Ayako Sumii
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Kenshiro Kido
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Sachiko Otsuki
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Takahiro Kato
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Ryuji Nakamura
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Yasuo M Tsutsumi
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
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Omari M, Durrani T, Diaz Nuila ME, Thompson A, Irvine T, Edwards R, Das R, Zaman A, Farag M, Alkhalil M. Cardiac output in patients with small annuli undergoing transcatheter aortic valve implantation with self-expanding versus balloon expandable valve (COPS-TAVI). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00547-5. [PMID: 38955627 DOI: 10.1016/j.carrev.2024.06.017] [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: 02/26/2024] [Revised: 06/03/2024] [Accepted: 06/17/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND There is limited data on cardiac output in patients with small aortic annuli undergoing trans-catheter aortic valve implantation (TAVI) according to the implanted platform of balloon-expandable (BEV) compared to self-expanding valves (SEV). METHODS This is a retrospective analysis of consecutive patients with severe aortic stenosis and small annuli who underwent successful TAVI. Cardiac output was measured using echocardiography within 4 weeks following TAVI. Data were recorded and analysed by an experienced operator who was not aware of the type of the implanted valve. RESULTS 138 patients were included in the analysis, of whom 57 % underwent TAVI with BEV. Clinical and echocardiographic characteristics were comparable between the two platforms, except for more frequent previous cardiac surgery and smaller indexed aortic valve in the BEV group. There was no relationship between computed tomography-derived aortic annulus area and cardiac output post TAVI. When compared to patients who underwent TAVI with BEV, those with SEV had larger cardiac output [mean difference - 0.50 l/min, 95 % CI (-0.99, -0.01)] and cardiac index [mean difference - 0.20 l/min/m2, 95 % CI (-0.47, 0.07)], although the latter did not reach statistical significance. Unlike patients with small body surface area, in those with large body surface area both cardiac output and cardiac index were statistically larger in patients who underwent SEV compared to BEV. CONCLUSION Cardiac output, as measured by echocardiography, was larger in patients with small annuli who underwent TAVI procedure with SEV compared to BEV. Such difference was more evident in patients with large body surface area.
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Affiliation(s)
- Muntaser Omari
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK
| | | | | | | | - Tim Irvine
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Richard Edwards
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Rajiv Das
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Azfar Zaman
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Mohamed Farag
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Mohammad Alkhalil
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK.
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Pallante F, Costa F, Garcia Ruiz V, Vizzari G, Iannello P, Teresi L, Carciotto G, Lo Giudice S, Iuvara G, Laterra G, Regueiro A, Giustino G, Alonso Briales JH, Hernandez JM, Barbanti M, Micari A, Patanè F. Antithrombotic Therapy in Patients Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2024; 13:3636. [PMID: 38999202 PMCID: PMC11242616 DOI: 10.3390/jcm13133636] [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: 05/18/2024] [Accepted: 06/18/2024] [Indexed: 07/14/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) now represents the mainstay of treatment for severe aortic stenosis. Owing to its exceptional procedural efficacy and safety, TAVI has been extended to include patients at lower surgical risk, thus now encompassing a diverse patient population receiving this treatment. Yet, long-term outcomes also depend on optimal medical therapy for secondary vascular prevention, with antithrombotic therapy serving as the cornerstone. Leveraging data from multiple randomized controlled trials, the current guidelines generally recommend single antithrombotic therapy, with either single antiplatelet therapy (SAPT) or oral anticoagulation (OAC) alone in those patients without or with atrial fibrillation, respectively. Yet, individualization of this pattern, as well as specific case uses, may be needed based on individual patient characteristics and concurrent procedures. This review aims to discuss the evidence supporting antithrombotic treatments in patients treated with TAVI, indications for a standardized treatment, as well as specific considerations for an individualized approach to treatment.
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Affiliation(s)
- Francesco Pallante
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Francesco Costa
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, 98122 Messina, Italy
- Departamento de Medicina UMA, Área del Corazón, Hospital Universitario Virgen de la Victoria, CIBERCV, IBIMA Plataforma BIONAND, 29010 Malaga, Spain
| | - Victoria Garcia Ruiz
- Departamento de Medicina UMA, Área del Corazón, Hospital Universitario Virgen de la Victoria, CIBERCV, IBIMA Plataforma BIONAND, 29010 Malaga, Spain
| | - Giampiero Vizzari
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | | | - Lucio Teresi
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Gabriele Carciotto
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Stefania Lo Giudice
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Giustina Iuvara
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Giulia Laterra
- Faculty of Medicine and Surgery, Università degli Studi di Enna "Kore", 94100 Enna, Italy
| | - Ander Regueiro
- Hospital Clinic, Cardiovascular Institute, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Gennaro Giustino
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Juan Horacio Alonso Briales
- Departamento de Medicina UMA, Área del Corazón, Hospital Universitario Virgen de la Victoria, CIBERCV, IBIMA Plataforma BIONAND, 29010 Malaga, Spain
| | - Jose Maria Hernandez
- Departamento de Medicina UMA, Área del Corazón, Hospital Universitario Virgen de la Victoria, CIBERCV, IBIMA Plataforma BIONAND, 29010 Malaga, Spain
| | - Marco Barbanti
- Faculty of Medicine and Surgery, Università degli Studi di Enna "Kore", 94100 Enna, Italy
| | - Antonio Micari
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, 98122 Messina, Italy
| | - Francesco Patanè
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, 98122 Messina, Italy
- Cardiology Division, Papardo Hospital, 98158 Messina, Italy
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Micovic S, Nobre A, Choi JW, Solinas M, Shehada SE, Torella M, Baeza C, Parrino E, Pollari F, Troise G, Kappert U, Mellert F, Je HG, Argano V, Lam KY, Rinaldi M, Gutermann H, Meuris B. Early outcomes of aortic valve replacement with Perceval PLUS sutureless valve: results of the prospective multicentric MANTRA study. J Cardiothorac Surg 2024; 19:340. [PMID: 38902742 PMCID: PMC11191267 DOI: 10.1186/s13019-024-02861-1] [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: 02/06/2024] [Accepted: 06/14/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND The aim of this study is to report the preliminary real-word clinical and hemodynamic performance from the MANTRA study in patients undergoing aortic valve replacement with Perceval PLUS sutureless valve. METHODS MANTRA is an ongoing "umbrella" prospective, multi-center, international post-market study to collect real-life safety and performance data on Corcym devices (Corcym S.r.l, Saluggia, Italy). Clinical and echocardiographic outcomes were collected preoperatively, at discharge and at each follow up. KCCQ-12 and EQ-5D-5L quality of life questionnaires were collected preoperatively and at 30-days. RESULTS A total of 328 patients underwent aortic valve replacement with Perceval PLUS in 29 International institutions. Patients were enrolled from July 2021 to October 2023 and enrollment is still ongoing. Mean age was 71.9 ± 6.4 years, mean EuroSCORE II was 2.9 ± 3.9. Minimally invasive approach was performed in 44.2% (145/328) of patients; concomitant procedures were done in 40.8% (134/328) of cases. Thirty-day mortality was 1.8% (6/328) and no re-interventions were reported. Pacemaker implant was required in 4.0% (13/328) of the patients. The assessment of the functional status demonstrated marked and stable improvement in NYHA class in most patients at 30-day follow-up, with significant increase of KCCQ-12 summary score (from 58.8 ± 23.0 to 71.8 ± 22.1, p < 0.0001) and EQ-5D-5L VAS score (from 64.5 ± 20.4 to 72.6 ± 17.5, p < 0.0001). Mean pressure gradient decreased from 46.2 ± 17.3 mmHg to 10.1 ± 4.7 mmHg at 30-day follow-up. Low or no incidence of moderate-to-severe paravalvular or central leak was reported. CONCLUSIONS Preliminary results demonstrate good clinical outcomes and significant improvement of Quality of Life at 30-days, excellent early hemodynamic performance within patient implanted with Perceval PLUS. TRIAL REGISTRATION The MANTRA study has been registered in ClinicalTrials.gov (NCT05002543, Initial release 26 July 2021).
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Affiliation(s)
- Slobodan Micovic
- Dedinje Cardiovascular Institute, Milana Tepica 1, Belgrade, 11000, Serbia.
| | - Angelo Nobre
- Hospital de Santa Maria Lisbon, Lisbon, Portugal
| | | | | | | | - Michele Torella
- University of Campania "L. Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Cristian Baeza
- University Hospitals Cleveland Medical Center, Cleveland, USA
| | | | | | - Giovanni Troise
- Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Utz Kappert
- Herzzentrum Dresden GmbH Universitätsklinik, Dresden, Germany
| | | | - Hyung Gon Je
- Pusan National University Yangsan Hospital, Yangsan, South Korea
| | | | - Ka Yan Lam
- Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Mauro Rinaldi
- A.O.U. Città Della Salute E Della Scienza Di Torino - Ospedale Molinette, Turin, Italy
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Giuliani C, Zanuttini A, Salaun E, Côté N, Clavel MA, Pibarot P. Subclinical valve leaflet thrombosis following bioprosthetic aortic valve replacement. Curr Opin Cardiol 2024:00001573-990000000-00160. [PMID: 38899782 DOI: 10.1097/hco.0000000000001161] [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] [Indexed: 06/21/2024]
Abstract
PURPOSE OF REVIEW Subclinical leaflet thrombosis (SLT) is often an incidental finding characterized by a thin layer of thrombus involving one, two or three leaflets, with typical appearance on multi-detector computed tomography (MDCT) of hypo-attenuating defect at the aortic side of the leaflet, also called hypo-attenuating leaflet thickening (HALT). SLT may occur following both transcatheter aortic replacement (TAVR) or biological surgical aortic valve replacement (SAVR). The aim of this review is to present an overview of the current state of knowledge on the incidence, diagnosis, clinical impact, and management of SLT following TAVR or SAVR. RECENT FINDINGS SLT occurs in 10-20% of patients following TAVR and is somewhat more frequent than following SAVR (5-15%). SLT may regress spontaneously without treatment in about 50% of the cases but may also progress to clinically significant valve thrombosis in some cases. Oral anticoagulation with vitamin K antagonist is reasonable if SLT is detected by echocardiography and/or MDCT during follow-up and is generally efficient to reverse SLT. SLT is associated with mild increase in the risk of stroke but has no impact on survival. SLT has been linked with accelerated structural valve deterioration and may thus impact valve durability and long-term outcomes. SUMMARY SLT is often an incidental finding on echocardiography or MDCT that occurs in 10-20% of patients following TAVR or 5-15% following biological SAVR and is associated with a mild increase in the risk of thrombo-embolic event with no significant impact on mortality but may be associated with reduced valve durability.
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Affiliation(s)
- Carlos Giuliani
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada
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50
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López Martínez H, Vilalta V, Farjat-Pasos J, Ferrer-Sistach E, Mohammadi S, Escabia C, Kalavrouziotis D, Resta H, Borrellas A, Dumont E, Carrillo X, Paradis JM, Fernández-Nofrerías E, Delgado V, Rodés-Cabau J, Bayes-Genis A. Heart failure hospitalization following surgical or transcatheter aortic valve implantation in low-risk aortic stenosis. ESC Heart Fail 2024. [PMID: 38894578 DOI: 10.1002/ehf2.14887] [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: 04/13/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 06/21/2024] Open
Abstract
AIMS In low-risk patients with severe aortic stenosis (AS), sutureless surgical aortic valve replacement (SU-SAVR) may be an alternative to transcatheter aortic valve implantation (TAVI). The risk of heart failure hospitalization (HFH) after aortic valve replacement (AVR) in this population is incompletely characterized. This study aims to investigate the incidence, predictors, and outcomes of HFH in patients undergoing SU-SAVR versus TAVI. METHODS AND RESULTS Patients referred for AVR between 2013 and 2020 at two centres were consecutively included. The decision for SU-SAVR or TAVI was determined by a multidisciplinary Heart Team. Cox regression and competing risk analysis were conducted to assess adverse events. Of 594 patients (mean age 77.5 ± 6.4, 59.8% male), 424 underwent SU-SAVR, while 170 underwent TAVI. Following a mean follow-up of 34.1 ± 23.1 months, HFH occurred in 112 (27.8%) SU-SAVR patients and in 8 (4.8%) TAVI patients (P < 0.001). The SU-SAVR cohort exhibited higher all-cause mortality (138 [32.5%] patients compared with 30 [17.6%] in the TAVI cohort [P < 0.001]). These differences remained significant after sensitivity analyses with 1:1 propensity score matching for baseline variables. SU-SAVR with HFH was associated with increased all-cause mortality (61.6% vs. 23.1%, P < 0.001). Independent associates of HFH in SU-SAVR patients included diabetes, atrial fibrillation, chronic obstructive pulmonary disease, lower glomerular filtration rate and lower left ventricular ejection fraction. SU-SAVR patients with HFH had a 12-month LVEF of 59.4 ± 12.7. CONCLUSIONS In low-risk AS, SU-SAVR is associated with a higher risk of HFH and all-cause mortality compared to TAVI. In patients with severe AS candidate to SU-SAVR or TAVI, TAVI may be the preferred intervention.
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Affiliation(s)
| | - Victoria Vilalta
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | | | - Claudia Escabia
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Helena Resta
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Andrea Borrellas
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Eric Dumont
- Quebec Heart & Lung Institute, Laval University, Quebec, Canada
| | - Xavier Carrillo
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Victoria Delgado
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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