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Zhou Q, Wen J, Zhu Q, Fan J, Guan X, Chen X, He Y, Guo Y, Jiang J, Ding X, Pu Z, Huang Z, Li C, Zhang M, Liu X, Xu X, Wang J. Long-term prosthetic-associated subclinical thrombotic events evaluation by cardiac CTA after transcatheter aortic valve implantation: incidence and outcomes. Insights Imaging 2024; 15:125. [PMID: 38816554 PMCID: PMC11139807 DOI: 10.1186/s13244-024-01681-0] [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: 03/12/2024] [Accepted: 03/22/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE To observe prosthetic-associated subclinical thrombotic events (PASTE) after transcatheter aortic valve implantation (TAVI) by cardiac CTA, and assess their impact on long-term patient outcomes. MATERIALS We prospectively and consecutively enrolled 188 patients with severe aortic stenosis treated with TAVI from February 2014 to April 2017. At 5 years, 61 of 141 survived patients who had completed annual follow-up CTA (≥ 5 years) were included. We analyzed PASTE by CTA, including hypoattenuated leaflet thickening (HALT), sinus filling defect (SFD), and prosthesis filling defect (PFD). The primary outcome was a major adverse cardiovascular composite outcome (MACCO) of stroke, cardiac re-hospitalization, and bioprosthetic valve dysfunction (BVD); the secondary outcomes were bioprosthetic hemodynamics deterioration (PGmean) and cardiac dysfunction (LVEF). RESULTS During a median follow-up time of 5.25 years, long-term incidence of HALT, SFD, and PFD were 54.1%, 37.7%, and 73.8%, respectively. In the primary outcome, SFD and early SFD were associated with the MACCO (SFD: p = 0.005; early SFD: p = 0.018), and SFD was a predictor of MACCO (HR: 2.870; 95% CI: 1.010 to 8.154, p = 0.048). In the secondary outcomes, HALT was associated with increased PGmean (p = 0.031), while persistent HALT was correlated with ΔPGmean (β = 0.38, p = 0.035). SFD was negatively correlated with ΔLVEF (β = -0.39, p = 0.041), and early SFD was negatively correlated with LVEF and ΔLVEF (LVEF: r = -0.50, p = 0.041; ΔLVEF: r = -0.53, p = 0.030). CONCLUSIONS PASTE were associated with adverse long-term outcomes, bioprosthetic hemodynamics deterioration, and cardiac dysfunction. In particular, SFD was a predictor of MACCO and may be a potential target for anticoagulation after TAVI (NCT02803294). REGISTRATION URL: https://www. CLINICALTRIALS gov ; Unique identifier: NCT02803294. CRITICAL RELEVANCE STATEMENT PASTE, especially SFD, after TAVI based on cardiac CTA findings impacts the long-term outcomes of patients which is a predictor of long-term major adverse outcomes in patients and may be a potential target for anticoagulation after TAVI. KEY POINTS Transcatheter aortic valve implantation is being used more often; associated subclinical thromboses have not been thoroughly evaluated. Prosthetic-associated subclinical thrombotic events were associated with adverse outcomes, bioprosthetic hemodynamics deterioration, and cardiac dysfunction. Studies should be directed at these topics to determine if they should be intervened upon.
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Affiliation(s)
- Qijing Zhou
- Department of Radiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jiaqi Wen
- Department of Radiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Qifeng Zhu
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jiaqi Fan
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Xiaojun Guan
- Department of Radiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xinyi Chen
- Department of Radiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yuxin He
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yuchao Guo
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jubo Jiang
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xinfa Ding
- Department of Radiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Zhaoxia Pu
- Department of Echocardiography, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Zhaoxu Huang
- Department of Echocardiography, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Cheng Li
- Department of Nursing, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Minming Zhang
- Department of Radiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
- Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xianbao Liu
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
- Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xiaojun Xu
- Department of Radiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
- Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jian'an Wang
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
- Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
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Taghizadeh-Waghefi A, Petrov A, Jatzke P, Wilbring M, Kappert U, Matschke K, Alexiou K, Arzt S. Minimally Invasive Isolated Aortic Valve Replacement in a Potential TAVI Cohort of Patients Aged ≥ 75 Years: A Propensity-Matched Analysis. J Clin Med 2023; 12:4963. [PMID: 37568365 PMCID: PMC10420005 DOI: 10.3390/jcm12154963] [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: 02/26/2023] [Revised: 07/09/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023] Open
Abstract
(1) Background and Objectives: Transcatheter aortic valve implantation is guideline-recommended from the age of 75. However, this European guideline recommendation is based on limited evidence, since no interaction between age and primary outcome has been found in guideline-stated references. This study aimed to compare the short-term outcomes of minimally invasive isolated aortic valve replacement in patients aged ≥ 75 with those of younger patients; (2) Patients and Methods: This retrospective cohort study included 1339 patients who underwent minimally invasive isolated aortic valve replacement at our facility between 2014 and 2022. This cohort was divided into two age-based groups: <75 and ≥75 years. Operative morbidity and mortality were compared between groups. Further analysis was performed using propensity score matching; (3) Results: After matching, 347 pairs of patients were included and analyzed. Despite the higher EuroSCORE II in the ≥75 group (2.2 ± 1.3% vs. 1.80 ± 1.34%, p ≤ 0.001), the 30-day mortality (1.4% vs. 1.2%; p = 0.90) and major adverse cardiac and cerebrovascular events, such as perioperative myocardial infarction (0.0% vs. 1.2%, p = 0.12) and stroke (1.4% vs. 2.6%, p = 0.06), were comparable between both treatment groups; (4) Conclusions: Minimally invasive aortic valve replacement is a safe treatment method for patients aged ≥ 75. Our results indicate that the unilateral cut-off of 75 years is not a limiting factor for performing minimally invasive aortic valve replacement.
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Affiliation(s)
- Ali Taghizadeh-Waghefi
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Faculty of Medicine, Technical University of Dresden, 01037 Dresden, Germany
| | - Asen Petrov
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Faculty of Medicine, Technical University of Dresden, 01037 Dresden, Germany
| | - Philipp Jatzke
- Anesthesiology and Intensive Care Medicine, Dresden University Hospital, Faculty of Medicine, Technical University of Dresden, 01307 Dresden, Germany
| | - Manuel Wilbring
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Faculty of Medicine, Technical University of Dresden, 01037 Dresden, Germany
| | - Utz Kappert
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Faculty of Medicine, Technical University of Dresden, 01037 Dresden, Germany
| | - Klaus Matschke
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Faculty of Medicine, Technical University of Dresden, 01037 Dresden, Germany
| | - Konstantin Alexiou
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Faculty of Medicine, Technical University of Dresden, 01037 Dresden, Germany
| | - Sebastian Arzt
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Faculty of Medicine, Technical University of Dresden, 01037 Dresden, Germany
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7
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Shah BN. National Institute for Health and Care Excellence (NICE) guidance on heart valve disease. Heart 2023; 109:817-822. [PMID: 36653169 DOI: 10.1136/heartjnl-2022-321095] [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: 06/27/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
The National Institute for Health and Care Excellence (NICE) guidelines are evidence-based recommendations for health and care in England. In late 2021, NICE published its first ever guidance on the investigation and management of adults with heart valve disease. This followed on from recent updates to the international societal practice guidelines on heart valve disease produced by the American College of Cardiology and American Heart Association (in 2020) and the European Society of Cardiology and European Association for Cardiothoracic Surgery (in 2021). The purpose of the NICE guidance has significant differences from societal guidelines, as NICE guidance is designed for implementation within the UK's taxpayer-funded National Health Service and thus must account not just for clinical effectiveness of treatments but cost-effectiveness also. This explains some of the differences between recent recommendations from these bodies, most notably in the treatment of patients with symptomatic severe aortic stenosis, in which NICE clearly explains that cost implications influenced their final guidance (which differs from the recently published European and North American guidelines). The aims of this review article are to provide an overview of the scope and recommendations of the NICE guideline and to compare and contrast the guidelines, highlighting reasons for differences between the guidance from professional societies and NICE and discussing the relative strengths and weaknesses of the NICE guideline.
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Affiliation(s)
- Benoy Nalin Shah
- Cardiology, University Hospital Southampton NHS Foundation Trust Cardiovascular and Thoracic Service, Southampton, UK
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Crea F. Challenges in the management of aortic stenosis, multiple valve disease, culture-negative endocarditis, and cardiac surgery during pregnancy. Eur Heart J 2022; 43:2715-2719. [PMID: 35908774 DOI: 10.1093/eurheartj/ehac381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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