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Frank D, Kennon S, Bonaros N, Romano M, Di Mario C, van Ginkel DJ, Bor W, Kasel M, De Backer O, Hachaturyan V, Lüske CM, Kurucova J, Bramlage P, Styra R. Quality of Life Measures in Aortic Stenosis Research: A Narrative Review. Cardiology 2023; 148:556-570. [PMID: 37442111 PMCID: PMC10733944 DOI: 10.1159/000531465] [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: 07/04/2022] [Accepted: 05/31/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Elderly patients with aortic stenosis (AS) not only have a reduced life expectancy but also a reduced quality of life (QoL). The benefits of an AS intervention may be considered a balance between a good QoL and a reasonably extended life. However, the different questionnaires being used to determine the QoL were generally not developed for the specific situation of patients with AS and come with strengths and considerable weaknesses. The objective of this article was to provide an overview of the available QoL instruments in AS research, describe their strengths and weaknesses, and provide our assessment of the utility of the available scoring instruments for QoL measurements in AS. SUMMARY We identified and reviewed the following instruments that are used in AS research: Short Form Health Survey (SF-36/SF-12), EuroQol-5D (EQ-5D), the Illness Intrusiveness Rating Scale (IIRS), the HeartQoL, the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Minnesota Living with Heart Failure Questionnaire (MLHF), the MacNew Questionnaire, and the Toronto Aortic Stenosis Quality of Life Questionnaire (TASQ). KEY MESSAGES There is no standardized assessment of QoL in patients with AS. Many different questionnaires are being used, but they are rarely specific for AS. There is a need for AS-specific research into the QoL of patients as life prolongation may compete for an improved QoL in this elderly patient group.
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Affiliation(s)
- Derk Frank
- Department of Internal Medicine III (Cardiology, Angiology and Critical Care), UKSH University Clinical Center Schleswig-Holstein and DZHK (German Centre for Cardiovascular Research), Partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Simon Kennon
- Department of Cardiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, UK
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Mauro Romano
- Department of Thoracic and Cardiovascular Surgery, Department of Interventional Cardiology, Hôpital Privé Jacques Cartier, Massy, France
| | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Dirk-Jan van Ginkel
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Wilbert Bor
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Markus Kasel
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Ole De Backer
- Interventional Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | | | - Claudia M. Lüske
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Rima Styra
- Department of Psychiatry, University Health Network, Toronto, ON, Canada
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Nowicka-Sauer K, Jarmoszewicz K, Molisz A, Sobczak K, Sauer M, Topolski M. Applying Machine Learning to Construct a Model of Risk of Depression in Patients Following Cardiac Surgery with the Use of the SF-12 Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4876. [PMID: 36981783 PMCID: PMC10048966 DOI: 10.3390/ijerph20064876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Depression is a common problem in patients with cardiovascular diseases. Identifying a risk factor model of depression has been postulated. A model of the risk of depression would provide a better understanding of this disorder in this population. We sought to construct a model of the risk factors of depression in patients following cardiac surgery, with the use of machine learning. METHODS AND MEASURES Two hundred and seventeen patients (65.4% men; mean age 65.14 years) were asked to complete the short form health survey-12 (SF-12v.2), three months after hospital discharge. Those at risk of depression were identified based on the SF-12 mental component summary (MCS). Centroid class principal component analysis (CCPCA) and the classification and regression tree (CART) were used to design a model. RESULTS A risk of depression was identified in 29.03% of patients. The following variables explained 82.53% of the variance in depression risk: vitality, limitation of activities due to emotional problems (role-emotional, RE), New York Heart Association (NYHA) class, and heart failure. Additionally, CART revealed that decreased vitality increased the risk of depression to 45.44% and an RE score > 68.75 increased it to 63.11%. In the group with an RE score < 68.75, the NYHA class increased the risk to 41.85%, and heart failure further increased it to 44.75%. CONCLUSION Assessing fatigue and vitality can help health professionals with identifying patients at risk of depression. In addition, assessing functional status and dimensions of fatigue, as well as the impact of emotional state on daily functioning, can help determine effective intervention options.
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Affiliation(s)
- Katarzyna Nowicka-Sauer
- Department of Family Medicine, Faculty of Medicine, Medical University of Gdańsk, Dębinki 2 Str., 80-211 Gdańsk, Poland
- Department of Cardiac Surgery, Kashubian Centre for Cardiac and Vascular Diseases, Ceynowa Specialist Hospital, Jagalskiego 10 Str., 84-200 Wejherowo, Poland;
| | - Krzysztof Jarmoszewicz
- Department of Cardiac Surgery, Kashubian Centre for Cardiac and Vascular Diseases, Ceynowa Specialist Hospital, Jagalskiego 10 Str., 84-200 Wejherowo, Poland;
| | - Andrzej Molisz
- Department of Otolaryngology, University Clinical Centre, Medical University of Gdańsk, Smoluchowskiego 17 Str., 80-214 Gdansk, Poland;
| | - Krzysztof Sobczak
- Division of Medical Sociology and Social Pathology, Faculty of Health Sciences, Medical University of Gdańsk, Tuwima 15 Str., 80-210 Gdańsk, Poland;
| | - Marta Sauer
- Radiation Protection Office, University Clinical Centre, Medical University of Gdańsk, Smoluchowskiego 17 Str., 80-214 Gdańsk, Poland;
| | - Mariusz Topolski
- Department of Systems and Computer Networks, Faculty of Information and Communication Technology, Wroclaw University of Science and Technology, Janiszewskiego 11/17 Str., 50-372 Wroclaw, Poland;
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3
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Jarmoszewicz K, Nowicka-Sauer K, Wera K, Meslin-Kuźniak A, Beta S, Pietrzykowska M. Predictors of patient-reported health following cardiac surgery. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:278-285. [PMID: 33565744 DOI: 10.23736/s0021-9509.21.11452-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patient-reported health status is one of the most important aspects of cardiovascular outcomes. The aim of this study was to assess patient-reported health and its determinants following cardiac surgery. METHODS Cross-sectional study was performed among 128 patients (mean age: 66.02; 35.9% women). Three months after surgery patients filled in The Short Form 12 Health Survey (SF-12) and Brief-Illness Perception Questionnaire (B-IPQ). Patient-reported health was assessed using SF-12 General Health component. RESULTS The mean General Health score was 47.34 (SD=20.94). General Health was significantly positively correlated with SF-12 Physical and Mental Component Summary (P<0.01). Significant negative correlations were noted between General Health and European System for Cardiac Operative Risk Factor (EuroSCORE) (P=0.012) and Body Mass Index (BMI) (P=0.026). Higher scores on B-IPQ Consequences, Timeline, Identity, Emotional Response (P<0.01) and Concern (P=0.03) were related to worse General Health. Higher perceived effectiveness of surgery (P<0.01) and Treatment control (P=0.003) were associated with higher General Health score. More negative illness perception was significantly related to lower General Health (P<0.01). No significant associations between General Health and mode and weight of the procedure, myocardial infarction, previous percutaneous coronary intervention, New York Heart Association (NYHA) and Canadian Cardiovascular Society (CCS) class and postsurgical complications were noted. Structural equation modeling (SEM) revealed that illness perception domains, BMI and EuroSCORE are the main determinants of General Health. CONCLUSIONS Modifiable factors, especially illness perception are important determinants of patient-reported health after cardiac surgery. Evaluation of illness perception seems vital since it may lead to address patients' concerns and improve outcomes.
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Affiliation(s)
| | - Katarzyna Nowicka-Sauer
- Department of Cardiac Surgery, Florian Ceynowa Specialist Hospital, Wejherowo, Poland - .,Department of Family Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Kamil Wera
- Department of Cardiology, Mikołaj Kopernik Specialist Municipal Hospital in Toruń, Toruń, Poland
| | - Anna Meslin-Kuźniak
- Private Practitioner in Psychotherapy, Neurologopedic Therapy and Sensory Integration, Gdańsk, Poland
| | - Sebastian Beta
- Department of Cardiac Surgery, Florian Ceynowa Specialist Hospital, Wejherowo, Poland
| | - Małgorzata Pietrzykowska
- Department of Family Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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4
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Edwards KS, Chow EKH, Dao C, Hossepian D, Johnson AG, Desai M, Shah S, Lee A, Yeung AC, Fischbein M, Fearon WF. Impact of cognitive behavioral therapy on depression symptoms after transcatheter aortic valve replacement: A randomized controlled trial. Int J Cardiol 2020; 321:61-68. [PMID: 32800909 DOI: 10.1016/j.ijcard.2020.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 07/04/2020] [Accepted: 08/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Depression is a significant concern after cardiac surgery and has not been studied in patients undergoing transcatheter aortic valve replacement (TAVR). We sought to examine the prevalence of pre-procedure depression and anxiety symptoms and explore whether brief bedside cognitive behavioral therapy (CBT) could prevent post-TAVR psychological distress. METHODS We prospectively recruited consecutive TAVR patients and randomized them to receive brief CBT or treatment as usual (TAU) during their hospitalization. Multi-level regression techniques were used to evaluate changes by treatment arm in depression, anxiety, and quality of life from baseline to 1 month post-TAVR adjusted for sex, race, DM, CHF, MMSE, and STS score. RESULTS One hundred and forty six participants were randomized. The mean age was 82 years, and 43% were female. Self-reported depression and anxiety scores meeting cutoffs for clinical level distress were 24.6% and 23.2% respectively. Both TAU and CBT groups had comparable improvements in depressive symptoms at 1-month (31% reduction for TAU and 35% reduction for CBT, p = .83). Similarly, both TAU and CBT groups had comparable improvements in anxiety symptoms at 1-month (8% reduction for TAU and 11% reduction for CBT, p = .1). Quality of life scores also improved and were not significantly different between the two groups. CONCLUSIONS Pre-procedure depression and anxiety may be common among patients undergoing TAVR. However, TAVR patients show spontaneous improvement in depression and anxiety scores at 1-month follow up, regardless of brief CBT. Further research is needed to determine whether more tailored CBT interventions may improve psychological and medical outcomes.
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Affiliation(s)
| | - Eric K H Chow
- Quantitative Sciences Unit, Stanford University, United States of America
| | - Catherine Dao
- Department of Medicine, Stanford University, United States of America
| | - Derik Hossepian
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, United States of America
| | - Audrey G Johnson
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, United States of America
| | - Manisha Desai
- Quantitative Sciences Unit, Stanford University, United States of America
| | - Sonia Shah
- Department of Medicine, Stanford University, United States of America
| | - Anson Lee
- Department of Cardiothoracic Surgery, Stanford University, United States of America
| | - Alan C Yeung
- Department of Medicine, Stanford University, United States of America
| | - Michael Fischbein
- Department of Cardiothoracic Surgery, Stanford University, United States of America
| | - William F Fearon
- Department of Medicine, Stanford University, United States of America
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5
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Ciuca C, Ferrari S, Placuzzi L, Marrozzini C, Taglieri N, Bordoni B, Dall'Ara G, Moretti C, Montefiori M, Chattat R, Marzocchi A, Saia F. Cognitive functions: evaluation and changes after transcatheter aortic valve implantation in elderly patients. Future Cardiol 2017; 13:229-237. [PMID: 28585899 DOI: 10.2217/fca-2016-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To assess the prevalence and postprocedural evolution of cognitive impairment (CI) in patients undergoing transcatheter aortic valve implantation. METHODS 62 patients were enrolled. Mini Mental state examination (MMSE), verbal memory test (VMT), visual search test (VST) and phonemic verbal fluency (PVF) were used to evaluate the cognitive status. CI was considered when a pathological result of MMSE was confirmed by VMT, VST and PVF. RESULTS A total of 26.2% patients had CI at baseline. MMSE, VMT, VST and PVF were pathologic in 39, 16.1, 8.1 and 22.6% of the patients, respectively. Overall, no significant differences in cognitive function in any dimension were observed from baseline up to 1-year follow-up. CONCLUSION CI is frequent in patients undergoing transcatheter aortic valve implantation, though the procedure does not forge cognitive status.
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Affiliation(s)
- Cristina Ciuca
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Susy Ferrari
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy.,Department of Psychology, University of Bologna, Italy
| | - Lisa Placuzzi
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy.,Department of Psychology, University of Bologna, Italy
| | - Cinzia Marrozzini
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Nevio Taglieri
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Barbara Bordoni
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Gianni Dall'Ara
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Carolina Moretti
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Michela Montefiori
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Italy
| | - Antonio Marzocchi
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Francesco Saia
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
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6
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Meguro K, Ishizaki J, Yanagisawa T, Koitabashi T, Kitamura T, Ako J. Non-occlusive mesenteric ischemia accompanied by aortic regurgitation after transcatheter aortic valve implantation. Cardiovasc Interv Ther 2016; 32:425-429. [PMID: 28028747 DOI: 10.1007/s12928-016-0450-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/20/2016] [Indexed: 01/16/2023]
Abstract
An 81-year-old male with severe symptomatic aortic stenosis with ventricular tachycardia was referred for treatment. Balloon aortic valvuloplasty was performed under cardiopulmonary resuscitation. Though transcatheter aortic valve implantation (TAVI) was considered high risk for annulus rupture and aortic regurgitation due to annular calcification, TAVI was performed because of extremely high surgical risk. Moderate-to-severe aortic regurgitation (AR) remained and progression of acidosis could not be managed with continuous hemodiafiltration. His autopsy revealed the development of non-occlusive mesenteric ischemia (NOMI) as the cause of progressive acidosis. AR and hemodynamic instability might contribute to the development and progression of NOMI after TAVI.
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Affiliation(s)
- Kentaro Meguro
- Department of Cardiovascular Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Junro Ishizaki
- Department of Cardiovascular Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Tomoyoshi Yanagisawa
- Department of Cardiovascular Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Toshimi Koitabashi
- Department of Cardiovascular Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Tadashi Kitamura
- Department of Cardiovascular Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
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7
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Olsson K, Nilsson J, Hörnsten Å, Näslund U. Patients' self-reported function, symptoms and health-related quality of life before and 6 months after transcatheter aortic valve implantation and surgical aortic valve replacement. Eur J Cardiovasc Nurs 2016; 16:213-221. [PMID: 27169460 DOI: 10.1177/1474515116650342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Aortic stenosis is the most common valve disease in western countries and has poor prognosis without treatment. Surgical aortic valve replacement (SAVR) is the gold standard, and transcatheter aortic valve implantation (TAVI) is a new method that is used in high-risk patients who are denied surgery. The purpose of treatment is not only to save life, but also to reduce symptoms and increase health-related quality of life (HRQoL). OBJECTIVE The aim of this study was to describe patients' self-reported outcomes in terms of physical function, symptoms, dependence, HRQoL, and cognitive function after TAVI and SAVR. METHODS All patients treated with TAVI during 1 year ( n = 24) and age-matched patients treated with SAVR ( n = 24) were included. Data were collected on the day before and at 6 months after treatment using structural questionnaires. RESULTS Self-rated function was low before treatment and increased at follow-up. A quarter of all patients reported syncope at baseline, and none reported this at follow-up. Breathlessness was reported by all patients to be the most limiting cardiac symptom, but the TAVI patients reported more severe symptoms. At 6 months' follow-up, symptoms were reduced, but breathlessness and fatigue were still common, especially in the TAVI group. HRQoL, which was very low in the TAVI group at baseline, increased in all dimensions except social function. CONCLUSION We found no change in cognitive function or dependence at follow-up. There was no difference in the size of improvement between groups. The results could be helpful when informing future patients in order to give them realistic expectations.
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Affiliation(s)
- Karin Olsson
- 1 Cardiology, Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,2 Department of Nursing, Umeå University, Umeå, Sweden
| | - Johan Nilsson
- 1 Cardiology, Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Åsa Hörnsten
- 2 Department of Nursing, Umeå University, Umeå, Sweden
| | - Ulf Näslund
- 1 Cardiology, Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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8
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Chen J, Nawaz N, Fox Z, Komlo C, Anwaruddin S, Desai N, Jagasia D, Herrmann HC, Han Y. Echocardiographic determinants of LV functional improvement after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2015; 87:1164-72. [PMID: 27145743 DOI: 10.1002/ccd.26302] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 07/13/2015] [Accepted: 10/04/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is an established therapy in high-risk patients with severe aortic stenosis. Among patients with reduced left ventricular ejection fraction (LVEF), it is unclear which patients will derive maximal benefit from TAVR. METHODS Clinical and echocardiographic data of patients with severe aortic stenosis and low LVEF (≤50%) who underwent TAVR at a single institution during 2009-2013 were retrospectively analyzed. Patients were divided into 2 groups post-TAVR based on improved LV function (Group A = ΔLVEF ≥ 10%) versus persistent LV dysfunction (Group B = ΔLVEF<10%). Echocardiographic parameters were assessed for their association with LVEF change post-TAVR. Kaplan-Meier analysis was performed to generate survival estimates. RESULTS Of 382 patients who underwent TAVR, 60 patients had low LVEF, LV function failed to improve ≥10% in 50% of patients following the procedure (Group B). At baseline echocardiograms, Group B had higher LVEF, stroke volume (SV), SV index; and lower E, E/E', and estimated pulmonary arterial systolic pressure (PASP) compared to Group A. Higher mortality was found in Group B compared to the Group A (p = 0.003) with a significantly shorter survival (Group A = 3.3 ± 0.1 years vs Group B = 2.7 ± 0.2 years, p = 0.003). One-year event free survival was 53.3% in Group B compared to 93.3% in Group A, with a stable trend over ensuing years (5-year survival; 53.3% versus 90.0%, p = 0.003). CONCLUSIONS In patients undergoing TAVR with depressed LV function, those who failed to improve were more likely to have relatively higher LVEF, SV, and SVI; and lower E, E/E', and PASP at baseline. Mortality rates were found to be higher in persistent LV dysfunction group. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Jinling Chen
- Cardiovascular Division, the Hospital of University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Echocardiography, Renmin Hospital of Wuhan University, Wuhan, China
| | - Nasir Nawaz
- Crozer Chester Medical Center, Crozer-Keystone Health System, Upland, Pennsylvania
| | - Zachary Fox
- Cardiovascular Surgery, the Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caroline Komlo
- Cardiovascular Surgery, the Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Saif Anwaruddin
- Cardiovascular Division, the Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nimesh Desai
- Cardiovascular Surgery, the Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dinesh Jagasia
- Cardiovascular Division, the Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Howard C Herrmann
- Cardiovascular Division, the Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yuchi Han
- Cardiovascular Division, the Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
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9
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Uddin A, Fairbairn TA, Djoukhader IK, Igra M, Kidambi A, Motwani M, Herzog B, Ripley DP, Musa TA, Goddard AJP, Blackman DJ, Plein S, Greenwood JP. Consequence of cerebral embolism after transcatheter aortic valve implantation compared with contemporary surgical aortic valve replacement: effect on health-related quality of life. Circ Cardiovasc Interv 2015; 8:e001913. [PMID: 25737407 DOI: 10.1161/circinterventions.114.001913] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Incidence of cerebral microinfarcts is higher after transcatheter aortic valve implantation (TAVI) compared with surgical aortic valve replacement (SAVR). It is unknown whether these lesions persist and what direct impact they have on health-related quality of life. The objective was to identify predictors of cerebral microinfarction and measure their effect on health-related quality of life during 6 months after TAVI when compared with SAVR. METHODS AND RESULTS Cerebral MRI was conducted at baseline, post procedure, and 6 months using diffusion-weighted imaging. Health-related quality of life was measured at baseline, 30 days, and 6 months with short form-12 health outcomes and EuroQol 5 dimensions questionnaires. One hundred eleven patients (TAVI, n=71; SAVR, n=40) were studied. The incidence (54 [77%] versus 17 [43%]; P=0.001) and number (3.4±4.9 versus 1.2±1.8; P=0.001) of new microinfarcts were greater after TAVI than after SAVR. The total volume per microinfarct was smaller in TAVI than in SAVR (0.23±0.24 versus 0.76±1.8 mL; P=0.04). The strongest associations for microinfarction were: TAVI (arch atheroma grade: r=0.46; P=0.0001) and SAVR (concomitant coronary artery bypass grafting: r=-0.33; P=0.03). Physical component score in TAVI increased after 30 days (32.1±6.6 versus 38.9±7.0; P<0.0001) and 6 months (40.4±9.3; P<0.0001); the improvement occurred later in SAVR (baseline: 34.9±10.6; 30 days: 35.9±10.2; 6 months: 42.8±11.2; P<0.001). After TAVI, there were no differences in the short form-12 health outcome scores according to the presence or size of new cerebral infarction. CONCLUSIONS Cerebral microinfarctions are more common after TAVI compared with SAVR but seem to have no negative effect on early (30 days) or medium term (6 months) health-related quality of life. Aortic atheroma (TAVI) and concomitant coronary artery bypass grafting (SAVR) are independent risk factors for cerebral microinfarction.
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Affiliation(s)
- Akhlaque Uddin
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Timothy A Fairbairn
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Ibrahim K Djoukhader
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Mark Igra
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Ananth Kidambi
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Manish Motwani
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Bernhard Herzog
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - David P Ripley
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Tarique Al Musa
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Anthony J P Goddard
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Daniel J Blackman
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - Sven Plein
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.)
| | - John P Greenwood
- From the Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (A.U., T.A.F., A.K., M.M., B.H., D.P.R., T.A.M., S.P., J.P.G.); and Departments of Cardiology and Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom (I.K.D., M.I., A.J.P.G., D.J.B., S.P., J.P.G.).
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10
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Health-related quality of life after transcatheter or surgical aortic valve replacement in high-risk patients with severe aortic stenosis: an updated review of literature. Curr Cardiol Rep 2014; 16:473. [PMID: 24585114 DOI: 10.1007/s11886-014-0473-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recent trials have highlighted the comparable mortality benefits and durability of the results for patients with severe aortic stenosis (AS) and high surgical risk managed with either transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (AVR). Various national guidelines and international regulatory bodies have approved TAVR, thereby leading to potential wide usage and dissemination of this technique worldwide. Quality-of-life outcomes, in spite of being an important measure of success and acceptability of the procedure, have not been publicized as extensively. For high risk patients with severe AS, implementation of TAVR has resulted in comparable survival, but different and novel adverse events compared with AVR. We present an updated review focusing on the quality-of-life outcomes and issues with this new and important procedural approach.
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11
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Abstract
In recent years, experience with transcatheter aortic valve implantation has led to improved outcomes in elderly patients with severe aortic stenosis (AS) who may not have previously been considered for intervention. These patients are often frail with significant comorbid conditions. As the prevalence of AS increases, there is a need for improved assessment parameters to determine the patients most likely to benefit from this novel procedure. This review discusses the diagnostic criteria for severe AS and the trials available to aid in the decision to refer for aortic valve procedures in the elderly.
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Affiliation(s)
- Matthew Finn
- Department of Cardiology, Columbia University Medical Center, New York, NY.
| | - Philip Green
- Department of Cardiology, Columbia University Medical Center, New York, NY
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12
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Deutsch MA, Bleiziffer S, Elhmidi Y, Piazza N, Voss B, Lange R, Krane M. Beyond adding years to life: health-related quality-of-life and functional outcomes in patients with severe aortic valve stenosis at high surgical risk undergoing transcatheter aortic valve replacement. Curr Cardiol Rev 2014; 9:281-94. [PMID: 24313648 PMCID: PMC3941091 DOI: 10.2174/1573403x09666131202121750] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 09/28/2012] [Accepted: 10/25/2012] [Indexed: 11/22/2022] Open
Abstract
Aortic valve stenosis (AVS) is the most frequent acquired valvular heart disease in western industrialized countries
and its prevalence considerably increases with age. Once becoming symptomatic severe AVS has a very poor prognosis.
Progressive and rapid symptom deterioration leads to an impairment of functional status and compromised healthrelated
quality-of-life (HrQoL) simultaneously. Until recently, surgical aortic valve replacement (SAVR) has been the
only effective treatment option for improving symptoms and prolonging survival. Transcatheter aortic valve replacement
(TAVR) emerged as an alternative treatment modality for those patients with severe symptomatic AVS in whom the risk
for SAVR is considered prohibitive or too high. TAVR has gained clinical acceptance with almost startling rapidity and
has even quickly become the standard of care for the treatment of appropriately selected individuals with inoperable AVS
during recent years. Typically, patients currently referred for and treated by TAVR are elderly with a concomitant variable
spectrum of multiple comorbidities, disabilities and limited life expectancy. Beyond mortality and morbidity, the assessment
of HrQoL is of paramount importance not only to guide patient-centered clinical decision-making but also to judge
this new treatment modality. As per current evidence, TAVR significantly improves HrQoL in high-surgical risk patients
with severe AVS with sustained effects up to two years when compared with optimal medical care and demonstrates
comparable benefits relative to SAVR. Along with a provision of a detailed overview of the current literature regarding functional and HrQoL outcomes in patients
undergoing TAVR, this review article addresses specific considerations of the HrQoL aspect in the elderly patient
and finally outlines the implications of HrQoL outcomes for medico-economic deliberations.
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Affiliation(s)
| | | | | | | | | | | | - Markus Krane
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universitat Munchen, Lazarettstrasse 36, 80636 Munich, Germany.
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13
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Use of the Minnesota Living With Heart Failure Questionnaire Among Elderly Patients With Aortic Stenosis. J Cardiovasc Nurs 2014; 29:185-97. [DOI: 10.1097/jcn.0b013e318279b76f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Wong CY, Green P, Williams M. Decision-making in transcatheter aortic valve replacement: the impact of frailty in older adults with aortic stenosis. Expert Rev Cardiovasc Ther 2014; 11:761-72. [PMID: 23750685 DOI: 10.1586/erc.13.45] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patients with severe aortic stenosis are commonly elderly and with significant comorbidity. Surgical intervention can improve symptoms and survival in severe aortic stenosis. However, a large proportion of patients do not undergo surgical intervention because they are deemed to be inoperable or too high risk. Over the last decade, transcatheter aortic valve replacement (TAVR) has been developed, providing an effective, less-invasive alternative to open cardiac surgery for inoperable or high-risk patients. The purpose of this review is to provide an overview of risk assessment in TAVR. Specifically, this article reviews the epidemiology of aortic stenosis, describes the risks and benefits of TAVR across multiple outcome measures, explores frailty and other elderly risk factors as metrics for improved risk assessment and discusses the application of improved risk assessment in TAVR decisions.
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Affiliation(s)
- Catherine Y Wong
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
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15
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Orvin K, Dvir D, Weiss A, Assali A, Vaknin-Assa H, Shapira Y, Gazit O, Sagie A, Kornowski R. Comprehensive prospective cognitive and physical function assessment in elderly patients undergoing transcatheter aortic valve implantation. Cardiology 2014; 127:227-35. [PMID: 24481462 DOI: 10.1159/000356696] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 10/16/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Transcatheter aortic valve implantation (TAVI) is occasionally associated with stroke and silent cerebral ischemia, which may affect cognitive and functional performance. The aim of this study was to evaluate the changes in cognitive performance and functional status following TAVI. METHODS We performed a comprehensive prospective functional, cognitive and quality of life (QOL) evaluation in consecutive patients who underwent TAVI using the CoreValve device (Medtronic Inc.). The evaluation was performed at baseline and 1 month after the procedure and included the 36-item Short-Form Health Survey for QOL assessment, Mini-Mental State Examination (MMSE), quantitative clock drawing test (Rouleau), color trails test, Cognistat evaluation, Barthel Index and Duke Activity Status Index. RESULTS A total of 36 patients completed the full pre- and post-TAVI evaluation. Mean age was 82.2 ± 4.2 years (52.8% men); 94.5% of patients had low functional class (New York Heart Association III/IV), and 13.9% had prior stroke. After the procedure, all patients had improved functional status and valve hemodynamics. At 1 month, there was a significant improvement in the MMSE and Cognistat evaluations (from 25.9 ± 3.3 to 27.6 ± 2.4, p < 0.001, and from 5 ± 1 to 5.7 ± 0.7, p = 0.001, respectively). CONCLUSIONS Our preliminary results of a comprehensive assessment of patients undergoing TAVI indicate favorable results for both functional performance and cognitive function early after the procedure.
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Affiliation(s)
- Katia Orvin
- Cardiology Department, Rabin Medical Center, Petach Tikva, Israel
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16
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Reinöhl J, von Zur Mühlen C, Moser M, Sorg S, Bode C, Zehender M. TAVI 2012: state of the art. J Thromb Thrombolysis 2013; 35:419-35. [PMID: 23114537 DOI: 10.1007/s11239-012-0825-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The development of "transcatheter aortic valve implantation (TAVI)" is changing the field of cardiovascular medicine rapidly. The basic principle of TAVI is the percutaneous implantation of a bioprosthesis mounted in a metal frame. The prosthesis, which is attached to the tip of the catheter, is positioned in the native aortic valve and expanded. The first successful implantation was made by Alain Cribier in 2002. Several smaller mono- and multicenter studies later confirmed the technical feasibility of this procedure. Its true value as an important, therapeutic alternative to open heart surgery in inoperable and high-risk patients is now confirmed in large multicenter registries and by the prospective, randomized PARTNER trial. Decisive for the future acceptance of the procedure and for a possible expansion of the indication spectrum will be (1) continuous further development of the implantation technique and the prosthesis design, (2) reduction of TAVI-associated complications, (3) confirmation of the initial positive long-term results and (4) confirmation of the promising results in the treatment of surgical prosthesis dysfunctions and of patients with low to intermediate risk.
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Affiliation(s)
- Jochen Reinöhl
- Department of Cardiology, Heart Center Freiburg University, Hugstetter Str. 55, 79106, Freiburg, Germany.
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17
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Clinical outcome and quality of life in octogenarians following transcatheter aortic valve implantation (TAVI) for symptomatic aortic stenosis. Int J Cardiol 2013; 168:281-6. [DOI: 10.1016/j.ijcard.2012.09.079] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 05/14/2012] [Accepted: 09/15/2012] [Indexed: 11/23/2022]
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18
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Horrocks J, Closs J, Astin F. Quality of life in older adults with aortic stenosis: a narrative review. Int J Older People Nurs 2013; 9:227-46. [DOI: 10.1111/opn.12026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 12/19/2012] [Indexed: 01/25/2023]
Affiliation(s)
| | - José Closs
- School of Healthcare; University of Leeds; Leeds UK
| | - Felicity Astin
- School of Nursing; Midwifery and Social Work, University of Salford; Salford UK
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19
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Shan L, Saxena A, McMahon R, Wilson A, Newcomb A. A systematic review on the quality of life benefits after aortic valve replacement in the elderly. J Thorac Cardiovasc Surg 2013; 145:1173-89. [PMID: 23415689 DOI: 10.1016/j.jtcvs.2013.01.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 12/18/2012] [Accepted: 01/11/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surgical aortic valve replacement is being increasingly performed in elderly patients with good perioperative outcomes and long-term survival. Evidence is limited on health-related quality of life after aortic valve replacement, which is an important measure of operative success in the elderly. METHODS A systematic review of clinical studies after January 2000 was performed to identify health-related quality of life in the elderly after aortic valve replacement. Strict inclusion and exclusion criteria were applied. Quality appraisal of each study also was performed using predefined criteria. Health-related quality of life results were synthesized through a narrative review with full tabulation of the results of all included studies. RESULTS Health-related quality of life improvements were shown across most or all domains in different health-related quality of life instruments. Elderly patients experienced marked symptomatic improvement. Health-related quality of life was equivalent or superior to both an age-matched population and younger patients undergoing identical procedures. There were excellent functional gains after surgery, but elderly patients remain susceptible to geriatric issues and mood problems. Concomitant coronary artery bypass did not affect health-related quality of life. There was a diverse range of study designs, methods, and follow-up times that limited direct comparison between studies. CONCLUSIONS Aortic valve replacement results in significant health-related quality of life benefits across a broad range of health domains in elderly patients. Age alone should not be a precluding factor for surgery. Data are heterogeneous and mostly retrospective. We recommend future studies based on consistent guidelines provided in this systematic review.
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Affiliation(s)
- Leonard Shan
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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20
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Gonçalves A, Marcos-Alberca P, Almeria C, Feltes G, Hernández-Antolín RA, Rodríguez E, Rodrigo JL, Cobiella J, Maroto L, Cardoso JCS, Macaya C, Zamorano JL. Quality of life improvement at midterm follow-up after transcatheter aortic valve implantation. Int J Cardiol 2013; 162:117-22. [DOI: 10.1016/j.ijcard.2011.05.050] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 04/20/2011] [Accepted: 05/13/2011] [Indexed: 11/30/2022]
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21
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Georgiadou P, Sbarouni E, Karavolias GK, Voudris V. Transcatheter aortic valve implantation: restoring the qualities of life in old age. Age Ageing 2013; 42:21-6. [PMID: 22910300 DOI: 10.1093/ageing/afs110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a tremendous therapeutic advance for patients with severe aortic stenosis and high-surgical risk. Since TAVI-treated patients are elderly with multiple co-existing conditions, limited life expectancy and disproportionate health-care expenditures, the aspect of the health-related quality of life (HRQoL) benefits becomes of fundamental importance. Based on recent evidence, TAVI appears to improve significantly HRQoL measures compared with optimal standard care, which are restored to age-adjusted population norms over time.
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Affiliation(s)
- Panagiota Georgiadou
- 2nd Division of Interventional Cardiology, Onassis Cardiac Surgery Center, 356 Syngrou Avenue, 176 74, Athens, Greece.
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22
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Arnold SV, Spertus JA, Lei Y, Allen KB, Chhatriwalla AK, Leon MB, Smith CR, Reynolds MR, Webb JG, Svensson LG, Cohen DJ. Use of the Kansas City Cardiomyopathy Questionnaire for Monitoring Health Status in Patients With Aortic Stenosis. Circ Heart Fail 2013; 6:61-7. [DOI: 10.1161/circheartfailure.112.970053] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Improving functional status and quality of life are important goals of treatment for patients with severe aortic stenosis. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a heart failure health status measure and has been used in studies of patients with aortic stenosis. However, its psychometric properties have not yet been evaluated in these patients.
Methods and Results—
We analyzed data from 955 patients, enrolled in the PARTNER trial of transcatheter aortic valve replacement, to evaluate the reliability, responsiveness, validity, and prognostic importance of the KCCQ in patients with severe aortic stenosis. The KCCQ was administered at baseline and at 1, 6, and 12 months after randomization to medical therapy, transcatheter aortic valve replacement, or surgical valve replacement. Among clinically stable patients, there were only small changes in the KCCQ domain scores over time (mean differences 0.1–4.2 points), and the intraclass correlation coefficients showed good agreement between paired assessments (0.65–0.76). However, the domain scores of patients who underwent transcatheter aortic valve replacement showed large changes after treatment (mean differences 13–30 points). Construct validity was demonstrated by comparing each domain against a relevant reference measure (Spearman correlations 0.46–0.69). Finally, among 157 patients randomized to medical management, lower KCCQ overall summary scores at baseline were strongly associated with an increased risk of mortality during the following 12 months.
Conclusions—
The KCCQ is a highly reliable, responsive, and valid measure of symptoms, functional status, and quality of life in patients with severe, symptomatic aortic stenosis.
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Affiliation(s)
- Suzanne V. Arnold
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (S.V.A., J.A.S., Y.L., K.B.A., A.K.C., D.J.C.); Columbia-Presbyterian Hospital, New York, NY (M.B.L., C.R.S.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); University of British Columbia and St. Paul’s Hospital, Vancouver, BC, Canada (J.G.W.); and Cleveland Clinic Foundation, Cleveland, OH (L.G.S.)
| | - John A. Spertus
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (S.V.A., J.A.S., Y.L., K.B.A., A.K.C., D.J.C.); Columbia-Presbyterian Hospital, New York, NY (M.B.L., C.R.S.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); University of British Columbia and St. Paul’s Hospital, Vancouver, BC, Canada (J.G.W.); and Cleveland Clinic Foundation, Cleveland, OH (L.G.S.)
| | - Yang Lei
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (S.V.A., J.A.S., Y.L., K.B.A., A.K.C., D.J.C.); Columbia-Presbyterian Hospital, New York, NY (M.B.L., C.R.S.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); University of British Columbia and St. Paul’s Hospital, Vancouver, BC, Canada (J.G.W.); and Cleveland Clinic Foundation, Cleveland, OH (L.G.S.)
| | - Keith B. Allen
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (S.V.A., J.A.S., Y.L., K.B.A., A.K.C., D.J.C.); Columbia-Presbyterian Hospital, New York, NY (M.B.L., C.R.S.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); University of British Columbia and St. Paul’s Hospital, Vancouver, BC, Canada (J.G.W.); and Cleveland Clinic Foundation, Cleveland, OH (L.G.S.)
| | - Adnan K. Chhatriwalla
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (S.V.A., J.A.S., Y.L., K.B.A., A.K.C., D.J.C.); Columbia-Presbyterian Hospital, New York, NY (M.B.L., C.R.S.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); University of British Columbia and St. Paul’s Hospital, Vancouver, BC, Canada (J.G.W.); and Cleveland Clinic Foundation, Cleveland, OH (L.G.S.)
| | - Martin B. Leon
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (S.V.A., J.A.S., Y.L., K.B.A., A.K.C., D.J.C.); Columbia-Presbyterian Hospital, New York, NY (M.B.L., C.R.S.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); University of British Columbia and St. Paul’s Hospital, Vancouver, BC, Canada (J.G.W.); and Cleveland Clinic Foundation, Cleveland, OH (L.G.S.)
| | - Craig R. Smith
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (S.V.A., J.A.S., Y.L., K.B.A., A.K.C., D.J.C.); Columbia-Presbyterian Hospital, New York, NY (M.B.L., C.R.S.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); University of British Columbia and St. Paul’s Hospital, Vancouver, BC, Canada (J.G.W.); and Cleveland Clinic Foundation, Cleveland, OH (L.G.S.)
| | - Matthew R. Reynolds
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (S.V.A., J.A.S., Y.L., K.B.A., A.K.C., D.J.C.); Columbia-Presbyterian Hospital, New York, NY (M.B.L., C.R.S.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); University of British Columbia and St. Paul’s Hospital, Vancouver, BC, Canada (J.G.W.); and Cleveland Clinic Foundation, Cleveland, OH (L.G.S.)
| | - John G. Webb
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (S.V.A., J.A.S., Y.L., K.B.A., A.K.C., D.J.C.); Columbia-Presbyterian Hospital, New York, NY (M.B.L., C.R.S.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); University of British Columbia and St. Paul’s Hospital, Vancouver, BC, Canada (J.G.W.); and Cleveland Clinic Foundation, Cleveland, OH (L.G.S.)
| | - Lars G. Svensson
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (S.V.A., J.A.S., Y.L., K.B.A., A.K.C., D.J.C.); Columbia-Presbyterian Hospital, New York, NY (M.B.L., C.R.S.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); University of British Columbia and St. Paul’s Hospital, Vancouver, BC, Canada (J.G.W.); and Cleveland Clinic Foundation, Cleveland, OH (L.G.S.)
| | - David J. Cohen
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (S.V.A., J.A.S., Y.L., K.B.A., A.K.C., D.J.C.); Columbia-Presbyterian Hospital, New York, NY (M.B.L., C.R.S.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); University of British Columbia and St. Paul’s Hospital, Vancouver, BC, Canada (J.G.W.); and Cleveland Clinic Foundation, Cleveland, OH (L.G.S.)
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Boothroyd LJ, Spaziano M, Guertin JR, Lambert LJ, Rodés-Cabau J, Noiseux N, Nguyen M, Dumont É, Carrier M, de Varennes B, Ibrahim R, Martucci G, Xiao Y, Morin JE, Bogaty P. Transcatheter aortic valve implantation: recommendations for practice based on a multidisciplinary review including cost-effectiveness and ethical and organizational issues. Can J Cardiol 2012; 29:718-26. [PMID: 23218465 DOI: 10.1016/j.cjca.2012.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 09/07/2012] [Accepted: 09/07/2012] [Indexed: 10/27/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a relatively new technology for the treatment of severe and symptomatic aortic valve stenosis. TAVI offers an alternative therapy for patients unable to be treated surgically because of contraindications or severe comorbidities. It is being rapidly dispersed in Canada, as it is worldwide. The objective of this article is to present our recommendations for the use of TAVI, based on a multidisciplinary evaluation of recently published evidence. We systematically searched and summarized published data (2008-2011) on benefits, risks, and cost-effectiveness of TAVI. We also examined ethical issues and organizational aspects of delivering the intervention. We discussed the soundness and applicability of our recommendations with clinical experts active in the field. The published TAVI results for high-risk and/or inoperable patients are promising in terms of survival, function, quality of life, and cost-effectiveness, although we noted large variability in the survival rates at 1 year and in the frequency of important adverse outcomes such as stroke. Until more data from randomized controlled trials and registries become available, prudence and discernment are necessary in the choice of patients most likely to benefit. Patients need to be well-informed about gaps in the evidence base. Our recommendations support the use of TAVI in the context of strict conditions with respect to patient eligibility, the patient selection process, organizational requirements, and the tracking of patient outcomes with a mandatory registry.
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Affiliation(s)
- Lucy J Boothroyd
- Institut national d'excellence en santé et en services sociaux, Montréal, Québec, Canada.
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD, Harrington RA, Bhatt DL, Ferrari VA, Fisher JD, Garcia MJ, Gardner TJ, Gentile F, Gilson MF, Hernandez AF, Jacobs AK, Kaul S, Linderbaum JA, Moliterno DJ, Weitz HH. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement: developed in collabration with the American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Failure Society of America, Mended Hearts, Society of Cardiovascular Anesthesiologists, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Thorac Cardiovasc Surg 2012; 144:e29-84. [PMID: 22898522 DOI: 10.1016/j.jtcvs.2012.03.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Stortecky S, Schmid V, Windecker S, Kadner A, Pilgrim T, Buellesfeld L, Khattab AA, Wenaweser P. Improvement of physical and mental health after transfemoral transcatheter aortic valve implantation. EUROINTERVENTION 2012; 8:437-43. [DOI: 10.4244/eijv8i4a69] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Health-Related Quality of Life After Transcatheter or Surgical Aortic Valve Replacement in High-Risk Patients With Severe Aortic Stenosis. J Am Coll Cardiol 2012; 60:548-58. [DOI: 10.1016/j.jacc.2012.03.075] [Citation(s) in RCA: 215] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 03/29/2012] [Accepted: 03/30/2012] [Indexed: 11/22/2022]
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Krane M, Deutsch MA, Piazza N, Muhtarova T, Elhmidi Y, Mazzitelli D, Voss B, Ruge H, Badiu CC, Kornek M, Bleiziffer S, Lange R. One-year results of health-related quality of life among patients undergoing transcatheter aortic valve implantation. Am J Cardiol 2012; 109:1774-81. [PMID: 22520622 DOI: 10.1016/j.amjcard.2012.02.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 02/01/2012] [Accepted: 02/01/2012] [Indexed: 10/28/2022]
Abstract
Recently, it has been demonstrated that transcatheter aortic valve implantation (TAVI) can result in significant improvement in patients' quality of life (QOL) in the short term. At present, however, little is known about the long-term improvements in QOL after TAVI. Thus, our aim was to prospectively assess the 1-year QOL outcome of patients undergoing TAVI. We performed a prospective analysis of 186 patients with symptomatic severe aortic valve stenosis ineligible for conventional aortic valve replacement, who underwent TAVI with either the Medtronic CoreValve or Edwards Sapien device. A total of 106 patients completed the 1-year follow-up protocol. The QOL was measured using the Medical Outcomes Study 36-item short-form health survey questionnaire at baseline and at 3 months and 1 year of follow-up. At 1 year of follow-up, significant improvements in the Medical Outcomes Study 36-item short-form health survey questionnaire scores for physical functioning (baseline 34.6 ± 2.3 vs 1 year of follow-up 45.6 ± 2.7; p <0.001), role physical (20 ± 3.0 vs 34.2 ± 4.4; p <0.001), bodily pain (59.9 ± 3 vs 70 ± 2.7; p <0.01), general health (47.3 ± 1.5 vs 55.2 ± 2.1, p <0.001), vitality (35.9 ± 2 vs 48.5 ± 2; p <0.001), and mental health (62.2 ± 2.2 vs 67.3 ± 1.8; p <0.05) were observed compared to baseline. No significant improvement could be detected for social functioning (75.4 ± 2.5 vs 76.5 ± 2.6; p = 0.79) and role emotional (61.1 ± 4.3 vs 66.5 ± 4.7; p = 0.29). At 1 year of follow-up, the various physical and mental scores were comparable to an age-matched standard population. In conclusion, the present study has demonstrated that TAVI can improve the QOL status of high-surgical risk patients with severe aortic valve stenosis that can be maintained for ≤1 year postproceduraly in survivors. Although the mental subscales improved slightly, the mental component summary score failed to reach statistical significance in our study population.
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Gotzmann M, Lindstaedt M, Mügge A. From pressure overload to volume overload: aortic regurgitation after transcatheter aortic valve implantation. Am Heart J 2012; 163:903-11. [PMID: 22709742 DOI: 10.1016/j.ahj.2012.03.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 03/21/2012] [Indexed: 10/28/2022]
Abstract
Severe aortic valve stenosis is a common valvular heart disease that is characterized by left ventricular (LV) pressure overload. A lasting effect of pressure overload is LV remodeling, accompanied by concentric hypertrophy and increased myocardial stiffness. Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement for patients with severe symptomatic aortic valve stenosis and high surgical risk. Although TAVI has favorable hemodynamic performance, aortic valve regurgitation (AR) is the most frequent complication because of the specific technique used for implantation of transcatheter valves. During implantation, the calcified native valve is pushed aside, and the prosthesis usually achieves only an incomplete prosthesis apposition. As a consequence, the reported prevalence of moderate and severe AR after TAVI is 6% to 21%, which is considerably higher than that after a surgical valve replacement. Although mild AR probably has minor hemodynamic effects, even moderate AR might result in serious consequences. In moderate and severe AR after TAVI, a normal-sized LV with increased myocardial stiffness has been exposed to volume overload. Because the noncompliant LV is unable to raise end-diastolic volume, the end-diastolic pressure increases, and the forward stroke volume decreases. In recent years, an increasing number of patients have successfully undergone TAVI. Despite encouraging overall results, a substantial number of patients receive neither symptomatic nor prognostic benefits from TAVI. Aortic valve regurgitation has been considered a potential contributor to morbidity and mortality after TAVI. Therefore, various strategies and improvements in valve designs are mandatory to reduce the prevalence of AR after TAVI.
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Makkar RR, Fontana GP, Jilaihawi H, Kapadia S, Pichard AD, Douglas PS, Thourani VH, Babaliaros VC, Webb JG, Herrmann HC, Bavaria JE, Kodali S, Brown DL, Bowers B, Dewey TM, Svensson LG, Tuzcu M, Moses JW, Williams MR, Siegel RJ, Akin JJ, Anderson WN, Pocock S, Smith CR, Leon MB. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med 2012; 366:1696-704. [PMID: 22443478 DOI: 10.1056/nejmoa1202277] [Citation(s) in RCA: 978] [Impact Index Per Article: 81.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Transcatheter aortic-valve replacement (TAVR) is the recommended therapy for patients with severe aortic stenosis who are not suitable candidates for surgery. The outcomes beyond 1 year in such patients are not known. METHODS We randomly assigned patients to transfemoral TAVR or to standard therapy (which often included balloon aortic valvuloplasty). Data on 2-year outcomes were analyzed. RESULTS A total of 358 patients underwent randomization at 21 centers. The rates of death at 2 years were 43.3% in the TAVR group and 68.0% in the standard-therapy group (P<0.001), and the corresponding rates of cardiac death were 31.0% and 62.4% (P<0.001). The survival advantage associated with TAVR that was seen at 1 year remained significant among patients who survived beyond the first year (hazard ratio, 0.58; 95% confidence interval [CI], 0.36 to 0.92; P=0.02 with the use of the log-rank test). The rate of stroke was higher after TAVR than with standard therapy (13.8% vs. 5.5%, P=0.01), owing, in the first 30 days, to the occurrence of more ischemic events in the TAVR group (6.7% vs. 1.7%, P=0.02) and, beyond 30 days, to the occurrence of more hemorrhagic strokes in the TAVR group (2.2% vs. 0.6%, P=0.16). At 2 years, the rate of rehospitalization was 35.0% in the TAVR group and 72.5% in the standard-therapy group (P<0.001). TAVR, as compared with standard therapy, was also associated with improved functional status (P<0.001). The data suggest that the mortality benefit after TAVR may be limited to patients who do not have extensive coexisting conditions. Echocardiographic analysis showed a sustained increase in aortic-valve area and a decrease in aortic-valve gradient, with no worsening of paravalvular aortic regurgitation. CONCLUSIONS Among appropriately selected patients with severe aortic stenosis who were not suitable candidates for surgery, TAVR reduced the rates of death and hospitalization, with a decrease in symptoms and an improvement in valve hemodynamics that were sustained at 2 years of follow-up. The presence of extensive coexisting conditions may attenuate the survival benefit of TAVR. (Funded by Edwards Lifesciences; ClinicalTrials.gov number, NCT00530894.).
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Serial Change in Health-Related Quality of Life Over 1 Year After Transcatheter Aortic Valve Implantation. J Am Coll Cardiol 2012; 59:1672-80. [DOI: 10.1016/j.jacc.2012.01.035] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 01/10/2012] [Accepted: 01/25/2012] [Indexed: 01/04/2023]
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD, Harrington RA, Bhatt DL, Ferrari VA, Fisher JD, Garcia MJ, Gardner TJ, Gentile F, Gilson MF, Hernandez AF, Jacobs AK, Kaul S, Linderbaum JA, Moliterno DJ, Weitz HH. 2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. Catheter Cardiovasc Interv 2012; 79:1023-82. [DOI: 10.1002/ccd.24351] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD. 2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2012; 93:1340-95. [PMID: 22300625 DOI: 10.1016/j.athoracsur.2012.01.084] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 01/26/2012] [Accepted: 01/26/2012] [Indexed: 12/20/2022]
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol 2012; 59:1200-54. [PMID: 22300974 DOI: 10.1016/j.jacc.2012.01.001] [Citation(s) in RCA: 544] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Saia F, Lemos PA, Bordoni B, Cervi E, Boriani G, Ciuca C, Taglieri N, Mariani J, Filho RK, Marzocchi A. Transcatheter aortic valve implantation with a self-expanding nitinol bioprosthesis. Catheter Cardiovasc Interv 2012; 79:712-9. [DOI: 10.1002/ccd.23336] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 08/01/2011] [Accepted: 08/07/2011] [Indexed: 11/07/2022]
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Health-Related Quality of Life After Transcatheter Aortic Valve Replacement in Inoperable Patients With Severe Aortic Stenosis. Circulation 2011; 124:1964-72. [DOI: 10.1161/circulationaha.111.040022] [Citation(s) in RCA: 248] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Transcatheter aortic valve replacement (TAVR) has been shown to improve survival compared with standard therapy in patients with severe aortic stenosis who cannot have surgery. The effects of TAVR on health-related quality of life have not been reported from a controlled study.
Methods and Results—
The Placement of Aortic Transcatheter Valves (PARTNER) trial randomized patients with symptomatic, severe aortic stenosis who were not candidates for surgical valve replacement to TAVR (n=179) or standard therapy (n=179). Health-related quality of life was assessed at baseline and at 1, 6, and 12 months with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the 12-item Short Form-12 General Health Survey (SF-12). The primary end point was the KCCQ overall summary score (range, 0–100; higher=better). At baseline, mean KCCQ summary scores (35±20) and SF-12 physical summary scores (28±7) were markedly depressed. Although the KCCQ summary score improved from baseline in both groups, the extent of improvement was greater after TAVR compared with control at 1 month (mean between-group difference, 13 points; 95% confidence interval, 8–19;
P
<0.001) with larger benefits at 6 months (mean difference, 21 points; 95% confidence interval, 15–27;
P
<0.001) and 12 months (mean difference, 26 points; 95% confidence interval, 19–33;
P
<0.001). At 12 months, TAVR patients also reported higher SF-12 physical and mental health scores with mean differences compared with standard care of 5.7 and 6.4 points, respectively (
P
<0.001 for both comparisons).
Conclusions—
Among inoperable patients with severe aortic stenosis, compared with standard care, TAVR resulted in significant improvements in health-related quality of life that were maintained for at least 1 year.
Clinical Trials Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00530894.
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Ussia G, Barbanti M, Cammalleri V, Scarabelli M, Mulè M, Aruta P, Pistritto AM, Immè S, Capodanno D, Sarkar K, Gulino S, Tamburino C. Quality-of-life in elderly patients one year after transcatheter aortic valve implantation for severe aortic stenosis. EUROINTERVENTION 2011; 7:573-9. [DOI: 10.4244/eijv7i5a93] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Georgiadou P, Kontodima P, Sbarouni E, Karavolias GK, Smirli A, Xanthos T, Troupis T, Khouri M, Papadimitriou L, Voudris V. Long-term quality of life improvement after transcatheter aortic valve implantation. Am Heart J 2011; 162:232-7. [PMID: 21835282 DOI: 10.1016/j.ahj.2011.06.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 06/06/2011] [Indexed: 01/22/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is a novel therapeutic option for severe aortic stenosis in old patients with high surgical risk. The aim of this study was to assess changes in quality of life (QoL) along with functional status and late survival after this procedure. METHODS Thirty-six consecutive patients (80.5 ± 5.9 years, 21 men and 15 women) with a logistic Euroscore of 29.7 ± 13.7 underwent TAVI using the 18-Fr CoreValve prosthesis. Aortic valve prosthesis was inserted retrograde using a femoral or a subclavian arterial approach. QoL was evaluated by administering the Short Form 36 (SF-36) tool and the shorter SF-12 version 2 (SF-12v2) questionnaires before and 1-year after TAVI. RESULTS TAVI was successfully performed in all patients. The estimated 1-year overall survival rate using Kaplan-Meier method was 68%. One-year follow-up also showed a marked improvement in echocardiographic parameters (peak gradient 76.2 ± 26.1 vs 15.4 ± 7.8 mm Hg, P < .001; aortic valve area 0.7 ± 0.1 vs 2.6 ± 2.7 cm(2), P < .001) with a significant change in New York Heart Association class (3 ± 0.7 vs 1.2 ± 0.4, P < .001). Both preprocedural summary SF-36 and SF-12v12 physical and mental scores showed a significant improvement 1 year after TAVI (21.6 vs 46.7, P < .001; 42.9 vs 55.2, P < .001; 22 vs 48.9, P < .001; 43.3 vs 52.2, P < .001, respectively). CONCLUSIONS Our results show a marked 1-year clinical benefit in functional status and physical and mental health in patients who underwent TAVI.
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Brocks Y, Börgermann J, Wiemer M, Kleikamp G, Scholz W, Petri A, Gummert J, Tigges-Limmer K. Transkatheter-Aortenklappenimplantation. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2011. [DOI: 10.1007/s00398-011-0838-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yiu KH, Ewe SH, Klautz RJ, Schalij MJ, Bax JJ, Delgado V. Selecting patients for transcatheter aortic valve implantation. Interv Cardiol 2011. [DOI: 10.2217/ica.11.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Gotzmann M, Bojara W, Lindstaedt M, Ewers A, Bösche L, Germing A, Lawo T, Bechtel M, Laczkovics A, Mügge A. One-year results of transcatheter aortic valve implantation in severe symptomatic aortic valve stenosis. Am J Cardiol 2011; 107:1687-92. [PMID: 21439537 DOI: 10.1016/j.amjcard.2011.01.058] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 01/18/2011] [Accepted: 01/18/2011] [Indexed: 10/18/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an alternative therapy for symptomatic severe aortic valve stenosis in high-risk patients with several co-morbidities. We evaluated the 1-year effects of TAVI on quality of life, exercise capacity, neurohormonal activation, and myocardial hypertrophy. From June 2008 to October 2009, consecutive patients aged ≥75 years with symptomatic severe aortic valve stenosis (area <1 cm(2)) and a logistic euroSCORE ≥15% or aged >60 years with additional specified risk factors underwent TAVI. An aortic valve prosthesis (CoreValve) was inserted in a retrograde fashion. Examinations were performed before and 30 days and 1 year after TAVI. An assessment of the quality of life (Minnesota Living with Heart Failure Questionnaire), a 6-minute walking test, measurement of B-type natriuretic peptide, and echocardiography were performed. In 51 patients (mean age 78 ± 6.6 years, mean left ventricular ejection fraction 58.4 ± 12.2%), the follow-up examinations were performed after TAVI. The 1-year follow-up visit after TAVI revealed significantly improved quality of life (baseline Minnesota Living with Heart Failure Questionnaire score 39.6 ± 19 vs 26.1 ± 18, p <0.001) and more distance covered in the 6-minute walking test (baseline 185 ± 106 vs 266 ± 118 m, p <0.001). The B-type natriuretic peptide level had decreased (baseline 642 ± 634 vs 323 ± 266 pg/ml, p <0.001), and the left ventricular mass index had decreased (156 ± 45 vs 130 ± 42 g/m(2), p <0.001). The left ventricular diameter and ejection fraction remained unchanged. In conclusion, TAVI leads to significantly reduced neurohormonal activation, regression of myocardial hypertrophy, and lasting enhancement of quality of life and exercise capacity in patients with symptomatic and severe aortic stenosis 1 year after intervention.
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Nuis RJ, Piazza N, Van Mieghem NM, Otten AM, Tzikas A, Schultz CJ, van der Boon R, van Geuns RJ, van Domburg RT, Koudstaal PJ, Kappetein AP, Serruys PW, de Jaegere PP. In-hospital complications after transcatheter aortic valve implantation revisited according to the Valve Academic Research Consortium definitions. Catheter Cardiovasc Interv 2011; 78:457-67. [PMID: 21563291 DOI: 10.1002/ccd.23018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 01/22/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To determine the occurrence of in-hospital complications after transcatheter aortic valve implantation (TAVI) according to the Valve Academic Research Consortium (VARC) criteria in addition to the length of stay (LOS). BACKGROUND The absence of uniformity in endpoint definitions challenges the comparison between previously reported major adverse cerebro- and cardiovascular event rates after TAVI. To address this, in 2009, the VARC was established aiming to provide standardized endpoint definitions for TAVI clinical trials. METHODS Between November 2005 and September 2010, we prospectively enrolled 150 consecutive patients who underwent TAVI with the Medtronic CoreValve System in our institution. Complications, prosthetic valve associated endpoints, and therapy-specific endpoints were defined according to the definitions provided by the VARC. RESULTS The mean age (±SD) was 81 (±7) years and 55% were female. Thirty-day or in-hospital mortality was 11%, and the 30-day combined safety endpoint was 22%. Seventy-six patients (51%) had ≥1 cardiovascular and/or noncardiovascular complication of whom 16 also underwent a new permanent pacemaker implantation (PPI). In the 74 patients with uneventful TAVI, 12 patients (8%) underwent PPI. TAVI was truly uneventful in 62 patients (41%). Bleeding complications were observed most frequently (31%), followed by acute kidney injury (18%), vascular complications (16%), and stroke/TIA (11%). The median LOS in patients with a complicated and a truly uncomplicated TAVI was 14.0 (8.0-20.5) and 8.0 (7.0-10.8) days, respectively (P < 0.001). CONCLUSION TAVI was associated with ≥1 cardiovascular and/or noncardiovascular event in 51% of the patients; new PPI was needed in another 8%, and TAVI was truly uncomplicated in 41%. Complications and need for new PPI significantly prolonged LOS.
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Affiliation(s)
- Rutger-Jan Nuis
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Bagur R, Rodés-Cabau J, Dumont É, De Larochellière R, Doyle D, Pibarot P, Côté M, Clavel MA, Villeneuve J, Gutiérrez M, Poirier P, Bertrand OF. Performance-based functional assessment of patients undergoing transcatheter aortic valve implantation. Am Heart J 2011; 161:726-34. [PMID: 21473972 DOI: 10.1016/j.ahj.2010.12.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 12/10/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Very few data exist on the functional evaluation of patients with severe symptomatic aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). The aims of this prospective study were (1) to evaluate the Duke Activity Status Index (DASI) as a measure of functional status pre-TAVI and post-TAVI, (2) to determine the clinical parameters associated with DASI changes after TAVI, and (3) to compare functional status as evaluated by DASI and the New York Heart Association (NYHA) class with exercise capacity as evaluated by the 6-minute walk test (6MWT) in such patients. METHODS A total of 76 patients (80 ± 8 years old) who underwent successful TAVI were included. All patients completed the DASI self-questionnaire at baseline and at 6 months after TAVI, and 46 patients also performed a 6MWT. RESULTS The mean DASI increased from 10.3 ± 5.4 to 16.3 ± 8.3 at 6 months after TAVI (P < .0001). However, the DASI did not change or even decreased to some extent in 30% of patients after TAVI. Renal dysfunction as evaluated by the estimated glomerular filtration rate was identified as the independent predictor of DASI impairment after TAVI (OR 1.7 for each decrease in estimated glomerular filtration rate of 10 mL/min/1.73 m(2), 95% CI 1.3-2.3, P = .005). The mean distance walked increased from 165.9 ± 77.6 to 211.8 ± 78.7 m (P = .0001) at follow-up. The DASI showed a good correlation with the distance walked at baseline (r = 0.55, P < .0001) and at follow-up (r = 0.66, P < .0001). The NYHA class improved to some degree in all but 5 patients; however, the NYHA class did not correlate with the results of DASI and the 6MWT. CONCLUSIONS Transcatheter aortic valve implantation was associated with a significant increase in functional status at 6-month follow-up as evaluated by the DASI, although no improvement was observed in about one third of patients. The presence of baseline renal dysfunction better determined this lack of improvement in functional status. The DASI, but not the NYHA class, correlated with distance walked in the 6MWT. These results suggest that the DASI might become a useful tool for evaluating both candidates for and the impact of TAVI procedures.
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Dodson JA, Maurer MS. Changing nature of cardiac interventions in older adults. AGING HEALTH 2011; 7:283-295. [PMID: 21743812 PMCID: PMC3129702 DOI: 10.2217/ahe.11.12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Older adults represent a rapidly growing segment of the population in developed countries. Advancing age is the most powerful risk factor for the development of cardiovascular disease (CVD), and CVD-related mortality increases markedly in older individuals. Procedures for patients with CVD, including percutaneous coronary intervention, aortic valve replacement and implantable cardioverter defibrillators were all initially validated in younger individuals but are increasingly being applied in older adults who for the most part have been significantly understudied in clinical trials. While advanced age alone is not a contraindication to these procedures, with the advent of less invasive methods to manage CVD including percutaneous techniques to treat both coronary artery disease and valvular heart disease, future research will need to weigh the potential harms of intervention in a population of older adults with multiple medical comorbidities and complex physiologic phenotypes against outcomes that include preventing functional decline and improving quality of life.
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Affiliation(s)
- John A Dodson
- Division of Cardiology, Columbia University Medical Center, NY, USA
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Medical Center, NY, USA
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Khawaja MZ, Rajani R, Cook A, Khavandi A, Moynagh A, Chowdhary S, Spence MS, Brown S, Khan SQ, Walker N, Trivedi U, Hutchinson N, De Belder AJ, Moat N, Blackman DJ, Levy RD, Manoharan G, Roberts D, Khogali SS, Crean P, Brecker SJ, Baumbach A, Mullen M, Laborde JC, Hildick-Smith D. Permanent pacemaker insertion after CoreValve transcatheter aortic valve implantation: incidence and contributing factors (the UK CoreValve Collaborative). Circulation 2011; 123:951-60. [PMID: 21339482 DOI: 10.1161/circulationaha.109.927152] [Citation(s) in RCA: 251] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Permanent pacemaker (PPM) requirement is a recognized complication of transcatheter aortic valve implantation. We assessed the UK incidence of permanent pacing within 30 days of CoreValve implantation and formulated an anatomic and electrophysiological model. METHODS AND RESULTS Data from 270 patients at 10 centers in the United Kingdom were examined. Twenty-five patients (8%) had preexisting PPMs; 2 patients had incomplete data. The remaining 243 were 81.3±6.7 years of age; 50.6% were male. QRS duration increased from 105±23 to 135±29 milliseconds (P<0.01). Left bundle-branch block incidence was 13% at baseline and 61% after the procedure (P<0.001). Eighty-one patients (33.3%) required a PPM within 30 days. Rates of pacing according to preexisting ECG abnormalities were as follows: right bundle-branch block, 65.2%; left bundle-branch block, 43.75%; normal QRS, 27.6%. Among patients who required PPM implantation, the median time to insertion was 4.0 days (interquartile range, 2.0 to 7.75 days). Multivariable analysis revealed that periprocedural atrioventricular block (odds ratio, 6.29; 95% confidence interval, 3.55 to 11.15), balloon predilatation (odds ratio, 2.68; 95% confidence interval, 2.00 to 3.47), use of the larger (29 mm) CoreValve prosthesis (odds ratio, 2.50; 95% confidence interval, 1.22 to 5.11), interventricular septum diameter (odds ratio, 1.18; 95% confidence interval, 1.10 to 3.06), and prolonged QRS duration (odds ratio, 3.45; 95% confidence interval, 1.61 to 7.40) were independently associated with the need for PPM. CONCLUSION One third of patients undergoing a CoreValve transcatheter aortic valve implantation procedure require a PPM within 30 days. Periprocedural atrioventricular block, balloon predilatation, use of the larger CoreValve prosthesis, increased interventricular septum diameter and prolonged QRS duration were associated with the need for PPM.
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Affiliation(s)
- M Z Khawaja
- UK CoreValve Collaborative, Sussex Cardiac Centre, Brighton & Sussex University Hospital Trust, Eastern Road, Brighton, East Sussex, BN2 5BE, UK
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Helton TJ, Kapadia SR, Tuzcu EM. Clinical trial experience with transcatheter aortic valve insertion. Int J Cardiovasc Imaging 2011; 27:1143-54. [DOI: 10.1007/s10554-011-9825-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 01/27/2011] [Indexed: 01/26/2023]
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49
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De Carlo M, Giannini C, Ettori F, Fiorina C, Guarracino F, Curello S, Scioti G, Minzioni G, Chizzola G, Matteo D, Petronio AS. Impact of treatment choice on the outcome of patients proposed for transcatheter aortic valve implantation. EUROINTERVENTION 2011; 6:568-74. [PMID: 21044909 DOI: 10.4244/eijv6i5a96] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Transcatheter aortic valve implantation (TAVI) is a new option for patients with severe aortic stenosis at high surgical risk. We compared the clinical outcome of patients referred for TAVI and subsequently treated with TAVI, surgical aortic valve replacement (SAVR), balloon aortic valvuloplasty (BAV), or medical management (MM). METHODS AND RESULTS All consecutive patients (n=166, EuroSCORE 24.9 ± 13.9%) referred for TAVI to our two centres were enrolled in a prospective registry and were assigned to SAVR (n=21), TAVI with the CoreValve prosthesis (n=75), BAV (n=20), or MM (n=50) by a multi-specialty team. The primary endpoint was 6-month cardiac mortality. Patients undergoing BAV had a significantly higher EuroSCORE (33.6 ± 15.9%; p=0.01). Median follow-up time was nine months (interquartile range 4.5-12.4 months). Six-month freedom from cardiac death was 81.0 ± 8.6%, 92.0 ± 3.1%, 72.9 ± 10.5%, and 72.7 ± 6.5% for SAVR, TAVI, BAV, and MM groups, respectively. Freedom from major cardiac and cerebrovascular events was 76.2 ± 9.3%, 83.9 ± 4.3%, 72.9 ± 10.5%, and 65.6 ± 6.8% for SAVR, TAVI, BAV, and MM groups, respectively. CONCLUSIONS With respect to medical management and BAV, TAVI was associated with lower cardiac mortality at six months. Clinical outcome after TAVI was similar to that of less sick patients undergoing SAVR.
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Affiliation(s)
- Marco De Carlo
- Cardiac Catheterisation Laboratory, Cardiothoracic Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
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Leon MB, Piazza N, Nikolsky E, Blackstone EH, Cutlip DE, Kappetein AP, Krucoff MW, Mack M, Mehran R, Miller C, Morel MA, Petersen J, Popma JJ, Takkenberg JJM, Vahanian A, van Es GA, Vranckx P, Webb JG, Windecker S, Serruys PW. Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the Valve Academic Research Consortium. Eur Heart J 2011; 32:205-17. [PMID: 21216739 PMCID: PMC3021388 DOI: 10.1093/eurheartj/ehq406] [Citation(s) in RCA: 504] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To propose standardized consensus definitions for important clinical endpoints in transcatheter aortic valve implantation (TAVI), investigations in an effort to improve the quality of clinical research and to enable meaningful comparisons between clinical trials. To make these consensus definitions accessible to all stakeholders in TAVI clinical research through a peer reviewed publication, on behalf of the public health. BACKGROUND Transcatheter aortic valve implantation may provide a worthwhile less invasive treatment in many patients with severe aortic stenosis and since its introduction to the medical community in 2002, there has been an explosive growth in procedures. The integration of TAVI into daily clinical practice should be guided by academic activities, which requires a harmonized and structured process for data collection, interpretation, and reporting during well-conducted clinical trials. METHODS AND RESULTS The Valve Academic Research Consortium established an independent collaboration between Academic Research organizations and specialty societies (cardiology and cardiac surgery) in the USA and Europe. Two meetings, in San Francisco, California (September 2009) and in Amsterdam, the Netherlands (December 2009), including key physician experts, and representatives from the US Food and Drug Administration (FDA) and device manufacturers, were focused on creating consistent endpoint definitions and consensus recommendations for implementation in TAVI clinical research programs. Important considerations in developing endpoint definitions included (i) respect for the historical legacy of surgical valve guidelines; (ii) identification of pathophysiological mechanisms associated with clinical events; (iii) emphasis on clinical relevance. Consensus criteria were developed for the following endpoints: mortality, myocardial infarction, stroke, bleeding, acute kidney injury, vascular complications, and prosthetic valve performance. Composite endpoints for TAVI safety and effectiveness were also recommended. CONCLUSION Although consensus criteria will invariably include certain arbitrary features, an organized multidisciplinary process to develop specific definitions for TAVI clinical research should provide consistency across studies that can facilitate the evaluation of this new important catheter-based therapy. The broadly based consensus endpoint definitions described in this document may be useful for regulatory and clinical trial purposes.
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Affiliation(s)
- Martin B Leon
- Columbia University Medical Center, Center for Interventional Vascular Therapy, 173 Fort Washington Avenue, Heart Center, New York, NY 10032, USA.
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