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Tokuda Y, Saiki M, Inoue T, Kinugasa Y, Tamura K, Tateishi A, Oshima Y, Hisamochi K, Yunoki K. A Case of Transapical Thoracic Endovascular Repair for Thoracic Aortic Aneurysm with a Complicated Access Route. Ann Vasc Dis 2024; 17:309-312. [PMID: 39359547 PMCID: PMC11444829 DOI: 10.3400/avd.cr.24-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/10/2024] [Indexed: 10/04/2024] Open
Abstract
Thoracic endovascular aortic repair (TEVAR) for thoracic aortic aneurysms (TAAs) is an alternative treatment option for high-risk patients. While conventionally performed via a transfemoral approach, it is sometimes difficult due to poor access routes. We report the case of a 90-year-old man who was incidentally diagnosed with a descending TAA while undergoing computed tomography for esophageal cancer. The patient had undergone Y-graft replacement twice. His Y-graft leg was highly angulated; therefore, a transfemoral approach was considered difficult. Consequently, transapical TEVAR was performed. The postoperative course was uneventful. Transapical TEVAR can be a useful treatment option for TAAs with poor access routes in super-old patients.
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Affiliation(s)
- Yuhei Tokuda
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, City, Japan
| | - Munehiro Saiki
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, City, Japan
| | - Tomoya Inoue
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, City, Japan
| | - Yusuke Kinugasa
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, City, Japan
| | - Kentaro Tamura
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, City, Japan
| | - Atsushi Tateishi
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, City, Japan
| | - Yu Oshima
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, City, Japan
| | - Kunikazu Hisamochi
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, City, Japan
| | - Keiji Yunoki
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, City, Japan
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Machanahalli Balakrishna A, Ismayl M, Palicherla A, Aboeata A, Goldsweig AM, Zhao DX, Vallabhajosyula S. Impact of prior coronary artery bypass grafting on periprocedural and short-term outcomes of patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis. Coron Artery Dis 2023; 34:42-51. [PMID: 36326179 DOI: 10.1097/mca.0000000000001200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The effect of prior coronary artery bypass graft (CABG) on the outcomes of transcatheter aortic valve replacement (TAVR) remains incompletely characterized. In this meta-analysis, we investigated the impact of prior CABG on TAVR outcomes. METHODS A systematic search was conducted in PubMed, Google Scholar, and Cochrane databases from inception to 24 July 2022, using the search terms 'TAVR', 'CABG', 'peri-procedural complications', and 'mortality'. The major outcomes were peri-procedural complications, intraprocedural mortality, 30-day mortality, and 30-day cardiac mortality. We used random-effects models to aggregate data and to calculate pooled incidence and risk ratios with 95% confidence intervals (CIs). RESULTS Among 116 results from the systematic search, a total of 8 studies (5952 patients) were included. Compared to patients without previous CABG, patients with prior CABG undergoing TAVR were younger, predominantly male sex, had more comorbidities, higher rates of peri-procedural myocardial infarction (MI) [relative risk (RR) 1.93; 95% CI, 1.09-3.43; P = 0.03], but lower rates of stroke (RR 0.71; 95% CI, 0.51-0.99; P = 0.04), major vascular complications (RR 0.70; 95% CI, 0.51-0.95; P = 0.02), and major bleeding (RR 0.70; 95% CI, 0.56-0.88; P = 0.002). There were no significant differences between the two cohorts in rates of pacemaker implantation, cardiac tamponade, acute kidney injury, intra-procedural mortality, 30-day mortality, and 30-day cardiac mortality. CONCLUSION Among patients undergoing TAVR, a history of prior CABG was not associated with an increased risk of periprocedural complications (except for acute MI) or short-term mortality compared to those without CABG.
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Affiliation(s)
| | - Mahmoud Ismayl
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Anirudh Palicherla
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Ahmed Aboeata
- Division of Cardiovascular Medicine, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Andrew M Goldsweig
- Department of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - David X Zhao
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Chien S, Clark C, Maheshwari S, Koutsogiannidis CP, Zamvar V, Giordano V, Lim K, Pessotto R. Benefits of rapid deployment aortic valve replacement with a mini upper sternotomy. J Cardiothorac Surg 2020; 15:226. [PMID: 32847577 PMCID: PMC7448500 DOI: 10.1186/s13019-020-01268-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical aortic valve replacement (AVR) is currently deemed the gold standard of care for patients with severe aortic stenosis. Currently, most AVRs are safely performed through a full median sternotomy approach. With an increasingly elderly and high-risk patient population, major advances in valve technology and surgical technique have been introduced to reduce perioperative risk and post-operative complications associated with the full sternotomy approach, in order to ensure surgical AVR remains the gold standard. For example, minimally invasive approaches (most commonly via mini sternotomy) have been developed to improve patient outcomes. The advent of rapid deployment valve technology has also been shown to improve morbidity and mortality by reducing cardiopulmonary bypass and aortic cross-clamp times, as well as facilitating the use of minimal access approaches. Rapid deployment valves were introduced into our department at the Royal Infirmary of Edinburgh in 2014. The aim of this study is to investigate if utilising the combination of rapid deployment valves and a mini sternotomy minimally invasive approach resulted in improved outcomes in various patient subgroups. METHODS Over a 3-year period, we identified 714 patients who underwent isolated AVR in our centre. They were divided into two groups: 61 patients (8.5%) were identified who received rapid deployment AVR via J-shaped mini upper sternotomy (MIRDAVR group), whilst 653 patients (91.5%) were identified who received either a full sternotomy (using a conventional prosthesis or rapid deployment valve) or minimally invasive approach using a conventional valve (CONVAVR group). We retrospectively analysed data from our cardiac surgery database, including pre-operative demographics, intraoperative times and postoperative outcomes. Outcomes were also compared in two different subgroups: octogenarians and high-risk patients. RESULTS Pre-operative demographics showed that there were significantly more female and elderly patients in the MIRDAVR group. The MIRDAVR group had significantly reduced cardiopulmonary bypass (63.7 min vs. 104 min, p = 0.0001) and aortic cross-clamp times (47.3 min vs. 80.1 min, p = 0.0001) compared to the CONVAVR group. These results were particularly significant in the octogenarian population, who also had a reduced length of ICU stay (30.9 h vs. 65.6 h, p = 0.049). In high-risk patients (i.e. logistic EuroSCORE I > 10%), minimally invasive-rapid deployment aortic valve replacement is still beneficial and is also characterized by significantly shorter cardiopulmonary bypass time (69.1 min vs. 96.1 min, p = 0.03). However, post-operative correlations, such as length of ICU stay, become no more significant, likely due to serious co-morbidities in this patient group. CONCLUSION We have demonstrated that minimally invasive rapid deployment aortic valve replacement is associated with significantly reduced cardiopulmonary bypass and aortic cross-clamp times. This correlation is much stronger in the octogenarian population, who were also found to have significantly reduced length of ICU stay. Our study raises the suggestion that this approach should be utilised more frequently in clinical practice, particularly in octogenarian patients.
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Affiliation(s)
- Siobhan Chien
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK.
| | - Callum Clark
- Department of General Medicine, University Hospital Hairmyres, East Kilbride, UK
| | | | | | - Vipin Zamvar
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Vincenzo Giordano
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Kelvin Lim
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Renzo Pessotto
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
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Miki T, Senoo K, Ohkura T, Kadoya Y, Ito N, Kuwabara K, Nakanishi N, Zen K, Nakamura T, Yamano T, Shiraishi H, Shirayama T, Matoba S. Importance of Preoperative Computed Tomography Assessment of the Membranous Septal Anatomy in Patients Undergoing Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve. Circ J 2020; 84:269-276. [DOI: 10.1253/circj.cj-19-0823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tomonori Miki
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
| | - Keitaro Senoo
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
- Department of Cardiac Arrhythmia Research and Innovation, Kyoto Prefectural University of Medicine
| | - Takashi Ohkura
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
| | - Yoshito Kadoya
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
| | - Nobuyasu Ito
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
| | - Kensuke Kuwabara
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
| | - Naohiko Nakanishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
| | - Kan Zen
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
| | - Tetsuhiro Yamano
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
- Department of Cardiac Arrhythmia Research and Innovation, Kyoto Prefectural University of Medicine
| | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
- Department of Cardiac Arrhythmia Research and Innovation, Kyoto Prefectural University of Medicine
| | - Takeshi Shirayama
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
- Department of Cardiac Arrhythmia Research and Innovation, Kyoto Prefectural University of Medicine
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
- Department of Cardiac Arrhythmia Research and Innovation, Kyoto Prefectural University of Medicine
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5
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Ueshima D, Barioli A, Nai Fovino L, D'Amico G, Fabris T, Brener SJ, Tarantini G. The impact of pre‐existing peripheral artery disease on transcatheter aortic valve implantation outcomes: A systematic review and meta‐analysis. Catheter Cardiovasc Interv 2019; 95:993-1000. [DOI: 10.1002/ccd.28335] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Daisuke Ueshima
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Alberto Barioli
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Luca Nai Fovino
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Gianpiero D'Amico
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Tommaso Fabris
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
| | - Sorin J. Brener
- Department of Medicine, Cardiac Catheterization LaboratoryNew York‐Presbyterian Brooklyn Methodist Hospital Brooklyn New York
| | - Giuseppe Tarantini
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua Medical School Padua Italy
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6
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Wagner G, Steiner S, Gartlehner G, Arfsten H, Wildner B, Mayr H, Moertl D. Comparison of transcatheter aortic valve implantation with other approaches to treat aortic valve stenosis: a systematic review and meta-analysis. Syst Rev 2019; 8:44. [PMID: 30722786 PMCID: PMC6362570 DOI: 10.1186/s13643-019-0954-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 01/18/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVI) is an alternative treatment for patients with symptomatic severe aortic stenosis ineligible for surgical aortic valve replacement (SAVR) or at increased perioperative risk. Due to continually emerging evidence, we performed a systematic review and meta-analysis comparing benefits and harms of TAVI, SAVR, medical therapy, and balloon aortic valvuloplasty. METHODS We searched MEDLINE, Embase, and Cochrane CENTRAL from 2002 to June 6, 2017. We dually screened abstracts and full-text articles for randomized controlled trials (RCTs) and propensity score-matched observational studies. Two investigators independently rated the risk of bias of included studies and determined the certainty of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation). If data permitted, we performed meta-analyses using random- and fixed-effects models. RESULTS Out of 7755 citations, we included six RCTs (5862 patients) and 13 observational studies (6376 patients). In meta-analyses, patients treated with SAVR or TAVI had similar risks for mortality at 30 days (relative risk [RR] 1.05; 95% confidence interval [CI] 0.82 to 1.33) and 1 year (RR 1.02; 95% CI 0.93 to 1.13). TAVI had significantly lower risks for major bleeding but increased risks for major vascular complications, moderate or severe paravalvular aortic regurgitation, and new pacemaker implantation compared to SAVR. Comparing TAVI to medical therapy, mortality did not differ at 30 days but was significantly reduced at 1 year (RR 0.51; 95% CI 0.34 to 0.77). CONCLUSIONS Given similar mortality risks but different patterns of adverse events, the choice between TAVI and SAVR remains an individual one.
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Affiliation(s)
- Gernot Wagner
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria
| | - Sabine Steiner
- Division of Interventional Angiology, University Hospital Leipzig, Liebigstraße 20, Haus 4, 04103 Leipzig, Germany
| | - Gerald Gartlehner
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria
- RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Henrike Arfsten
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Brigitte Wildner
- University Library-Information Retrieval Office, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Harald Mayr
- Department of Internal Medicine 3, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Dunant-Platz 1, 3100 St. Poelten, Austria
- Institute for Research of Ischaemic Cardiac Disease and Rhythmology, Karl Landsteiner Society, Dunant-Platz 1, 3100 St. Poelten, Austria
| | - Deddo Moertl
- Department of Internal Medicine 3, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Dunant-Platz 1, 3100 St. Poelten, Austria
- Institute for Research of Ischaemic Cardiac Disease and Rhythmology, Karl Landsteiner Society, Dunant-Platz 1, 3100 St. Poelten, Austria
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7
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Suzuki-Eguchi N, Murata M, Itabashi Y, Shirakawa K, Fukuda M, Endo J, Tsuruta H, Arai T, Hayashida K, Shimizu H, Fukuda K. Prognostic value of pre-procedural left ventricular strain for clinical events after transcatheter aortic valve implantation. PLoS One 2018; 13:e0205190. [PMID: 30308001 PMCID: PMC6181329 DOI: 10.1371/journal.pone.0205190] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 08/28/2018] [Indexed: 12/04/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) is an alternative therapy for surgically high-risk patients with severe aortic stenosis (AS). Although TAVI improves survival of patients with severe AS, the mechanism of this effect remains to be clarified. We investigated the effects of TAVI on left ventricular (LV) function and identified the predictive parameters for cardiac events after TAVI. Methods and results We studied 128 patients with severe symptomatic AS who underwent TAVI. Echocardiographic assessments were performed before and after TAVI. In addition to the conventional echocardiographic parameters such as LV ejection fraction (LVEF) and LV mass index (LVMI), the LV global longitudinal strain (GLS) and early diastolic peak strain rate (SR_E) using two-dimensional speckle tracking echocardiography were also evaluated. All patients were assessed for clinical events including major adverse cardiac events and stroke according to Valve Academic Research Consortium-2 criteria. GLS, early diastolic peak velocity (eʹ), aortic regurgitation (AR) severity, and SR_E were significantly improved after TAVI. Thirteen patients had an event during the observational period of 591 days (median). Patients with events had higher LVMI, more severe AR, and worse GLS compared to those without events. Furthermore, receiver-operating curve analysis revealed that GLS was the strongest predictor for clinical events (p = 0.009; area under the curve, 0.73). Conclusion Preoperative LV geometric deformation and dysfunction, as a consequence of the cumulative burden of pressure overload, improved after TAVI and could predict cardiac events after TAVI.
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Affiliation(s)
| | - Mitsushige Murata
- Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan
- * E-mail:
| | - Yuji Itabashi
- Department of Laboratory Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Kousuke Shirakawa
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Memori Fukuda
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Jin Endo
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Hikaru Tsuruta
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Takahide Arai
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Hideyuki Shimizu
- Cardiovascular Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
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8
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Abawi M, Pagnesi M, Agostoni P, Chiarito M, van Jaarsveld RC, van Dongen CS, Slooter AJC, Colombo A, Kooistra NHM, Doevendans PAFM, Latib A, Stella PR. Postoperative Delirium in Individuals Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. J Am Geriatr Soc 2018; 66:2417-2424. [PMID: 30296342 DOI: 10.1111/jgs.15600] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/01/2018] [Accepted: 08/15/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate the incidence of in-hospital postoperative delirium (IHPOD) after transcatheter aortic valve replacement (TAVR). DESIGN Systematic review and meta-analysis. SETTING Elective procedures PARTICIPANTS: Individuals undergoing TAVR. MEASUREMENTS A literature search was conducted in PubMed, Embase, BioMedCentral, Google Scholar, and the Cochrane Central Register of Controlled Trials (up to December 2017). All observational studies reporting the incidence of IHPOD after TAVR (sample size > 25) were included in our meta-analysis. The reported incidence rates were weighted to obtain a pooled estimate rate with 95% confidence interval (CI). RESULTS Of 96 potentially relevant articles, 31 with a total of 32,389 individuals who underwent TAVR were included in the meta-analysis. The crude incidence of IHPOD after TAVR ranged from 0% to 44.6% in included studies, with a pooled estimate rate of 8.1% (95% CI=6.7-9.4%); heterogeneity was high (Q = 449; I = 93%; pheterogeneity < .001). The pooled estimate rate of IHPOD was 7.2% (95% CI=5.4-9.1%) after transfemoral (TF) TAVR and 21.4% (95% CI=10.3-32.5%) after non-TF TAVR. CONCLUSION Delirium occurs frequently after TAVR and is more common after non-TF than TF procedures. Recommendations are made with the aim of standardizing future research to reduce heterogeneity between studies on this important healthcare problem. J Am Geriatr Soc 66:2417-2424, 2018.
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Affiliation(s)
- Masieh Abawi
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Matteo Pagnesi
- Interventional Cardiology Unit San Raffaele Scientific Institute, Milan, Italy
| | - Pierfrancesco Agostoni
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Mauro Chiarito
- Cardio Center Humanitas Research Hospital, Rozzano Milan, Italy
| | - Romy C van Jaarsveld
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Charlotte S van Dongen
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arjen J C Slooter
- Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Antonio Colombo
- Interventional Cardiology Unit San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Nynke H M Kooistra
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pieter A F M Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Azeem Latib
- Interventional Cardiology Unit San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Pieter R Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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9
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Shah K, Chaker Z, Busu T, Badhwar V, Alqahtani F, Alvi M, Adcock A, Alkhouli M. Meta-Analysis Comparing the Frequency of Stroke After Transcatheter Versus Surgical Aortic Valve Replacement. Am J Cardiol 2018; 122:1215-1221. [PMID: 30089530 DOI: 10.1016/j.amjcard.2018.06.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/08/2018] [Accepted: 06/14/2018] [Indexed: 12/17/2022]
Abstract
Stroke is one of the most feared complications of aortic valve replacement. Although the outcomes of transcatheter aortic valve implantation (TAVI) improved substantially over time, concerns remained about a potentially higher incidence of stroke with TAVI compared with surgical replacement (SAVR). However, comparative data are sparse. We performed a meta-analysis comparing the incidence of stroke among patients undergoing TAVI versus SAVR. Of the 5067 studies screened, 28 eligible studies (22 propensity-score matched studies and 6 randomized trials) were analyzed. Primary endpoints were 30-day stroke and disabling stroke. Secondary endpoints were 1-year stroke and disabling stroke. A total of 23,587 patients were included, of whom 47.27% underwent TAVI and 52.72% underwent SAVR. For each endpoint, pooled estimates of odds ratio (OR) with 95% confidence interval (CI) were calculated. The pooled estimates for stroke (2.7% vs 3.1%, OR 0.86; 95% CI 0.72 to 1.02; p=0.08) and disabling stroke (2.5% vs 2.9%, OR 0.96; 95% CI 0.57 to 1.62; p=0.89) were comparable following TAVI versus SAVR at 30 days. Similarly, the pooled estimates for stroke (5.0% vs 4.6%, OR 1.01; 95% CI 0.79 to 1.28; p=0.96) and disabling stroke (4.1% vs 4.5%, OR 0.92; 95% CI 0.92 to 1.39; p=0.71) were similar at 1 year. A sensitivity analysis including only RCTs yielded similar results. Our meta-analysis documents comparable rates of strokes and disabling strokes following TAVI or SAVR both at 30 days and 1 year.
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Affiliation(s)
- Kuldeep Shah
- Division of Cardiology, West Virginia School of Medicine, Morgantown, WV
| | - Zakeih Chaker
- Department of Medicine, West Virginia School of Medicine, Morgantown, WV
| | - Tatiana Busu
- Department of Medicine, West Virginia School of Medicine, Morgantown, WV
| | - Vinay Badhwar
- Department of Cardiothoracic Surgery, West Virginia School of Medicine, Morgantown, WV
| | - Fahad Alqahtani
- Division of Cardiology, West Virginia School of Medicine, Morgantown, WV
| | - Muhammad Alvi
- Department of Neurology, West Virginia School of Medicine, Morgantown, WV
| | - Amelia Adcock
- Department of Neurology, West Virginia School of Medicine, Morgantown, WV
| | - Mohamad Alkhouli
- Division of Cardiology, West Virginia School of Medicine, Morgantown, WV.
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10
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Cerebrovascular Events With Transcatheter Aortic Valve Replacement: Can We Identify Those Who Are at Risk? J Am Coll Cardiol 2018; 68:685-7. [PMID: 27515326 DOI: 10.1016/j.jacc.2016.05.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 05/29/2016] [Indexed: 11/21/2022]
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11
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Ando T, Takagi H, Grines CL. Transfemoral, transapical and transcatheter aortic valve implantation and surgical aortic valve replacement: a meta-analysis of direct and adjusted indirect comparisons of early and mid-term deaths. Interact Cardiovasc Thorac Surg 2017; 25:484-492. [PMID: 28549125 DOI: 10.1093/icvts/ivx150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/06/2017] [Indexed: 11/13/2022] Open
Abstract
Clinical outcomes of transfemoral-transcatheter aortic valve implantation (TF-TAVI) versus surgical aortic valve replacement (SAVR) or transapical (TA)-TAVI are limited to a few randomized clinical trials (RCTs). Because previous meta-analyses only included a limited number of adjusted studies or several non-adjusted studies, our goal was to compare and summarize the outcomes of TF-TAVI vs SAVR and TF-TAVI vs TA-TAVI exclusively with the RCT and propensity-matched cohort studies with direct and adjusted indirect comparisons to reach more precise conclusions. We hypothesized that TF-TAVI would offer surgical candidates a better outcome compared with SAVR and TA-TAVI because of its potential for fewer myocardial injuries. A literature search was conducted through PUBMED and EMBASE through June 2016. Only RCTs and propensity-matched cohort studies were included. A direct meta-analysis of TF-TAVI vs SAVR, TA-TAVI vs SAVR and TF-TAVI vs TA-TAVI was conducted. Then, the effect size of an indirect meta-analysis was calculated from the direct meta-analysis. The effect sizes of direct and indirect meta-analyses were then combined. A random-effects model was used to calculate the hazards ratio and the odds ratio with 95% confidence intervals. Early (in-hospital or 30 days) and mid-term (≥1 year) all-cause mortality rates were assessed. Our search resulted in 4 RCTs (n = 2319) and 14 propensity-matched cohort (n = 7217) studies with 9536 patients of whom 3471, 1769 and 4296 received TF, TA and SAVR, respectively. Direct meta-analyses and combined direct and indirect meta-analyses of early and mid-term deaths with TF-TAVI and SAVR were similar. Early deaths with TF-TAVI vs TA-TAVI were comparable in direct meta-analyses (odds ratio 0.64, P = 0.35) and direct and indirect meta-analyses combined (odds ratio 0.73, P = 0.24). Mid-term deaths with TF-TAVI vs TA-TAVI were increased (hazard ratio 0.83, P = 0.07) in a direct meta-analysis and became significant after addition of the indirect meta-analysis (hazard ratio 0.78, 95% confidence interval 0.67-0.92, P = 0.003). In conclusion, TF-TAVI was associated with similar early and mid-term deaths compared with SAVR. The number of early deaths was not significantly different between TF-TAVI and TA-TAVI, whereas there were fewer mid-term deaths with TF-TAVI than with TA-TAVI.
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Affiliation(s)
- Tomo Ando
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center, Detroit, MI, USA
| | - Hisato Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Cindy L Grines
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center, Detroit, MI, USA
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Murakami T, Nishimura S, Hosono M, Nakamura Y, Sohgawa E, Sakai Y, Shibata T. Transapical Endovascular Repair of Thoracic Aortic Pathology. Ann Vasc Surg 2017; 43:56-64. [DOI: 10.1016/j.avsg.2016.10.054] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/23/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
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International Expert Consensus on Sutureless and Rapid Deployment Valves in Aortic Valve Replacement Using Minimally Invasive Approaches. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 11:165-73. [PMID: 27540996 PMCID: PMC4996354 DOI: 10.1097/imi.0000000000000287] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective To define the benefit of sutureless and rapid deployment valves in current minimally invasive approaches in isolated aortic valve replacement. Methods A panel of 28 international experts with expertise in both minimally invasive aortic valve replacement and rapid deployment valves was constituted. After thorough literature review, the experts rated evidence-based recommendations in a modified Delphi approach. Results No guideline could be retrieved. Thirty-three clinical trials and 9 systematic reviews could be identified for detailed text analysis to obtain a total of 24 recommendations. After rating by the experts 12, final recommendations were identified: preoperative computed tomographic scan as well as intraoperative transesophageal echocardiography are highly recommended. Suitable annular sizes are 19 to 27 mm. There is a contraindication for bicuspid valves only for type 0 and for annular abscess or destruction due to infective endocarditis. The use of sutureless and rapid deployment valves reduces extracorporeal circulation and aortic cross-clamp time and leads to less early complications as prolonged ventilation, blood transfusion, atrial fibrillation, pleural effusions, paravalvular leakages and aortic regurgitation, and renal replacement therapy, respectively. These clinical outcomes result in reduced intensive care unit and hospital stay and reduced costs. The use of sutureless and rapid deployment valves will lead to a higher adoption rate of minimally invasive approaches in aortic valve replacement. Respect should be taken to a necessary short learning curve for both sutureless and minimally invasive programs. Conclusions Sutureless and rapid deployment aortic valve replacement together with minimally invasive approaches offers an attractive option in aortic valve placement for patients requiring biological valve replacement.
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Kallinikou Z, Berger A, Ruchat P, Khatchatourov G, Fleisch I, Korkodelovic B, Henchoz E, Marti RA, Cook S, Togni M, Goy JJ. Transcutaneous aortic valve implantation using the carotid artery access: Feasibility and clinical outcomes. Arch Cardiovasc Dis 2017; 110:389-394. [PMID: 28433509 DOI: 10.1016/j.acvd.2016.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/19/2016] [Accepted: 10/13/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Transcarotid access is an alternative route for transcutaneous aortic valve implantation (TAVI) in patients with impossible transfemoral access. AIMS We evaluated the safety, effectiveness and early and late clinical outcomes of CoreValve® implantation via the common carotid artery. METHODS Eighteen patients (10 men, 8 women; mean age 84±5 years) at high surgical risk (mean EuroSCORE II 16±13%) with significant peripheral artery disease underwent TAVI via common carotid artery access under general anaesthesia. Mean aortic valve area was 0.64±0.13cm2 (0.36±0.07cm2/m2). RESULTS At a mean follow-up of 605±352 days, two patients (11%) had died in hospital, on days 6 and 20, as a result of sepsis with multiorgan failure (n=1) or pneumonia (n=1). There were no perioperative deaths, myocardial infarctions or strokes. Perioperative prosthesis embolization occurred in one patient (6%), requiring implantation of a second valve. In-hospital complications occurred in four patients (23%): blood transfusion for transient significant bleeding at the access site in one patient (6%); permanent pacemaker implantation in two patients (11%); and pericardial drainage in one patient (6%). The rate of event-free in-hospital stay was 66%. Post-procedural echocardiography showed very good haemodynamic performance, with a mean gradient of 8±3mmHg. Moderate paravalvular leak was present in one patient (6%). Mean intensive care unit stay was 48±31h; mean in-hospital stay was 7±3 days. CONCLUSION TAVI performed by transcarotid access in this small series of severely ill patients was associated with a low incidence of complications, which were associated with the procedure itself rather than the access route.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Stéphane Cook
- Department of Cardiology, University and Hospital of Fribourg, Switzerland; Clinique Cecil, Lausanne, Switzerland
| | - Mario Togni
- Department of Cardiology, University and Hospital of Fribourg, Switzerland; Clinique Cecil, Lausanne, Switzerland
| | - Jean-Jacques Goy
- Department of Cardiology, University and Hospital of Fribourg, Switzerland; Clinique Cecil, Lausanne, Switzerland.
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Hannan EL, Samadashvili Z, Stamato NJ, Lahey SJ, Wechsler A, Jordan D, Sundt TM, Gold JP, Ruiz CE, Ashraf MH, Smith CR. Utilization and 1-Year Mortality for Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement in New York Patients With Aortic Stenosis: 2011 to 2012. JACC Cardiovasc Interv 2017; 9:578-85. [PMID: 27013157 DOI: 10.1016/j.jcin.2015.12.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/12/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate changes in the use of transcatheter aortic valve replacement (TAVR) relative to surgical aortic valve replacement (SAVR) and to examine relative 1-year TAVR and SAVR outcomes in 2011 to 2012 in a population-based setting. BACKGROUND TAVR has become a popular option for patients with severe aortic stenosis, particularly for higher-risk patients. METHODS New York's Cardiac Surgery Reporting System was used to identify TAVR and SAVR volumes and to propensity match TAVR and SAVR patients using numerous patient risk factors contained in the registry to compare 1-year mortality rates. Mortality rates were also compared for different levels of patient risk. RESULTS The total number of aortic valve replacement patients increased from 2,291 in 2011 to 2,899 in 2012, an increase of 27%. The volume of SAVR patients increased by 7.1% from 1,994 to 2,135 and the volume of TAVR patients increased 157% from 297 to 764. The percentage of SAVR patients that were at higher risk (≥3% New York State [NYS] score, equivalent to a Society of Thoracic Surgeons score of about 8%) decreased from 27% to 23%, and the percentage of TAVR patients that were at higher risk decreased from 83% to 76%. There was no significant difference in 1-year mortality between TAVR and SAVR patients (15.6% vs. 13.1%; hazard ratio [HR]: 1.30 [95% confidence interval (CI): 0.89 to 1.92]). There were no differences among patients with NYS score <3% (12.5% vs. 10.2%; HR: 1.42 [95% CI: 0.68 to 2.97]) or among patients with NYS score ≥3% (17.1% vs. 14.5%; HR: 1.27 [95% CI: 0.81 to 1.98]). CONCLUSIONS TAVR has assumed a much larger share of all aortic valve replacements for severe aortic stenosis, and the average level of pre-procedural risk has decreased substantially. There are no differences between 1-year mortality rates for TAVR and SAVR patients.
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Affiliation(s)
- Edward L Hannan
- School of Public Health, University at Albany, State University of New York, Albany, New York.
| | - Zaza Samadashvili
- School of Public Health, University at Albany, State University of New York, Albany, New York
| | - Nicholas J Stamato
- Department of Cardiology, Campbell County Memorial Hospital, Gillette, Wyoming
| | - Stephen J Lahey
- Division of Cardiothoracic Surgery, University of Connecticut, Storrs, Connecticut
| | - Andrew Wechsler
- Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Desmond Jordan
- Department of Surgery, Columbia-Presbyterian Medical Center, New York, New York
| | - Thoralf M Sundt
- Cardiac Surgical Division, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Carlos E Ruiz
- Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, New York
| | - Mohammed H Ashraf
- Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, New York
| | - Craig R Smith
- Department of Surgery, Columbia-Presbyterian Medical Center, New York, New York
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Villablanca PA, Mathew V, Thourani VH, Rodés-Cabau J, Bangalore S, Makkiya M, Vlismas P, Briceno DF, Slovut DP, Taub CC, McCarthy PM, Augoustides JG, Ramakrishna H. A meta-analysis and meta-regression of long-term outcomes of transcatheter versus surgical aortic valve replacement for severe aortic stenosis. Int J Cardiol 2016; 225:234-243. [DOI: 10.1016/j.ijcard.2016.10.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/04/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
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17
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Fanning JP, Wesley AJ, Walters DL, Eeles EM, Barnett AG, Platts DG, Clarke AJ, Wong AA, Strugnell WE, O'Sullivan C, Tronstad O, Fraser JF. Neurological Injury in Intermediate-Risk Transcatheter Aortic Valve Implantation. J Am Heart Assoc 2016; 5:e004203. [PMID: 27849158 PMCID: PMC5210348 DOI: 10.1161/jaha.116.004203] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 08/09/2016] [Indexed: 12/02/2022]
Abstract
BACKGROUND The application of transcatheter aortic valve implantation (TAVI) to intermediate-risk patients is a controversial issue. Of concern, neurological injury in this group remains poorly defined. Among high-risk and inoperable patients, subclinical injury is reported on average in 75% undergoing the procedure. Although this attendant risk may be acceptable in higher-risk patients, it may not be so in those of lower risk. METHODS AND RESULTS Forty patients undergoing TAVI with the Edwards SAPIEN-XT™ prosthesis were prospectively studied. Patients were of intermediate surgical risk, with a mean±standard deviation Society of Thoracic Surgeons score of 5.1±2.5% and a EuroSCORE II of 4.8±2.4%; participant age was 82±7 years. Clinically apparent injury was assessed by serial National Institutes of Health Stroke Scale assessments, Montreal Cognitive Assessments (MoCA), and with the Confusion Assessment Method. These identified 1 (2.5%) minor stroke, 1 (2.5%) episode of postoperative delirium, and 2 patients (5%) with significant postoperative cognitive dysfunction. Subclinical neurological injury was assessed using brain magnetic resonance imaging, including diffusion-weighted imaging (DWI) sequences preprocedure and at 3±1 days postprocedure. This identified 68 new DWI lesions present in 60% of participants, with a median±interquartile range of 1±3 lesions/patient and volumes of infarction of 24±19 μL/lesion and 89±218 μL/patient. DWI lesions were associated with a statistically significant reduction in early cognition (mean ΔMoCA -3.5±1.7) without effect on cognition, quality of life, or functional capacity at 6 months. CONCLUSIONS Objectively measured subclinical neurological injuries remain a concern in intermediate-risk patients undergoing TAVI and are likely to manifest with early neurocognitive changes. CLINICAL TRIAL REGISTRATION URL: http://www.anzctr.org.au. Australian & New Zealand Clinical Trials Registry: ACTRN12613000083796.
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Affiliation(s)
- Jonathon P Fanning
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- The Heart & Lung Institute, Metro North Hospital and Health Service District, Brisbane, Queensland, Australia
- The University of Queensland, Herston, Queensland, Australia
| | - Allan J Wesley
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Herston, Queensland, Australia
| | - Darren L Walters
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia
- The Heart & Lung Institute, Metro North Hospital and Health Service District, Brisbane, Queensland, Australia
- The University of Queensland, Herston, Queensland, Australia
| | - Eamonn M Eeles
- Department of Geriatrics, The Prince Charles Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Herston, Queensland, Australia
| | - Adrian G Barnett
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David G Platts
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia
- The Heart & Lung Institute, Metro North Hospital and Health Service District, Brisbane, Queensland, Australia
- The University of Queensland, Herston, Queensland, Australia
| | - Andrew J Clarke
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
- The Heart & Lung Institute, Metro North Hospital and Health Service District, Brisbane, Queensland, Australia
| | - Andrew A Wong
- The University of Queensland, Herston, Queensland, Australia
- Department of Neurology, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Wendy E Strugnell
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Cliona O'Sullivan
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Oystein Tronstad
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Department of Physiotherapy, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Adult Intensive Care Unit, The Prince Charles Hospital, Brisbane, Queensland, Australia
- The Heart & Lung Institute, Metro North Hospital and Health Service District, Brisbane, Queensland, Australia
- The University of Queensland, Herston, Queensland, Australia
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Takagi H, Umemoto T. Worse survival after transcatheter aortic valve implantation than surgical aortic valve replacement: A meta-analysis of observational studies with a propensity-score analysis. Int J Cardiol 2016; 220:320-7. [DOI: 10.1016/j.ijcard.2016.06.261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/15/2016] [Accepted: 06/27/2016] [Indexed: 12/24/2022]
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Kawaguchi AT, Collet JP, Cluzel P, Makri R, Laali M, DeFrance C, Furuya H, Murakami A, Leprince P. Preoperative Risk Levels and Vascular Access in Transcatheter Aortic Valve Implantation-A Single-Institute Analysis. Artif Organs 2016; 41:130-138. [PMID: 27654027 DOI: 10.1111/aor.12754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 02/26/2016] [Accepted: 03/10/2016] [Indexed: 01/02/2023]
Abstract
Although transcatheter aortic valve implantation (TAVI) has been indicated for patients with high surgical risk, indications for or against the procedure become more difficult as vascular access becomes more proximal and/or invasive in order to accommodate patients with even higher risks. We compared preoperative factors including the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Society of Thoracic Surgeons Predicted Risk of Mortality (STS) score with postoperative survival in 195 patients undergoing TAVI during 2.5 years (January 2010 to June 2012), when vascular access routes were developed from iliofemoral (IL/Fm access, n = 149), axillo-clavicular, apical, and direct aortic approaches (alternative access, n = 46). Logistic regression analyses showed that alternative access was associated with reduced 30-day survival (P = 0.024), while high surgical risk (>15% in both EuroSCORE and STS score) was associated with reduced 1-year survival (P = 0.046). Thus, patients treated via IL/Fm access had acceptable outcome regardless of preoperative risk levels while patients with low surgical risk (<15%) had favorable outcome irrespective of access route. Since the remaining patients with combined risk factors, high preoperative risk level (>15%) requiring alternative access, had a prohibitive risk in our experience, they might have been considered untreatable or not amenable even to TAVI and offered medical or alternative managements.
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Affiliation(s)
- Akira T Kawaguchi
- Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Tokai University School of Medicine, Isehara
| | - Jean Philippe Collet
- Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Philippe Cluzel
- Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Ralouka Makri
- Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Mojgan Laali
- Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Catherine DeFrance
- Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | | | - Pascal Leprince
- Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Hannan EL, Samadashvili Z, Jordan D, Sundt TM, Stamato NJ, Lahey SJ, Gold JP, Wechsler A, Ashraf MH, Ruiz C, Wilson S, Smith CR. Thirty-Day Readmissions After Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis in New York State. Circ Cardiovasc Interv 2016; 8:e002744. [PMID: 26227347 DOI: 10.1161/circinterventions.115.002744] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several studies have compared short-term and medium-term mortality rates for patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR), but no studies have compared short-term readmission rates for the 2 procedures. METHODS AND RESULTS New York's Cardiac Surgery Reporting System was used to propensity match 617 TAVI and 1981 SAVR patients using numerous patient risk factors contained in the registry. The 389 propensity-matched pairs were then used to analyze differences in readmission rates between the 2 groups. TAVI and SAVR readmission rates were also compared for patients with a history of congestive heart failure and for patients aged ≥80. Also, reasons for readmission for TAVI and SAVR patients were examined and compared. Readmission rates were not statistically different for all propensity-matched TAVI and SAVR patients (respective rates, 18.8% and 19.3%; P=0.86). After further adjustment using a logistic regression model, there was still no significant difference (adjusted odds ratio, 0.97; 95% confidence interval [0.68-1.39]). For patients aged ≥80, the 30-day readmission rates were 19.9% and 22.0% (P=0.59), and when further adjusted using the logistic regression model, adjusted odds ratio=0.89 (0.55-1.45). For patients with a history of congestive heart failure, the respective rates were 22.8% and 20.4% (P=0.56), and with further adjustment, adjusted odds ratio became 1.15 (0.72-1.82). CONCLUSIONS There are no statistically significant differences between TAVI and SAVR patients in short-term readmission rates.
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Affiliation(s)
- Edward L Hannan
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.).
| | - Zaza Samadashvili
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Desmond Jordan
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Thoralf M Sundt
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Nicholas J Stamato
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Stephen J Lahey
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Jeffrey P Gold
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Andrew Wechsler
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Mohammed H Ashraf
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Carlos Ruiz
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Sean Wilson
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Craig R Smith
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
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Grabert S, Lange R, Bleiziffer S. Incidence and causes of silent and symptomatic stroke following surgical and transcatheter aortic valve replacement: a comprehensive review. Interact Cardiovasc Thorac Surg 2016; 23:469-76. [PMID: 27241049 DOI: 10.1093/icvts/ivw142] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 04/11/2016] [Indexed: 12/24/2022] Open
Abstract
Stroke associated with aortic valve replacement in calcific aortic stenosis, either via transcatheter implantation (TAVR) or via surgical replacement (SAVR), is one of the most devastating complications. However, data concerning the clinical impact and incidence of clinical and silent stroke complicating SAVR and TAVR are varying. This comprehensive review of the literature explores the genuine incidence of neurological events after these procedures. Additionally, potential factors responsible for the discrepancies in stroke rates in the current literature are analysed and a lack of uniform neurological definitions and standardized neurological assessments revealed. Current stroke rates after TAVR show a decline from 7 to 1.7-4.8% in recent studies. Randomized studies comparing TAVR with SAVR yielded initially a significantly higher stroke rate after TAVR procedures as opposed to SAVR. Recently published data showed opposite results with strokes being higher following SAVR. Current data concerning stroke after surgical valve replacement report significantly higher rates of clinical strokes (17%) than previously mentioned in the literature (≤4.9%). Silent cerebral lesions were detected in 68-93% after TAVR and 38-54% after SAVR. A broader application of cerebral protection devices may help to reduce embolic cerebral events.
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Affiliation(s)
- Stephanie Grabert
- Department of Cardiovascular Surgery, German Heart Center Munich, Clinic at the Technical University, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Clinic at the Technical University, Munich, Germany
| | - Sabine Bleiziffer
- Department of Cardiovascular Surgery, German Heart Center Munich, Clinic at the Technical University, Munich, Germany
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22
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Transient and persistent conduction abnormalities following transcatheter aortic valve replacement with the Edwards-Sapien prosthesis: a comparison between antegrade vs. retrograde approaches. J Interv Card Electrophysiol 2016; 47:143-151. [DOI: 10.1007/s10840-016-0145-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 05/16/2016] [Indexed: 11/25/2022]
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23
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Glauber M, Moten SC, Quaini E, Solinas M, Folliguet TA, Meuris B, Miceli A, Oberwalder PJ, Rambaldini M, Teoh KHT, Bhatnagar G, Borger MA, Bouchard D, Bouchot O, Clark SC, Dapunt OE, Ferrarini M, Fischlein TJM, Laufer G, Mignosa C, Millner R, Noirhomme P, Pfeiffer S, Ruyra-Baliarda X, Shrestha ML, Suri RM, Troise G, Gersak B. International Expert Consensus on Sutureless and Rapid Deployment Valves in Aortic Valve Replacement Using Minimally Invasive Approaches. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mattia Glauber
- Istituto Clinico Sant’ Ambrogio, Clinical & Research Hospital IRCCS-Gruppo Ospedaliero San Donato, Milano, Italy
| | - Simon C. Moten
- Austin Health and Royal Melbourne Hospital, Melbourne, Australia
| | - Eugenio Quaini
- Istituto Clinico Sant’ Ambrogio, Clinical & Research Hospital IRCCS-Gruppo Ospedaliero San Donato, Milano, Italy
| | - Marco Solinas
- Ospedale del Cuore G. Pasquinucci, Fondazione Toscana G. Monasterio, Massa, Italy
| | | | | | - Antonio Miceli
- Istituto Clinico Sant’ Ambrogio, Clinical & Research Hospital IRCCS-Gruppo Ospedaliero San Donato, Milano, Italy
| | | | | | - Kevin H. T. Teoh
- Southlake Regional Health Centre, McMaster University, Hamilton, Canada
| | - Gopal Bhatnagar
- Trillium Cardiovascular Associates, Mississauga, Ontario, Canada
| | | | | | | | | | | | - Matteo Ferrarini
- Istituto Clinico Sant’ Ambrogio, Clinical & Research Hospital IRCCS-Gruppo Ospedaliero San Donato, Milano, Italy
| | | | | | | | | | | | | | | | | | | | | | - Borut Gersak
- University Medical Center Ljubljana, Ljubljana, Slovenia
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Saxena A, Dhurandhar V, Bannon PG, Newcomb AE. The Benefits and Pitfalls of the Use of Risk Stratification Tools in Cardiac Surgery. Heart Lung Circ 2016; 25:314-8. [PMID: 26857968 DOI: 10.1016/j.hlc.2015.12.094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 12/11/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
Risk assessment tools are increasingly used in surgery. In cardiac surgery, risk models are used for patient counselling, surgical decision-making, performance benchmarking, clinical research, evaluation of new therapies and quality assurance, among others. However, they have numerous disadvantages which need to be considered. This article evaluates the utility of risk assessment tools in cardiac surgery including a discussion of their advantages and disadvantages.
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Affiliation(s)
- Akshat Saxena
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Vikrant Dhurandhar
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; The Baird Institute, Sydney, NSW, Australia
| | - Paul G Bannon
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; The Baird Institute, Sydney, NSW, Australia
| | - Andrew E Newcomb
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Melbourne, Vic, Australia.
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25
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Zhao F, Xie X, Roach M. Computer Vision Techniques for Transcatheter Intervention. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2015; 3:1900331. [PMID: 27170893 PMCID: PMC4848047 DOI: 10.1109/jtehm.2015.2446988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/10/2015] [Accepted: 06/09/2015] [Indexed: 12/02/2022]
Abstract
Minimally invasive transcatheter technologies have demonstrated substantial promise for the diagnosis and the treatment of cardiovascular diseases. For example, transcatheter aortic valve implantation is an alternative to aortic valve replacement for the treatment of severe aortic stenosis, and transcatheter atrial fibrillation ablation is widely used for the treatment and the cure of atrial fibrillation. In addition, catheter-based intravascular ultrasound and optical coherence tomography imaging of coronary arteries provides important information about the coronary lumen, wall, and plaque characteristics. Qualitative and quantitative analysis of these cross-sectional image data will be beneficial to the evaluation and the treatment of coronary artery diseases such as atherosclerosis. In all the phases (preoperative, intraoperative, and postoperative) during the transcatheter intervention procedure, computer vision techniques (e.g., image segmentation and motion tracking) have been largely applied in the field to accomplish tasks like annulus measurement, valve selection, catheter placement control, and vessel centerline extraction. This provides beneficial guidance for the clinicians in surgical planning, disease diagnosis, and treatment assessment. In this paper, we present a systematical review on these state-of-the-art methods. We aim to give a comprehensive overview for researchers in the area of computer vision on the subject of transcatheter intervention. Research in medical computing is multi-disciplinary due to its nature, and hence, it is important to understand the application domain, clinical background, and imaging modality, so that methods and quantitative measurements derived from analyzing the imaging data are appropriate and meaningful. We thus provide an overview on the background information of the transcatheter intervention procedures, as well as a review of the computer vision techniques and methodologies applied in this area.
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Affiliation(s)
- Feng Zhao
- Department of Computer ScienceSwansea UniversitySwanseaSA2 8PPU.K.
| | - Xianghua Xie
- Department of Computer ScienceSwansea UniversitySwanseaSA2 8PPU.K.
| | - Matthew Roach
- Department of Computer ScienceSwansea UniversitySwanseaSA2 8PPU.K.
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Kawaguchi AT, D'Allessandro C, Collet JP, Cluzel P, Makri R, Leprince P. Ventricular Conduction Defects After Transcatheter Aortic Valve Implantation: A Single-Institute Analysis. Artif Organs 2015; 39:409-15. [DOI: 10.1111/aor.12393] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Akira T. Kawaguchi
- Chirurgie Thoracique et Cardiovasculaire; Groupe Hospitalier Pitié-Salpêtrière; Paris France
| | - Cosimo D'Allessandro
- Chirurgie Thoracique et Cardiovasculaire; Groupe Hospitalier Pitié-Salpêtrière; Paris France
| | | | - Philippe Cluzel
- Department d'Imagerie et de Radiologie Interventionelle; Groupe Hospitalier Pitié-Salpêtrière; Paris France
| | - Ralouka Makri
- Department d'Anesthésie Reanimation, Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris; Groupe Hospitalier Pitié-Salpêtrière; Paris France
| | - Pascal Leprince
- Chirurgie Thoracique et Cardiovasculaire; Groupe Hospitalier Pitié-Salpêtrière; Paris France
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27
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Huber C, Praz F, O'Sullivan CJ, Langhammer B, Gloekler S, Stortecky S, von Allmen RS, Meier B, Carrel T, Englberger L, Windecker S, Wenaweser P. Transcarotid aortic valve-in-valve implantation for degenerated stentless aortic root conduits with severe regurgitation: a case series. Interact Cardiovasc Thorac Surg 2015; 20:694-700. [DOI: 10.1093/icvts/ivv053] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 02/24/2015] [Indexed: 11/14/2022] Open
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Thoracic Aorta Stent Grafting through Transapical Access. Ann Vasc Surg 2015; 29:362.e5-9. [DOI: 10.1016/j.avsg.2014.09.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 09/09/2014] [Accepted: 09/14/2014] [Indexed: 11/20/2022]
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Cioffi G, Tomasi C, Rossi A, Nistri S, Tarantini L, Faden G, Mazzone C, Di Lenarda A, Ettori F, Stefenelli C, Faggiano P. Does treatment assignment influence the prognosis of patients with symptomatic severe aortic stenosis? Cardiovasc Ultrasound 2015; 13:2. [PMID: 25575911 PMCID: PMC4298079 DOI: 10.1186/1476-7120-13-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 12/16/2014] [Indexed: 01/20/2023] Open
Abstract
Objective Aortic valve replacement (AVR) is the standard therapy in patients with symptomatic aortic stenosis (AS). In high surgical risk patients, alternative therapeutic options to medical treatment (MT) such as trans-catheter aortic valve implantation (TAVI) or balloon aortic valvuloplasty (BAV) have been proposed. In this study we evaluated whether treatment assignment influences per se the prognosis of these subjects. Patients and methods Criteria for treatment assignment were based on patient’s clinical conditions, Logistic EuroSCORE and other co-morbidities ignored by EuroSCORE. Due to baseline clinical differences between patients with diverse treatment assignment, we used propensity score matching to achieve balance. Results 368 patients were studied: 141 underwent AVR, 127 TAVI, 49 BAV and 51 MT. 84 events (deaths for all causes) occurred during 14 months of follow-up: 11 AVR (8%), 26 TAVI (20%), 18 MT (35%), 29 BAV group (59%). Traditional Cox analysis identified treatment assignment as independent predictor of events (HR 1.82 [CI 1.10-3.25]) together with lower left ventricular ejection fraction, impaired renal function and history of heart failure. Matched Cox analysis by propensity score confirmed treatment assignment as an independent prognosticator of events (HR 1.90 [CI 1.27-2.85]), and showed similar rate events in TAVI and AVR patients, while it was significantly increased in BAV and MT patients. Conclusions Treatment assignment may influence outcome of symptomatic patients with AS.
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Affiliation(s)
- Giovanni Cioffi
- Department of Cardiology, Villa Bianca Hospital Trento, Via Piave 78, 38100 Trento, Italy.
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Sinning JM, Adenauer V, Scheer AC, Lema Cachiguango SJ, Ghanem A, Hammerstingl C, Sedaghat A, Müller C, Vasa-Nicotera M, Grube E, Nickenig G, Werner N. Doppler-based renal resistance index for the detection of acute kidney injury and the non-invasive evaluation of paravalvular aortic regurgitation after transcatheter aortic valve implantation. EUROINTERVENTION 2014; 9:1309-16. [PMID: 24168854 DOI: 10.4244/eijv9i11a221] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Acute kidney injury (AKI) is a strong but rather late predictor of mortality after transcatheter aortic valve implantation (TAVI). Early clinically useful markers for the detection of AKI and prediction of outcome are needed in order to control and improve management of periprocedural complications after TAVI. The aim of our study was to assess the predictive value of the Doppler-based renal resistance index (RRI), which correlates inversely with effective renal blood flow and creatinine clearance, for AKI in patients undergoing TAVI and to evaluate its association with paravalvular aortic regurgitation (PAR). METHODS AND RESULTS TAVI was performed with the Medtronic CoreValve prosthesis in 132 consecutive high-risk patients (mean logistic EuroSCORE: 30.3±18.2%). RRI, serum creatinine and cystatin C level were determined before, and 4 hrs, 24 hrs, 48 hrs, 72 hrs, and 7 days after TAVI. AKI occurred in 32/132 patients (24.2%). While serum creatinine and cystatin C levels decreased at first after TAVI (also in most patients developing AKI), the RRI increased significantly immediately after the procedure from 0.79±0.09 to 0.87±0.12 in patients developing AKI (p=0.003). A RRI >0.85 predicted post-interventional AKI with a sensitivity of 58% and specificity of 86%, and was superior to the serum creatinine level (p<0.001). In addition, an elevated RRI was significantly related to haemodynamic changes after TAVI and was associated with the occurrence of moderate/severe PAR (p<0.001). CONCLUSIONS Measurement of the Doppler-based RRI predicts risk for AKI and increased mortality rates at an early post-procedural time point and is related to the occurrence of more-than-mild paravalvular aortic regurgitation after TAVI.
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Affiliation(s)
- Jan-Malte Sinning
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
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Volodarsky I, Shimoni S, George J. The current status of transcutaneous aortic valve implantation. Expert Rev Cardiovasc Ther 2014; 12:1205-18. [PMID: 25223332 DOI: 10.1586/14779072.2014.954553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is a relatively novel procedure first performed in 2002 and has undergone rapid development since then. Its main indication is treatment of severe symptomatic aortic valve stenosis. Initially, the procedure was indicated for very sick patients who were not eligible for surgical aortic valve replacement. However, rapid development of the technology and operator skill required for TAVI allowed widening of the indications for its use. Currently, there is evidence that TAVI could be better than the surgical intervention in a broad population and not only in the most sick. This paper reviews the medical literature regarding TAVI, including the relevant medical equipment, different modes of its deployment, main complications of the procedure, main indications and contraindications, and the outcome of the patients who undergo it.
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Magnetically Guided Recellularization of Decellularized Stented Porcine Pericardium-Derived Aortic Valve for TAVI. ASAIO J 2014; 60:582-6. [DOI: 10.1097/mat.0000000000000110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Nagaraja V, Raval J, Eslick GD, Ong ATL. Transcatheter versus surgical aortic valve replacement: a systematic review and meta-analysis of randomised and non-randomised trials. Open Heart 2014; 1:e000013. [PMID: 25332780 PMCID: PMC4189306 DOI: 10.1136/openhrt-2013-000013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 05/26/2014] [Accepted: 07/15/2014] [Indexed: 12/18/2022] Open
Abstract
Introduction Many patients deemed inoperable for surgical aortic valve replacement (SAVR) have been treated successfully by transcatheter aortic-valve replacement (TAVR). This meta-analysis is designed to evaluate the performance of TAVR in comparison with SAVR. Methods A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, the Cochrane library, Google Scholar, Science Direct and Web of Science. Original data were abstracted from each study and used to calculate a pooled OR and 95% CI. Results Among three randomised controlled trials (RCTs), differences between the two cohorts were not statistically significant for the frequency of stroke (OR=1.94, 95% CI=0.813 to 4.633), incidence of myocardial infarction (MI), (OR=0.765, 95% CI=0.05 to 11.76) 30-day mortality rate, 1-year mortality rate (0.82, 95% CI=0.62 to 1.09) and acute kidney injury incidence rate. The non-RCTs demonstrated that the TAVR group had an amplified frequency aortic regurgitation at discharge (OR=5.465, 95% CI=3.441 to 8.680). While differences between the two cohorts were not statistically significant for the incidence of MI (OR=0.697, 95% CI=0.22 to 2.21), stroke (OR=0.575, 95% CI=0.263 to 1.259), acute renal failure requiring haemodialysis (OR=0.943, 95% CI=0.276 to 3.222), 30-day mortality (OR=0.869, 95% CI=0.621 to 1.216) and the need for a pacemaker (OR=1.832, 95% CI=0.869 to 3.862), a lower incidence of patients needing transfusion (OR=0.349, 95% CI=0.121 to 1.005) and new-onset atrial fibrillation (OR=0.296, 95% CI=0.124 to 0.706) was seen in the TAVR group. Conclusions Randomised and observational evidence adjusted on the baseline patient’s characteristics finds a similar risk for 30 days mortality, 1-year mortality, stroke, MI and acute kidney injury in TAVR and SAVR.
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Affiliation(s)
- Vinayak Nagaraja
- Prince of Wales Clinical School, University of New South Wales, Prince of Wales Hospital, Australia ; The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Sydney, NSW, Australia
| | - Jwalant Raval
- Department of Cardiology, Blacktown Hospital, Australia
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Sydney, NSW, Australia
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Blumenstein J, Van Linden A, Arsalan M, Moellmann H, Liebtrau C, Walther T, Kempfert J. Transapical access: current status and future directions. Expert Rev Med Devices 2014; 9:15-22. [DOI: 10.1586/erd.11.66] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tice JA, Sellke FW, Schaff HV. Transcatheter aortic valve replacement in patients with severe aortic stenosis who are at high risk for surgical complications: summary assessment of the California Technology Assessment Forum. J Thorac Cardiovasc Surg 2013; 148:482-91.e6. [PMID: 24252939 DOI: 10.1016/j.jtcvs.2013.09.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/11/2013] [Accepted: 09/23/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The California Technology Assessment Forum is dedicated to assessment and public reporting of syntheses of available data on medical technologies. In this assessment, transcatheter aortic valve replacement (TAVR) was evaluated for patients with severe aortic stenosis (AS) who are at high risk for complications. METHODS AND RESULTS In this assessment, 5 criteria were used: Regulatory approval, sufficient scientific evidence to allow conclusions on effectiveness, evidence that the technology improves net health outcomes, evidence that the technology is as beneficial as established methods, and availability of the technology outside investigational settings. In this assessment, all 5 criteria were judged to have been met. The primary benefit of TAVR is the ability to treat AS in patients who would otherwise be ineligible for surgical aortic valve replacement. It may also be useful for patients at high surgical risk by potentially reducing periprocedural complications and avoiding the morbidity and recovery from undergoing heart surgery. Potential harms include the need for conversion to an open procedure, perioperative death, myocardial infarction, stroke, bleeding, valve embolization, aortic regurgitation, heart block that requires a permanent pacemaker, renal failure, pulmonary failure, and major vascular complications such as cardiac perforation or arterial dissection. Potential long-term harms include death, stroke, valve failure or clotting, and endocarditis. As highlighted at the February 2012 California Technology Assessment Forum meeting, the dispersion of this technology to new centers across the United States must proceed with careful thought given to training and proctoring multidisciplinary teams to become new centers of excellence. CONCLUSIONS TAVR is a potentially lifesaving procedure that may improve quality of life for patients at high risk for surgical AVR. However, attention needs to be paid to appropriate patient selection, their preoperative evaluation, surgical techniques, and postoperative care to preserve and improve on the results attained in the Placement of Aortic Transcatheter Valve trial. Specialty societies are collaborating to ensure that this happens in a rational and comprehensive manner.
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Affiliation(s)
- Jeffrey A Tice
- Division of General Internal Medicine, Department of Medicine University of California San Francisco, San Francisco, Calif
| | - Frank W Sellke
- Division of Cardiothoracic Surgery, Department of Surgery, Brown Medical School and Rhode Island Hospital, Providence, RI.
| | - Hartzell V Schaff
- Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
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Panchal HB, Ladia V, Desai S, Shah T, Ramu V. A meta-analysis of mortality and major adverse cardiovascular and cerebrovascular events following transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis. Am J Cardiol 2013; 112:850-60. [PMID: 23756547 DOI: 10.1016/j.amjcard.2013.05.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/02/2013] [Accepted: 05/02/2013] [Indexed: 11/19/2022]
Abstract
The purpose of this meta-analysis was to compare postprocedural mortality and major adverse cardiovascular and cerebrovascular events between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) for severe aortic stenosis. Seventeen studies (n = 4,659) comparing TAVI (n = 2,267) and SAVR (n = 2,392) were included. End points were baseline logistic European System for Cardiac Operative Risk Evaluation score, all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, transient ischemic attack, and major bleeding events. Mean differences or risk ratios with 95% confidence intervals were computed, and p values <0.05 were considered significant. The population was matched for risk between the 2 groups on the basis of logistic European System for Cardiac Operative Risk Evaluation score for all outcomes except 30-day all-cause mortality, which had a high-risk population in the TAVI group (p = 0.02). There was no significant difference found in all-cause mortality at 30 days (p = 0.97) and at an average of 85 weeks (p = 0.07). There was no significant difference in cardiovascular mortality (p = 0.54) as well as the incidence of myocardial infarction (p = 0.59), stroke (p = 0.36), and transient ischemic attack (p = 0.85) at averages of 86, 72, 66, and 89 weeks, respectively. Compared with patients who underwent TAVI, those who underwent SAVR had a significantly higher frequency of major bleeding events (p <0.0001) at mean follow-up of 66 weeks. In conclusion, TAVI has similar cardiovascular and all-cause mortality to SAVR at early and long-term follow-up. TAVI is superior to SAVR for major bleeding complications and noninferior to SAVR for postprocedural myocardial infarctions and cerebrovascular events. TAVI is a safe alternative to SAVR in selected high-risk elderly patients with severe aortic stenosis.
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Affiliation(s)
- Hemang B Panchal
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA.
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Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis: Results from an intermediate risk propensity-matched population of the Italian OBSERVANT study. Int J Cardiol 2013; 167:1945-52. [DOI: 10.1016/j.ijcard.2012.05.028] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 03/16/2012] [Accepted: 05/04/2012] [Indexed: 11/18/2022]
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Petronio AS, De Carlo M, Giannini C, De Caro F, Bortolotti U. Subclavian TAVI: more than an alternative access route. EUROINTERVENTION 2013; 9 Suppl:S33-7. [DOI: 10.4244/eijv9ssa7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cao C, Ang SC, Indraratna P, Manganas C, Bannon P, Black D, Tian D, Yan TD. Systematic review and meta-analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis. Ann Cardiothorac Surg 2013; 2:10-23. [PMID: 23977554 DOI: 10.3978/j.issn.2225-319x.2012.11.09] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 11/15/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has emerged as an acceptable treatment modality for patients with severe aortic stenosis who are deemed inoperable by conventional surgical aortic valve replacement (AVR). However, the role of TAVI in patients who are potential surgical candidates remains controversial. METHODS A systematic review was conducted using five electronic databases, identifying all relevant studies with comparative data on TAVI versus AVR. The primary endpoint was all-cause mortality. A number of periprocedural outcomes were also assessed according to the Valve Academic Research Consortium endpoint definitions. RESULTS Fourteen studies were quantitatively assessed and included for meta-analysis, including two randomized controlled trials and eleven observational studies. Results indicated no significant differences between TAVI and AVR in terms of all-cause and cardiovascular related mortality, stroke, myocardial infarction or acute renal failure. A subgroup analysis of randomized controlled trials identified a higher combined incidence of stroke or transient ischemic attacks in the TAVI group compared to the AVR group. TAVI was also found to be associated with a significantly higher incidence of vascular complications, permanent pacemaker requirement and moderate or severe aortic regurgitation. However, patients who underwent AVR were more likely to experience major bleeding. Both treatment modalities appeared to effectively reduce the transvalvular mean pressure gradient. CONCLUSIONS The available data on TAVI versus AVR for patients at a higher surgical risk showed that major adverse outcomes such as mortality and stroke appeared to be similar between the two treatment modalities. Evidence on the outcomes of TAVI compared with AVR in the current literature is limited by inconsistent patient selection criteria, heterogeneous definitions of clinical endpoints and relatively short follow-up periods. The indications for TAVI should therefore be limited to inoperable surgical candidates until long-term data become available.
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Affiliation(s)
- Christopher Cao
- The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia; ; Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia
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Rahnavardi M, Santibanez J, Sian K, Yan TD. A systematic review of transapical aortic valve implantation. Ann Cardiothorac Surg 2013; 1:116-28. [PMID: 23977482 DOI: 10.3978/j.issn.2225-319x.2012.07.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 07/06/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) through a transapical approach (TAAVI) for severe aortic stenosis becomes the procedure of choice in cases where patients have peripheral artery disease and unfeasible access due to excessive atherosclerotic disease of the iliofemoral vessels and aorta. The present systematic review aimed to assess the safety, success rate, clinical outcomes, hemodynamic outcomes, and survival benefits of TAAVI. METHODS Electronic searches were performed in 6 databases from January 2000 to February 2012. The primary end points included feasibility and safety. Other end points included echocardiographic findings, functional class improvement, and survival. RESULTS After applying the inclusion and exclusion criteria, 48 out of 154 shortlisted potentially relevant articles were selected for assessment. Of these, 26 studies from 24 centers including total number of 2,807 patients were included for appraisal and data extraction. The current evidence on TAAVI for aortic stenosis is limited to observational studies. Successful TAAVI implantation occurred in >90% of patients. On average, the procedure took between 64 to 154 minutes to complete. The incidence of major adverse events included 30-day mortality (4.7-20.8%); cerebrovascular accident (0-16.3%); major tachyarrhythmia (0-48.8%); bradyarrhythmia requiring permanent pacemaker insertion (0-18.7%); cardiac tamponade (0-11%); major bleeding (1-17%); myocardial infarction (0-6%); aortic dissection/rupture (0-5%); moderate to severe paravalvular leak (0.7-24%); cardiopulmonary bypass support (0-15%); conversion to surgery (0-9.5%); and valve-in-valve implantation (0.6-8%). Mean aortic valve area improved from 0.4-0.7 cm(2) before TAAVI to 1.4-2.1 cm(2) after TAAVI. The peak pressure gradient across the aortic valve decreased from >70 mmHg to <20 mmHg after TAAVI. One-year survival ranged from 49.3% to 82% and the 3-year survival was 58% in 2 series. CONCLUSIONS TAAVI appears to be feasible with a reasonable safety and efficacy portfolio. Randomised controlled trials are required to compare transapical vs. transfemoral TAVI when both techniques are equally feasible.
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Affiliation(s)
- Mohammad Rahnavardi
- The Collaborative Research (CORE) Group, Sydney, Australia; ; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; ; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia
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Takagi H, Niwa M, Mizuno Y, Goto SN, Umemoto T. A meta-analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement. Ann Thorac Surg 2013; 96:513-9. [PMID: 23816417 DOI: 10.1016/j.athoracsur.2013.04.049] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 04/08/2013] [Accepted: 04/15/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Our preliminary meta-analysis suggests that transcatheter aortic valve implantation (TAVI) may not reduce the 30-day mortality rate over surgical aortic valve replacement (AVR) in high-risk patients with severe aortic stenosis (AS). We performed an updated formal meta-analysis of TAVI vs AVR for reduction not only of early but also of late all-cause mortality in AS. METHODS MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through October 2012. Eligible studies were randomized controlled trials or adjusted observational comparative studies of TAVI vs AVR enrolling individuals with AS and reporting early (30-day or in-hospital) or late all-cause mortality, or both, as an outcome. Odds ratios or hazard ratios with 95% confidence intervals (adjusted odds ratios or hazard ratios in case of observational studies) were abstracted from each study. RESULTS We identified two randomized trials and 15 adjusted observational studies enrolling 4,873 patients with severe AS. Pooled analysis suggested no significant difference in early (odds ratio, 0.92; 95% confidence interval, 0.70 to 1.19) and midterm (3-month to 3-year) total mortality (hazard ratio, 0.99; 95% confidence interval, 0.83 to 1.17) among patients assigned to TAVI vs AVR. Exclusion of any single study from the analysis did not substantively alter the overall result of our analysis. No evidence of significant publication bias was found. CONCLUSIONS Our meta-analysis of data of approximately 5,000 patients from 17 studies showed that TAVI is likely ineffective in reducing early and midterm all-cause mortality vs AVR in high-risk patients with AS.
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Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
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Costantino MF, Galderisi M, Dores E, Innelli P, Tarsia G, Di Natale M, Santoro C, De Stefano F, Esposito R, de Simone G. Parallel improvement of left ventricular geometry and filling pressure after transcatheter aortic valve implantation in high risk aortic stenosis: comparison with major prosthetic surgery by standard echo Doppler evaluation. Cardiovasc Ultrasound 2013; 11:18. [PMID: 23731705 PMCID: PMC3679950 DOI: 10.1186/1476-7120-11-18] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 06/01/2013] [Indexed: 01/05/2023] Open
Abstract
Purpose The effect of Transcatheter Aortic Valve Implantation (TAVI) on left ventricular (LV) geometry and function was compared to traditional aortic replacement (AVR) by major surgery. Methods 45 patients with aortic stenosis (AS) undergoing TAVI and 33 AVR were assessed by standard echo Doppler the day before and 2 months after the implantation. 2D echocardiograms were performed to measure left ventricular (LV) mass index (LVMi), relative wall thickness (RWT), ejection fraction (EF) and the ratio between transmitral E velocity and early diastolic velocity of mitral annulus (E/e’ ratio). Valvular-arterial impedance (Zva) was also calculated. Results At baseline, the 2 groups were comparable for blood pressure, heart rate, body mass index mean transvalvular gradient and aortic valve area. TAVI patients were older (p<0.0001) and had greater LVMi (p<0.005) than AVR group. After 2 months, both the procedures induced a significant reduction of transvalvular gradient and Zva but the decrease of LVMi and RWT was significant greater after TAVI (both p<0.0001). E/e’ ratio and EF were significantly improved after both the procedure but E/e’ reduction was greater after TAVI (p<0.0001). TAVI exhibited greater percent reduction in mean transvalvular gradient (p<0.05), Zva (p<0.02), LVMi (p<0.0001), RWT (p<0.0001) and E/e’ ratio (p<0.0001) than AVR patients. Reduction of E/e’ ratio was positively related with reduction of RWT (r = 0.46, p<0.002) only in TAVI group, even after adjusting for age and percent reduction of Zva (r =0.43, p<0.005). Conclusions TAVI induces a greater improvement of estimated LV filling pressure in comparison with major prosthetic surgery, due to more pronounced recovery of LV geometry, independent on age and changes of hemodynamic load.
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Svensson LG, Adams DH, Bonow RO, Kouchoukos NT, Miller DC, O'Gara PT, Shahian DM, Schaff HV, Akins CW, Bavaria JE, Blackstone EH, David TE, Desai ND, Dewey TM, D'Agostino RS, Gleason TG, Harrington KB, Kodali S, Kapadia S, Leon MB, Lima B, Lytle BW, Mack MJ, Reardon M, Reece TB, Reiss GR, Roselli EE, Smith CR, Thourani VH, Tuzcu EM, Webb J, Williams MR. Aortic Valve and Ascending Aorta Guidelines for Management and Quality Measures. Ann Thorac Surg 2013; 95:S1-66. [DOI: 10.1016/j.athoracsur.2013.01.083] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 12/24/2012] [Accepted: 01/15/2013] [Indexed: 12/31/2022]
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Nielsen HHM, Klaaborg KE, Nissen H, Terp K, Mortensen PE, Kjeldsen BJ, Jakobsen CJ, Andersen HR, Egeblad H, Krusell LR, Thuesen L, Hjortdal VE. A prospective, randomised trial of transapical transcatheter aortic valve implantation vs. surgical aortic valve replacement in operable elderly patients with aortic stenosis: the STACCATO trial. EUROINTERVENTION 2013; 8:383-9. [PMID: 22581299 DOI: 10.4244/eijv8i3a58] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS In a prospective randomised trial we aimed to compare transapical transcatheter aortic valve implantation (a-TAVI) with surgical aortic valve replacement (SAVR) in operable elderly patients. METHODS AND RESULTS The study was designed as a randomised controlled trial of a-TAVI (Edwards SAPIEN heart valve system; Edwards Lifesciences, Irvine, CA, USA) vs. SAVR. Operable patients with isolated aortic valve stenosis and an age ≥75 years were included. The primary endpoint was the composite of all-cause mortality, cerebral stroke and/or renal failure requiring haemodialysis at 30 days. After advice from the Data Safety Monitoring Board, the study was prematurely terminated after the inclusion of 70 patients because of an excess of events in the a-TAVI group. The primary endpoint was met in five a-TAVI patients (two deaths, two strokes, and one case of renal failure requiring dialysis) vs. one stroke in the SAVR group (p=0.07). In the a-TAVI group, one patient was converted to SAVR because of an abnormally positioned heart, and four patients were re-operated with open heart surgery because of annulus rupture (n=1), severe paravalvular leakage (n=2), and blockage of the left coronary artery (n=1). In the SAVR group, one patient was converted to TAVI because of a large intra-thoracic goitre. CONCLUSIONS Given the limitations of a small prematurely terminated study, our results suggest that a-TAVI in its present form may be associated with complications and device success rates in low-risk patients similar or even inferior to those found in high-risk patients with aortic valve stenosis. This will probably change in the near future with improved catheter based devices and better pre-procedural assessment.
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Affiliation(s)
- Hans H M Nielsen
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Skejby, Denmark
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Emmert MY, Weber B, Behr L, Sammut S, Frauenfelder T, Wolint P, Scherman J, Bettex D, Grünenfelder J, Falk V, Hoerstrup SP. Transcatheter aortic valve implantation using anatomically oriented, marrow stromal cell-based, stented, tissue-engineered heart valves: technical considerations and implications for translational cell-based heart valve concepts. Eur J Cardiothorac Surg 2013; 45:61-8. [PMID: 23657551 DOI: 10.1093/ejcts/ezt243] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES While transcatheter aortic valve implantation (TAVI) has rapidly evolved for the treatment of aortic valve disease, the currently used bioprostheses are prone to continuous calcific degeneration. Thus, autologous, cell-based, living, tissue-engineered heart valves (TEHVs) with regeneration potential have been suggested to overcome these limitations. We investigate the technical feasibility of combining the concept of TEHV with transapical implantation technology using a state-of-the-art transcatheter delivery system facilitating the exact anatomical position in the systemic circulation. METHODS Trileaflet TEHVs fabricated from biodegradable synthetic scaffolds were sewn onto self-expanding Nitinol stents seeded with autologous marrow stromal cells, crimped and transapically delivered into the orthotopic aortic valve position of adult sheep (n = 4) using the JenaValve transapical TAVI System (JenaValve, Munich, Germany). Delivery, positioning and functionality were assessed by angiography and echocardiography before the TEHV underwent post-mortem gross examination. For three-dimensional reconstruction of the stent position of the anatomically oriented system, a computed tomography analysis was performed post-mortem. RESULTS Anatomically oriented, transapical delivery of marrow stromal cell-based TEHV into the orthotopic aortic valve position was successful in all animals (n = 4), with a duration from cell harvest to TEHV implantation of 101 ± 6 min. Fluoroscopy and echocardiography displayed sufficient positioning, thereby entirely excluding the native leaflets. There were no signs of coronary obstruction. All TEHV tolerated the loading pressure of the systemic circulation and no acute ruptures occurred. Animals displayed intact and mobile leaflets with an adequate functionality. The mean transvalvular gradient was 7.8 ± 0.9 mmHg, and the mean effective orifice area was 1.73 ± 0.02 cm(2). Paravalvular leakage was present in two animals, and central aortic regurgitation due to a single-leaflet prolapse was detected in two, which was primarily related to the leaflet design. No stent dislocation, migration or affection of the mitral valve was observed. CONCLUSIONS For the first time, we demonstrate the technical feasibility of a transapical TEHV delivery into the aortic valve position using a commercially available and clinically applied transapical implantation system that allows for exact anatomical positioning. Our data indicate that the combination of TEHV and a state-of-the-art transapical delivery system is feasible, representing an important step towards translational, transcatheter-based TEHV concepts.
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Piazza N, Kalesan B, van Mieghem N, Head S, Wenaweser P, Carrel TP, Bleiziffer S, de Jaegere PP, Gahl B, Anderson RH, Kappetein AP, Lange R, Serruys PW, Windecker S, Jüni P. A 3-Center Comparison of 1-Year Mortality Outcomes Between Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement on the Basis of Propensity Score Matching Among Intermediate-Risk Surgical Patients. JACC Cardiovasc Interv 2013; 6:443-51. [DOI: 10.1016/j.jcin.2013.01.136] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 01/08/2013] [Accepted: 01/23/2013] [Indexed: 10/26/2022]
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Walther T, Arsalan M, Blumenstein J, van Linden A, Kempfert J. Aortic stenosis in high-risk patients. Surgical therapy. Herz 2013; 38:112-7. [PMID: 23471357 DOI: 10.1007/s00059-012-3746-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Conventional aortic valve replacement is the standard approach for treating aortic stenosis, it is performed via a full or partial sternotomy, and is associated with low risks for patients and with excellent long-term outcomes. This also holds true for octogenarians, if they present without relevant comorbidities. After resection of the calcified native leaflets, biological prostheses with good functionality and durability are implanted. Elderly patients with an increasing risk profile, however, should be treated by a heart team using transcatheter approaches including cardiac surgery.
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Affiliation(s)
- T Walther
- Kerckhoff Heart Center, Department of Cardiac Surgery, Kerckhoff Klinik, Benekestrasse 2-8, Bad Nauheim, Germany.
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Wilbring M, Tugtekin SM, Alexiou K, Simonis G, Matschke K, Kappert U. Transapical transcatheter aortic valve implantation vs conventional aortic valve replacement in high-risk patients with previous cardiac surgery: a propensity-score analysis. Eur J Cardiothorac Surg 2013; 44:42-7. [PMID: 23345180 DOI: 10.1093/ejcts/ezs680] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The present analysis compared clinical and mid-term outcomes of patients with previous cardiac surgery undergoing transapical transcatheter aortic valve implantation (TAVI) with propensity-matched patients undergoing conventional redo aortic valve replacement (cAVR). METHODS Since 2008, 508 patients were treated with TAVI. Fifty-three of these patients presented with a history of cardiac surgery and underwent transapical TAVI using the Edwards SAPIEN bioprosthesis. A propensity-matched control group of 53 patients receiving cAVR was generated out of the hospital's database. The mean age for all the patients was 77.8 ± 4.5 years. The logistic EuroSCORE was 28.4 ± 13.6% in mean, and mean EuroSCORE II was 8.56 ± 3.93%. The mean follow-up time was 245 ± 323 days, which equated to a total of 700 patient-months. RESULTS The observed hospital mortality did not differ significantly between TAVI and cAVR (TAVI: 9.4% and cAVR: 5.7%; P = 0.695). Six-month survival was 83.0% for the TAVI and 86.8% for the cAVR patients (P = 0.768). Postoperative bleedings (TAVI: 725 ± 1770 ml and cAVR: 1884 ± 6387; P = 0.022), the need for transfusion (TAVI: 1.7 ± 5.3 vs cAVR: 6.2 ± 13.7 units packed red blood cells (PRBC); P = 0.030), consecutive rethoracotomy (TAVI: 1.9% vs cAVR: 16.9%; P = 0.002) and postoperative delirium (TAVI: 11.5% vs cAVR: 28.3%; P = 0.046) were more common in the cAVR patients. The TAVI patients suffered more frequently from respiratory failure (TAVI: 11.3% vs cAVR: 0.0%; P = 0.017) and mean grade of paravalvular regurgitation (TAVI: 0.8 ± 0.2 vs cAVR: 0.0; P = 0.047). Although primary ventilation time (P = 0.020) and intensive care unit stay (P = 0.022) were shorter in the TAVI patients, mean hospital stay did not differ significantly (P = 0.108). CONCLUSIONS Transapical TAVI as well as surgical aortic valve replacement provided good clinical results. The pattern of postoperative morbidity and mortality was different for both entities, but the final clinical outcome did not differ significantly. Both techniques can be seen as complementary approaches by means of developing a tailor-made and patient-orientated surgery.
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Affiliation(s)
- Manuel Wilbring
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany.
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Transcatheter Valve-in-Valve Therapies: Patient Selection, Prosthesis Assessment and Selection, Results, and Future Directions. Curr Cardiol Rep 2013; 15:341. [DOI: 10.1007/s11886-012-0341-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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