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Kim H, Kang DY, Ahn JM, Kim JB, Yeung AC, Nishi T, Fearon WF, Cantey EP, Flaherty JD, Davidson CJ, Malaisrie SC, Kim N, Kim M, Lee J, Park J, Choi Y, Park SJ, Park DW. Race-Specific Impact of Conventional Surgical Risk Score on 1-Year Mortality After Transcatheter Aortic Valve Replacement. JACC. ASIA 2023; 3:376-387. [PMID: 37323869 PMCID: PMC10261892 DOI: 10.1016/j.jacasi.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/31/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
Background Interracial differences in the distribution and prognostic value of conventional Society of Thoracic Surgeons (STS) score on long-term mortality after transcatheter aortic valve replacement (TAVR) are uncertain. Objectives This study aims to compare the impact of STS scores on clinical outcomes at 1-year after TAVR between Asian and non-Asian populations. Methods We used the Trans-Pacific TAVR (TP-TAVR) registry, a multinational multicenter, observational registry involving patients undergoing TAVR at 2 major centers in the United States and 1 major center in Korea. Patients were classified into 3 groups (low, intermediate, and high-risk) according to the STS score and compared between STS risk groups and race. The primary outcome was all-cause mortality at 1-year. Results Among 1,412 patients, 581 were Asian and 831 were non-Asian. The distribution of the STS risk score group was different between Asian and non-Asian groups (62.5% low-, 29.8% intermediate-, and 7.7% high-risk in Asian vs 40.6% low-, 39.1% intermediate-, and 20.3% high-risk in non-Asian). In the Asian population, the all-cause mortality at 1-year was substantially higher in the high-risk STS group than in the low- and intermediate-risk groups (3.6% low-risk, 8.7% intermediate-risk, and 24.4% high-risk; log-rank P < 0.001), which was primarily driven by noncardiac mortality. In the non-Asian group, there was a proportional increase in all-cause mortality at 1-year according to the STS risk category (5.3% low-risk, 12.6% intermediate-risk, and 17.8% high-risk; log-rank P < 0.001). Conclusions In this multiracial registry of patients with severe aortic stenosis who underwent TAVR, we identified a differential proportion and prognostic impact of STS score on 1-year mortality between Asian and non-Asian patients (TP-TAVR [Transpacific TAVR Registry]; NCT03826264).
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Affiliation(s)
- Hoyun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Juyong Brian Kim
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alan C. Yeung
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Takeshi Nishi
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - William F. Fearon
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Eric P. Cantey
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - James D. Flaherty
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Charles J. Davidson
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - S. Christopher Malaisrie
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Nayoung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mijin Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinho Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinsun Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yeonwoo Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Charlesworth M, Williams BG, Buch MH. Advances in transcatheter aortic valve implantation, part 1: patient selection and preparation. BJA Educ 2021; 21:232-237. [PMID: 34026277 DOI: 10.1016/j.bjae.2021.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- M Charlesworth
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - B G Williams
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - M H Buch
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Agasthi P, Ashraf H, Pujari SH, Girardo ME, Tseng A, Mookadam F, Venepally NR, Buras M, Khetarpal BK, Allam M, Eleid MF, Greason KL, Beohar N, Siegel RJ, Sweeney J, Fortuin FD, Holmes DR, Arsanjani R. Artificial Intelligence Trumps TAVI2-SCORE and CoreValve Score in Predicting 1-Year Mortality Post-Transcatheter Aortic Valve Replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 24:33-41. [DOI: 10.1016/j.carrev.2020.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 01/19/2023]
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Tsampasian V, Panoulas V, Jabbour RJ, Ruparelia N, Malik IS, Hadjiloizou N, Frame MSc A, Sen S, Sutaria N, Mikhail GW, Nihoyannopoulos P. Left ventricular speckle tracking echocardiographic evaluation before and after TAVI. Echo Res Pract 2020; 7:29-38. [PMID: 36472209 PMCID: PMC7487179 DOI: 10.1530/erp-20-0009] [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: 07/18/2020] [Accepted: 07/28/2020] [Indexed: 12/14/2022] Open
Abstract
AIMS To assess left ventricular (LV) function before and after transcatheter aortic valve implantation (TAVI) using conventional echocardiographic parameters and global longitudinal LV strain (GLS) and compare outcomes between Edwards S3 and Evolut R valves. METHODS AND RESULTS Data were collected for consecutive patients undergoing TAVI at Hammersmith hospital between 2015 and 2018. Of the 303 patients, those with coronary artery disease and atrial fibrillation were excluded leading to a total of 85 patients, which constituted our study group. The mean follow-up was 49 ± 39 days. In total, 60% of patients were treated with Edwards S3 and 40% Evolut R. TAVI resulted in an early improvement of GLS (-13.96 to -15.25%, P = 0.01) but not ejection fraction (EF) (47.6 to 50.1%, P = 0.09). LV mass also improved, especially in patients with marked baseline LV hypertrophy (P < 0.001). There were no appreciable differences of LV function improvement and overall LV remodelling after TAVI between the two types of valves used (P = 0.14). CONCLUSIONS TAVI results in reverse remodelling and improvement of GLS, especially in patients with impaired baseline LV function. There were no differences in the extent of LV function improvement between Edwards S3 and Evolut R valves but there was a greater incidence of aortic regurgitation with Evolut R.
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Affiliation(s)
- Vasiliki Tsampasian
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK,Correspondence should be addressed to V Tsampasian:
| | - Vasileios Panoulas
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK,Imperial College London, National Heart and Lung Institute, London, UK,Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Richard J Jabbour
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK,Imperial College London, National Heart and Lung Institute, London, UK
| | - Neil Ruparelia
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Iqbal S Malik
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Angela Frame MSc
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sayan Sen
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Nilesh Sutaria
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Ghada W Mikhail
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK,Imperial College London, National Heart and Lung Institute, London, UK
| | - Petros Nihoyannopoulos
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK,Imperial College London, National Heart and Lung Institute, London, UK
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Rozenbaum Z, Maret E, Lax L, Shmilovich H, Finkelstein A, Steinvil A, Halkin A, Banai S, Cohen D, Topilsky Y, Berliner S, Fleischmann D, Aviram G. Impact of right ventricular volumes on the outcomes of TAVR: a volumetric analysis of preprocedural computed tomography. EUROINTERVENTION 2020; 16:e121-e128. [PMID: 31566570 DOI: 10.4244/eij-d-19-00651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to assess the prognostic implications of increased right ventricle volume index (RVVI) using cardiac-gated computed tomography angiography (CCTA) data among patients undergoing transcatheter valve replacement (TAVR). METHODS AND RESULTS CCTA of 323 patients who underwent TAVR at Stanford University Medical Center (CA, USA) and Tel Aviv Medical Center (Israel) between 2013 and 2016 was analysed by an automatic four-chamber volumetric software and grouped into quartiles according to RVVI. Higher one-year mortality rates were noted for the upper quartiles - 5%, 4.9%, 8.6%, and 16% (p=0.039), in Q1 <59 ml/m2, Q2 59-69 ml/m2, Q3 69-86 ml/m2, and Q4 >86 ml/m2, respectively. However, the differences were not significant after propensity score adjustments. Sub-analyses of Q1 demonstrated an escalating risk for one-year mortality in concordance to RVVI: HR 2.28, HR 2.76, and HR 4.7, for the upper 25th, 15th, and 5th percentiles, respectively (p<0.05 for all comparisons). After propensity score adjustments for clinical and echocardiographic characteristics, only the upper 5th percentiles (RVVI >120 ml/m2) retained statistical significance (HR 2.82, 95% CI: 1.02-7.78, p=0.045). Notably, 68.7% of patients from this group were considered low-intermediate risk for surgery. CONCLUSIONS Cardiac volumetric data by CCTA performed for procedural planning may help to predict outcome in patients undergoing TAVR.
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Affiliation(s)
- Zach Rozenbaum
- Department of Cardiology, Tel Aviv Medical affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Isreal
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Braghiroli J, Kapoor K, Thielhelm TP, Ferreira T, Cohen MG. Transcatheter aortic valve replacement in low risk patients: a review of PARTNER 3 and Evolut low risk trials. Cardiovasc Diagn Ther 2020; 10:59-71. [PMID: 32175228 DOI: 10.21037/cdt.2019.09.12] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has become a mainstay in treatment for patients with severe aortic stenosis who are considered high-risk surgical candidates. The use of TAVR in low-risk patients with severe aortic stenosis is being explored as an alternative to surgical aortic valve replacement (SAVR). Recent results from the Medtronic Evolut Low Risk trial and the Placement of Aortic Transcatheter Valves (PARTNER) 3 trial shed light on the use of TAVR in low-risk surgical candidates. The Evolut Low Risk trial compared TAVR with a self-expanding supra-annular bioprosthesis to SAVR in 1468 patients with severe aortic stenosis who were low surgical risk. Patients with a mean age of 74 and a mean Society of Thoracic Surgeons (STS) risk score of 1.9% were randomized to either TAVR or SAVR groups. Using the composite end point of death or disabling stroke at 24 months, the study found an incidence of 5.3% in the TAVR arm and 6.7% in the surgical arm. The Evolut Low Risk trial thus concluded that TAVR was statistically noninferior but not superior to SAVR (difference, -1.4 percentage points; 95% Bayesian credible interval for the difference, -4.9 to 2.1; posterior probability of noninferiority, >0.999). The PARTNER 3 trial assigned 1,000 patients with severe aortic stenosis and low surgical risk to either TAVR with transfemoral placement of balloon expandable valve or SAVR. Patients with a mean age of 73 and a mean STS score of 1.9% were randomized to either TAVR or SAVR groups. With respect to the primary endpoint of composite death from any cause, stroke, or rehospitalization, the study found an occurrence of 8.5% in TAVR and 15.1% in SAVR, confirming both noninferiority and superiority in the TAVR group [absolute difference, -6.6 percentage points; 95% confidence interval (CI), -10.8 to -2.5; P<0.001 for noninferiority; hazard ratio, 0.54; 95% CI, 0.37 to 0.79; P=0.001 for superiority]. Both the Evolut low risk trial and the PARTNER 3 trial provide evidence that the use of TAVR extends beyond the scope of high and intermediate risk surgical patients and is at the very least equivalent to SAVR in the treatment low-risk surgical candidates when using a transfemoral approach in patients without bicuspid aortic valves. In this article we provide an extensive review on the Evolute low risk and PARTNER 3 trials, including a discussion on clinically relevant outcomes.
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Affiliation(s)
- Joao Braghiroli
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Kunal Kapoor
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Torin P Thielhelm
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Tanira Ferreira
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
| | - Mauricio G Cohen
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospitals and Clinics, Miami, Florida, USA
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7
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Quine EJ, Duffy SJ, Stehli J, Dick RJ, Htun NM, Stub D, Walton AS. Comparison of Early Outcomes in Patients at Estimated Low, Intermediate and High Risk Undergoing Transcatheter Aortic Valve Implantation: A Multicentre Australian Experience. Heart Lung Circ 2020; 29:1174-1179. [PMID: 31980394 DOI: 10.1016/j.hlc.2019.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/19/2019] [Accepted: 12/01/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has been shown to be a safe and effective alternative to surgical aortic valve replacement (SAVR) in high- and intermediate-risk patients with severe aortic stenosis. TAVI for patients at lower risk of periprocedural mortality has not been extensively investigated. We aimed to describe outcomes in low-, intermediate- and high-risk patients undergoing TAVI in a multicentre Australian study. METHODS We evaluated data from 601 patients who underwent TAVI at two hospitals in Melbourne, from August 2008 to February 2018. Patients were stratified according to low risk (STS <4%), intermediate risk (Society for Thoracic Surgeons [STS] 4.0-7.9%) and high risk (STS >8%). Outcomes were reported according to Valve Academic Research Consortium-2 (VARC-2) criteria. RESULTS Mean age was 84±5 years and 49% were female. Two hundred and eighty-five (285) (47%) patients were low-risk, 243 (40%) were intermediate risk and 73 (12%) were high risk. Thirty-day (30-) mortality was low in all three groups (1.1%, 1.7% and 1.4%, respectively, p=0.8). Similarly, patients had a low risk of disabling stroke (0.4%, 1.3%, 0%, p=0.8). Rates of post-procedural permanent pacemaker were also similar (21%, 27%, 26%, p=0.5). At least moderate aortic regurgitation occurred in 9% of patients at discharge with no significant differences between groups. CONCLUSIONS In this large Australian multicentre cohort of TAVI patients, 30-day mortality, and post-procedural outcomes were excellent and similar across the patient-risk spectrum. Our study offers further support for the safety of TAVI in low-risk populations and demonstrates the limitations of the STS score.
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Affiliation(s)
- Edward J Quine
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia
| | - Julia Stehli
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia
| | - Ron J Dick
- Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia
| | - Nay M Htun
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; Monash University Department Epidemiology and Preventive Medicine, Melbourne, Vic, Australia.
| | - Antony S Walton
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia
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8
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Werner N, Zahn R, Beckmann A, Bauer T, Bleiziffer S, Hamm CW, Berkeredjian R, Berkowitsch A, Mohr FW, Landwehr S, Katus HA, Harringer W, Ensminger S, Frerker C, Möllmann H, Walther T, Schneider S, Lange R. Patients at Intermediate Surgical Risk Undergoing Isolated Interventional or Surgical Aortic Valve Implantation for Severe Symptomatic Aortic Valve Stenosis. Circulation 2019; 138:2611-2623. [PMID: 30571255 DOI: 10.1161/circulationaha.117.033048] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is increasingly being used for treatment of severe aortic valve stenosis in patients at intermediate risk for surgical aortic valve replacement (SAVR). Currently, real-world data comparing indications and clinical outcomes of patients at intermediate surgical risk undergoing isolated TAVR with those undergoing SAVR are scarce. METHODS We compared clinical characteristics and outcomes of patients with intermediate surgical risk (Society of Thoracic Surgeons score 4%-8%) who underwent isolated TAVR or conventional SAVR within the prospective, all-comers German Aortic Valve Registry. RESULTS A total of 7613 patients at intermediate surgical risk underwent isolated TAVR (n=6469) or SAVR (n=1144) at 92 sites in Germany between 2012 and 2014. Patients treated by TAVR were significantly older (82.5±5.0 versus 76.6±6.7 years, P<0.001) and had higher risk scores (logistic EuroSCORE [European System for Cardiac Operative Risk Evaluation]: 21.2±12.3% versus 14.2±9.5%, P<0.001; Society of Thoracic Surgeons score: 5.6±1.1 versus 5.2±1.0, P<0.001). Multivariable analyses revealed that advanced age, coronary artery disease, New York Heart Association class III/IV, pulmonary hypertension, prior cardiac decompensation, elective procedure, arterial occlusive disease, no diabetes mellitus, and a smaller aortic valve area were associated with performing TAVR instead of SAVR (all P<0.001). Unadjusted in-hospital mortality rates were equal for TAVR and SAVR (3.6% versus 3.6%, P=0.976), whereas unadjusted 1-year mortality was significantly higher in patients after TAVR (17.5% versus 10.8%, P<0.001). After propensity score matching, the difference in 1-year mortality between patients with TAVR and SAVR was no longer significant (17.1% versus 15.7%, P=0.59). CONCLUSIONS Patients at intermediate risk undergoing TAVR differ significantly from those treated with SAVR with regard to age and baseline characteristics. Isolated TAVR and SAVR were associated with an in-hospital mortality rate of 3.6%. In the propensity score analysis, there was no significant difference in 1-year mortality between patients with TAVR and SAVR.
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Affiliation(s)
- Nicolas Werner
- Medizinische Klinik B, Klinikum Ludwigshafen, Germany (N.W., R.Z.)
| | - Ralf Zahn
- Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, Langenbeck-Virchow-Haus Berlin, Germany (A. Beckmann)
| | - Andreas Beckmann
- Kardiologie-Angiologie, Universitätsklinikum Gießen, Germany (T.B., C.W.H.)
| | | | - Sabine Bleiziffer
- Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München, Germany (S.B., R.L.)
| | - Christian W Hamm
- Kardiologie, Kerckhoff Klinik, Bad Nauheim, Germany (C.W.H., A. Berkowitsch)
| | - Raffi Berkeredjian
- Klinik für Kardiologie, Angiologie, Pneumologie, Universitätsklinikum Heidelberg, Germany (R.B., H.A.K.)
| | | | - Friedrich W Mohr
- Herzzentrum Leipzig, Universitätsklinik Leipzig, Germany (F.W.M.)
| | - Sandra Landwehr
- Bundesgeschäftsstelle Qualitätssicherung Institut für Qualität und Patientensicherheit GmbH, Düsseldorf, Germany (S.L.)
| | - Hugo A Katus
- Klinik für Kardiologie, Angiologie, Pneumologie, Universitätsklinikum Heidelberg, Germany (R.B., H.A.K.)
| | | | - Stephan Ensminger
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany (S.E.)
| | | | - Helge Möllmann
- Klinik für Innere Medizin I, St.-Johannes-Hospital Dortmund, Germany (H.M.)
| | - Thomas Walther
- Herzchirurgie, Kerckhoff Klinik, Bad Nauheim, Germany (T.W.)
| | | | - Rüdiger Lange
- Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München, Germany (S.B., R.L.)
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Chen JF, Mori M, Geirsson A. "Real-World" TAVR Data in Constant Flux. Mayo Clin Proc 2019; 94:1643. [PMID: 31378239 DOI: 10.1016/j.mayocp.2019.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/18/2019] [Indexed: 11/18/2022]
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Mäkikallio T, Jalava MP, Husso A, Virtanen M, Laakso T, Ahvenvaara T, Tauriainen T, Maaranen P, Kinnunen EM, Dahlbacka S, Jaakkola J, Airaksinen J, Anttila V, Savontaus M, Laine M, Juvonen T, Valtola A, Raivio P, Eskola M, Niemelä M, Biancari F. Ten-year experience with transcatheter and surgical aortic valve replacement in Finland. Ann Med 2019; 51:270-279. [PMID: 31112060 PMCID: PMC7880078 DOI: 10.1080/07853890.2019.1614657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Aim: We investigated the outcomes of transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in Finland during the last decade. Methods: The nationwide FinnValve registry included data from 6463 patients who underwent TAVR or SAVR with a bioprosthesis for aortic stenosis from 2008 to 2017. Results: The annual number of treated patients increased three-fold during the study period. Thirty-day mortality declined from 4.8% to 1.2% for TAVR (p = .011) and from 4.1% to 1.8% for SAVR (p = .048). Two-year survival improved from 71.4% to 83.9% for TAVR (p < .001) and from 87.2% to 91.6% for SAVR (p = .006). During the study period, a significant reduction in moderate-to-severe paravalvular regurgitation was observed among TAVR patients and a reduction of the rate of acute kidney injury was observed among both SAVR and TAVR patients. Similarly, the rate of red blood cell transfusion and severe bleeding decreased significantly among SAVR and TAVR patients. Hospital stay declined from 10.4 ± 8.4 to 3.7 ± 3.4 days after TAVR (p < .001) and from 9.0 ± 5.9 to 7.8 ± 5.1 days after SAVR (p < .001). Conclusions: In Finland, the introduction of TAVR has led to an increase in the invasive treatment of severe aortic stenosis, which was accompanied by improved early outcomes after both SAVR and TAVR. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03385915 Key Messages This study demonstrated that the introduction of transcatheter aortic valve replacement has led to its widespread use as an invasive treatment for severe aortic stenosis. Early and 2-year survival after transcatheter and surgical aortic valve replacement has improved during past decade. Transcatheter aortic valve replacement has fulfilled its previously unmet clinical needs and has surpassed surgical aortic valve replacement as the most common invasive treatment for aortic stenosis.
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Affiliation(s)
- Timo Mäkikallio
- a Department of Internal Medicine , Oulu University Hospital , Oulu , Finland
| | - Maina P Jalava
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | | | - Marko Virtanen
- d Heart Hospital , Tampere University Hospital , Tampere , Finland
| | - Teemu Laakso
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Tuomas Ahvenvaara
- f Department of Surgery , Oulu University Hospital and University of Oulu , Finland
| | - Tuomas Tauriainen
- f Department of Surgery , Oulu University Hospital and University of Oulu , Finland
| | - Pasi Maaranen
- d Heart Hospital , Tampere University Hospital , Tampere , Finland
| | | | | | - Jussi Jaakkola
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Juhani Airaksinen
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Vesa Anttila
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Mikko Savontaus
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Mika Laine
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Tatu Juvonen
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Antti Valtola
- c Heart Center , Kuopio University Hospital , Kuopio , Finland
| | - Peter Raivio
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Markku Eskola
- d Heart Hospital , Tampere University Hospital , Tampere , Finland
| | - Matti Niemelä
- a Department of Internal Medicine , Oulu University Hospital , Oulu , Finland
| | - Fausto Biancari
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland.,f Department of Surgery , Oulu University Hospital and University of Oulu , Finland.,g Department of Surgery , University of Turku, Turku , Finland
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11
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Overtchouk P, Prendergast B, Modine T. Why should we extend transcatheter aortic valve implantation to low-risk patients? A comprehensive review. Arch Cardiovasc Dis 2019; 112:354-362. [PMID: 31014990 DOI: 10.1016/j.acvd.2019.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 02/07/2023]
Abstract
Within the past decade, transcatheter aortic valve implantation (TAVI) has become established as the optimal treatment option for elderly, inoperable and high-risk patients with severe aortic stenosis, and is now recommended by international guidelines. Randomized controlled trials have demonstrated the non-inferiority of TAVI to open surgery in intermediate-risk patients and, most recently, in low-risk patients. Further randomized controlled trials are underway, but existing studies have already provided reassuring data in this cohort, and TAVI is offered routinely to younger and lower-risk patients in numerous centers. Improvements in the design of devices and delivery systems, accompanied by increased operator experience, have dramatically improved the safety of the procedure, and further expansion into low-risk groups seems inevitable once concerns about valve durability and device cost have been addressed. In this article, we provide a review of the existing literature, and estimate the clinical impact of TAVI in low-risk patients. Abbreviated title: Why should we extend TAVI to low-risk patients?
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Affiliation(s)
- Pavel Overtchouk
- Department of Cardiology and Cardiovascular Surgery, Centre Hospitalier Regional et Universitaire de Lille, 59000 Lille, France
| | | | - Thomas Modine
- Department of Cardiology and Cardiovascular Surgery, Centre Hospitalier Regional et Universitaire de Lille, 59000 Lille, France.
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12
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Finkelstein A, Rozenbaum Z, Halkin A, Banai S, Bazan S, Barbash I, Segev A, Fefer P, Maor E, Danenberg H, Planner D, Orvin K, Assa HV, Assali A, Kornowski R, Steinvil A. Outcomes of Transcatheter Aortic Valve Implantation in Patients With Low Versus Intermediate to High Surgical Risk. Am J Cardiol 2019; 123:644-649. [PMID: 30528420 DOI: 10.1016/j.amjcard.2018.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/08/2018] [Accepted: 11/15/2018] [Indexed: 11/28/2022]
Abstract
Referral of low surgical risk (LSR) patients for transcatheter aortic valve implantation (TAVI) becomes common in multiple tertiary centers, and clinical trial data for this population are not available to date. We performed a retrospective analysis on an Israeli multicenter registry. LSR and intermediate-high surgical risk (I-HSR) were defined by a Society of Thoracic Surgery score of <4% and ≥4%, respectively. The cohort included 2336 patients (LSR n = 1198, I-HLR n = 1138). As compared with LSR, patients with I-HSR were older and had significantly higher rates of baseline comorbidities. Although devices success rates (94% vs 96%), paravalvular leak (3.5% vs 5.2%), and permanent pacemaker implantation (17.2 vs 18%) were comparable (p >0.05 for all comparisons), the safety outcome at 1 month (12.7% vs 9.8%), procedural mortality (1.9% vs 0.6%), and mortality at 3 years (30.1% vs 16.1%) were higher in patients with I-HSR (p <0.05 for all comparisons). In a subanalysis of patients with very LSR, comparable rates of device success and safety outcomes were observed, whereas mortality at 1 to 3 years was lower. In conclusion, although procedural outcomes were comparable between LSR and I-HSR TAVI patients, the rates of short- and long-term mortality, as well as the safety outcome, were lower in LSR patients.
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Affiliation(s)
- Ariel Finkelstein
- The Cardiology Department, Tel Aviv Sourasky Medical Center, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zach Rozenbaum
- The Cardiology Department, Tel Aviv Sourasky Medical Center, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Halkin
- The Cardiology Department, Tel Aviv Sourasky Medical Center, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Banai
- The Cardiology Department, Tel Aviv Sourasky Medical Center, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Samuel Bazan
- The Cardiology Department, Tel Aviv Sourasky Medical Center, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Barbash
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Paul Fefer
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Maor
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Danenberg
- The Cardiology Department, Hadassah Medical Center, Jerusalem, affiliated to the Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Planner
- The Cardiology Department, Hadassah Medical Center, Jerusalem, affiliated to the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Katia Orvin
- The Cardiology Department, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Vaknin Assa
- The Cardiology Department, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abid Assali
- The Cardiology Department, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- The Cardiology Department, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Steinvil
- The Cardiology Department, Tel Aviv Sourasky Medical Center, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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13
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Tarantini G, Lefèvre T, Terkelsen CJ, Frerker C, Ohlmann P, Mojoli M, Eltchaninoff H, Pinaud F, Redwood S, Windecker S. One-Year Outcomes of a European Transcatheter Aortic Valve Implantation Cohort According to Surgical Risk. Circ Cardiovasc Interv 2019; 12:e006724. [DOI: 10.1161/circinterventions.118.006724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology, University of Padova, Italy (G.T., M.M.)
| | - Thierry Lefèvre
- Department of Interventional Cardiology, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France (T.L.)
| | | | - Christian Frerker
- Department of Interventional Vascular Therapy, Asklepios Klinik St Georg, Hamburg, Germany (C.F.)
| | - Patrick Ohlmann
- Department of Cardiovascular Surgery, Les Hôpitaux Universitaires de Strasbourg, France (P.O.)
| | - Marco Mojoli
- Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology, University of Padova, Italy (G.T., M.M.)
| | - Hélène Eltchaninoff
- Department of Cardiology, Hôpital Charles Nicolle, University of Rouen, France (H.E.)
| | - Frédéric Pinaud
- Department of Cardiovascular and Cardiothoracic Surgery, Angers University Hospital, France (F.P.)
| | - Simon Redwood
- Department of Cardiology, King’s Health Partners, London, United Kingdom (S.R.)
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center Bern, Switzerland (S.W.)
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Lazkani M, Singh N, Howe C, Patel N, Colón MJ, Tasset M, Amabile O, Morris M, Fang HK, Pershad A. An updated meta-analysis of TAVR in patients at intermediate risk for SAVR. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:57-69. [DOI: 10.1016/j.carrev.2018.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 11/25/2022]
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Indolfi C, Bartorelli AL, Berti S, Golino P, Esposito G, Musumeci G, Petronio S, Tamburino C, Tarantini G, Ussia G, Vassanelli C, Spaccarotella C, Violini R, Mercuro G, Romeo F. Updated clinical indications for transcatheter aortic valve implantation in patients with severe aortic stenosis: expert opinion of the Italian Society of Cardiology and GISE. J Cardiovasc Med (Hagerstown) 2018; 19:197-210. [PMID: 29578921 DOI: 10.2459/jcm.0000000000000636] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: The introduction of percutaneous treatment of severe aortic stenosis with transcatheter aortic valve implantation (TAVI) remains one of the greatest achievements of interventional cardiology. In fact, TAVI emerged as a better option than either medical therapy or balloon aortic valvuloplasty for patients who cannot undergo surgical aortic valve replacement (SAVR) or are at high surgical risk. Recently, increased operator experience and improved device systems have led to a worldwide trend toward the extension of TAVI to low-risk or intermediate-risk patients. In this expert opinion paper, we first discuss the basic pathophysiology of aortic stenosis in different settings then the key results of recent clinical investigations on TAVI in intermediate-risk aortic stenosis patients are summarized. Particular emphasis is placed on the results of the nordic aortic valve intervention, placement of aortic transcatheter valves (PARTNER) 2 and Surgical Replacement and Transcatheter Aortic Valve Implantation Randomized trials. The PARTNER 2 was the first large randomized trial that evaluated the outcome of TAVI in patients at intermediate risk. The PARTNER 2 data demonstrated that TAVI is a feasible and reasonable alternative to surgery in intermediate-risk patients (Society of Thoracic Surgeons 4-8%), especially if they are elderly or frail. There was a significant interaction between TAVI approach and mortality, with transfemoral TAVI showing superiority over SAVR. Moreover, we examine the complementary results of the recently concluded Surgical Replacement and Transcatheter Aortic Valve Implantation trial. This prospective randomized trial demonstrated that TAVI is comparable with surgery (primary end point 12.6% in the TAVI group vs. 14.0% in the SAVR group) in severe aortic stenosis patients deemed to be at intermediate risk. We review the most relevant clinical evidence deriving from nonrandomized studies and meta-analyses. Altogether, clinical outcome available data suggest that TAVI with a newer generation device might be the preferred treatment option in this patient subgroup. Finally, the differences between the latest European and American Guidelines on TAVI were reported and discussed. The conclusion of this expert opinion article is that TAVI, if feasible, is the treatment of choice in patients with prohibitive or high surgical risk and may lead to similar or lower early and midterm mortality rates compared with SAVR in intermediate-risk patients with severe aortic stenosis.
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Affiliation(s)
- Ciro Indolfi
- Cattedra di Cardiologia, Università degli Studi Magna Graecia, Catanzaro, Italy
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Stortecky S, Franzone A, Heg D, Tueller D, Noble S, Pilgrim T, Jeger R, Toggweiler S, Ferrari E, Nietlispach F, Taramasso M, Maisano F, Grünenfelder J, Muller O, Huber C, Roffi M, Carrel T, Wenaweser P, Windecker S. Temporal trends in adoption and outcomes of transcatheter aortic valve implantation: a SwissTAVI Registry analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2018; 5:242-251. [DOI: 10.1093/ehjqcco/qcy048] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/03/2018] [Accepted: 10/08/2018] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
To describe temporal trends in adoption and performance of transcatheter aortic valve implantation (TAVI) in Switzerland over a period of 5 years.
Methods and results
Between 2011 and 2015, a total of 3493 patients were consecutively included in the SwissTAVI Registry (NCT01368250) and analysed for the purpose of this study. The primary outcome measure was all-cause mortality at 1 year after TAVI. Over the 5-year period, a six-fold increase in the number of procedures was observed, whereas the baseline surgical risk estimated by the Society of Thoracic Surgeon (STS) score declined (from 6.8 ± 4.4% to 4.6 ± 3.6, P < 0.001). Overall, 1-year mortality amounted to 12.8%; mortality was highest in the first annual cohorts (14.6%, 14.8%, and 15.9% in 2011, 2012, and 2013, respectively) and decreased to 13.4% in 2014 and 9.7% in 2015. While rates of cerebrovascular events, peri-procedural myocardial infarction, moderate/severe paravalvular regurgitation, and Stage 3 acute kidney injury did not significantly change over time, a significant reduction in life threatening or major bleeding was noted at 30-day follow-up during the latest compared with earlier years of recruitment.
Conclusion
This long-term recruitment analysis of a national TAVI registry showed rapid adoption paralleled by a progressive decrease of patients’ baseline risk profile. Early and late survival significantly improved over time as did the rate of life threatening or major bleeding.
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Affiliation(s)
- Stefan Stortecky
- Department of Cardiology and Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Franzone
- Department of Cardiology and Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dik Heg
- Department of Clinical Research, Clinical Trials Unit and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - David Tueller
- Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland
| | - Stephane Noble
- Division of Cardiology and Cardiovascular Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology and Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raban Jeger
- Department of Cardiology, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Stefan Toggweiler
- Department of Cardiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Enrico Ferrari
- Department of Cardiovascular Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology and Department of Cardiovascular Surgery, University Heart Centre Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Maurizio Taramasso
- Department of Cardiology and Department of Cardiovascular Surgery, University Heart Centre Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Francesco Maisano
- Department of Cardiology and Department of Cardiovascular Surgery, University Heart Centre Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Jürg Grünenfelder
- Department of Cardiology and Cardiovascular Surgery, Heart Clinic Hirslanden, Hirslanden Clinic Zurich, Zurich, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital—CHUV, Lausanne, Switzerland
| | - Christoph Huber
- Division of Cardiology and Cardiovascular Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Marco Roffi
- Division of Cardiology and Cardiovascular Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Thierry Carrel
- Department of Cardiology and Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Wenaweser
- Department of Cardiology and Cardiovascular Surgery, Heart Clinic Hirslanden, Hirslanden Clinic Zurich, Zurich, Switzerland
| | - Stephan Windecker
- Department of Cardiology and Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Schymik G, Herzberger V, Bergmann J, Bramlage P, Conzelmann LO, Würth A, Luik A, Schröfel H, Tzamalis P. Evolution of transcatheter aortic valve implantation over 7 years: results of a prospective single-centre registry of 2000 patients in a large municipal hospital (TAVIK Registry). BMJ Open 2018; 8:e022574. [PMID: 30366914 PMCID: PMC6224754 DOI: 10.1136/bmjopen-2018-022574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Use of transcatheter aortic valve implantation (TAVI) to treat severe aortic stenosis (AS) has gained popularity, accompanied by an evolution of patient and clinical factors. We aimed to characterise changes and evaluate their impact on outcomes. SETTING In this single-centre, German TAVIK registry patients undergoing TAVI between 2008 and 2015 were documented prospectively. PARTICIPANTS/INTERVENTIONS 2000 consecutive patients with AS undergoing TAVI were divided in four cohorts. 500 patients underwent TAVI in each of the following time bins: April 2008 to July 2010 (cohort I), July 2010 to April 2013 (cohort II), April 2012 to October 2013 (cohort III) and October 2013 to March 2015 (cohort IV). RESULTS The mean age was 81.8 years, without significant variation across cohorts. Compared with cohort I, prior MI (5.4%vs11.0%; p<0.001) and New York Heart Association class IV (10.0%vs3.6%; p<0.001) were less common in cohort IV. Across cohorts, there was a fall in EuroSCORE (24.3%-18.7%), frailty (48.4%-17.0%) and use of transapical access (43.6%-29.0%), while transfemoral access increased (56.4%-71.0%; p<0.001 for each). Periprocedurally, there was a fall in moderate/severe aortic regurgitation (3.2%-0.0%) and rate of unplanned cardiopulmonary bypass (4.0%-1.0%; both p<0.001). A similar trend applied to 30-day rate of major vascular complications (5.2%-1.8%; p=0.006), life-threatening bleeding (7.0%-3.0%; p<0.001) and cardiovascular mortality (4.4%-1.8%; p=0.020). One-year post-TAVI, mortality and stroke rates did not differ. CONCLUSIONS Evolution of TAVI between 2008 and 2015 saw a trend towards its usage in lower risk patients and rapid progression towards improved safety. Evaluation and refinement should now continue to further lessen stroke and pacemaker rates.
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Affiliation(s)
- Gerhard Schymik
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Valentin Herzberger
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Jens Bergmann
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | | | - Alexander Würth
- Department of Cardiology, Medical Clinic III, Vicentius Hospital Karlsruhe, Karlsruhe, Germany
| | - Armin Luik
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Holger Schröfel
- Department Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Panagiotis Tzamalis
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
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Anselmi A, Dachille A, Auffret V, Harmouche M, Roisne A, Bedossa M, Le Breton H, Verhoye JP. Evolution of Length of Stay After Surgical and Transcatheter Aortic Valve Implantation Over 8 Years in 1,849 Patients >75 Years of Age and Comparison Between Transfemoral and Transsubclavian Transcatheter Aortic Valve Implantation. Am J Cardiol 2018; 122:1387-1393. [PMID: 30107906 DOI: 10.1016/j.amjcard.2018.06.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/24/2018] [Accepted: 06/28/2018] [Indexed: 11/25/2022]
Abstract
Minimized length of hospitalization (LoS) and lower risk of hospitalization-related complications are key requirements in the treatment of aortic valve disease, mainly in the elderly candidates. Our objective was to evaluate evolution of LoS after surgical (SAVR) or transcatheter aortic valve implantation (TAVI) and its predictors. We enrolled 1,849 elderly (aged >75) patients receiving SAVR or TAVI from 2009 to 2016. In the surgical cohort (n = 1,006) the mean LoS slightly decreased from 13.81 ± 9.27 days (2009) to 10.96 ± 3.77 (2016); in the TAVI cohort (n = 843), LoS passed from 13.33 ± 9.17 (2009) to 6.21 ± 4.30 days (2016). All-cause mortality at 1 month was 3.77 % (SAVR) versus 4.7% (TAVI) (p >0.05). Among Transfemoral TAVI (TF, n = 681), and Transsubclavian TAVI (TS, n = 62), average LoS was comparable (7.38 days ± 7.11 vs 7.31 ± 4.32; median 6.0 and 6.0 days, p = 0.07). Procedural success was reached in 93% (TF) and in 85.4% (TS) (p = 0.20). There were no meaningful differences among TF and TS in terms of VARC-2 postprocedural morbidity, except for the rate of vascular access-related complications; these occurred in 8.8% of cases in the TF group versus 1.6% in the TS group (p = 0.05). In conclusion the present analysis showed a faster improvement in terms of LoS for TAVI compared with SAVR over 8 years of activity. The 2 strategies presented comparable all-causes mortality at 30 days. LoS, rates of procedural success and complications were comparable among TF and TS TAVI; nonetheless, vascular access-related complications were more frequent in the TF cohort. This suggests the validity of the TS route as an alternative to the TF approach.
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Cribier A. Commemorating the 15-year anniversary of TAVI: insights into the early stages of development, from concept to human application, and perspectives. EUROINTERVENTION 2018; 13:29-37. [PMID: 28504215 DOI: 10.4244/eijv13i1a3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Alain Cribier
- Department of Cardiology, University Hospital of Rouen, Rouen, France
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20
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Serruys PW, Modolo R, Reardon M, Miyazaki Y, Windecker S, Popma J, Chang Y, Kleiman NS, Lilly S, Amrane H, Boonstra PW, Kappetein AP, Onuma Y, Søndergaard L, van Mieghem N. One-year outcomes of patients with severe aortic stenosis and an STS PROM of less than three percent in the SURTAVI trial. EUROINTERVENTION 2018; 14:877-883. [DOI: 10.4244/eij-d-18-00460] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Junquera L, Ferreira-Neto A, Guimaraes L, Asmarats L, Del Val D, Wintzer-Wehekind J, Muntané-Carol G, Freitas-Ferraz A, Rodés-Cabau J. Transcatheter aortic valve replacement in low risk patients. Minerva Cardioangiol 2018; 67:19-38. [PMID: 30260144 DOI: 10.23736/s0026-4725.18.04783-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is a relatively new technology that has grown exponentially over the past decade. Although it was initially restricted to elderly patients at very high or prohibitive surgical risk, it is currently being evaluated as a treatment option in younger and lower risk patients. The increasing experience of the Heart Teams, along with the continued refinement of transcatheter valve technology has resulted in TAVR achieving results comparable to those of surgery for treating intermediate-risk patients. Furthermore, promising preliminary results have been obtained from observational and propensity matched studies in low risk patients, and a small randomized trial showed the non-inferiority of TAVR vs. SAVR regarding early and late (up to 6 years) outcomes. Three ongoing randomized trials will provide the definite response about the safety and efficacy of TAVR for treating low risk patients with severe aortic stenosis in the near future. The (expected) positive results of these studies would establish the basis for TAVR as the preferred treatment for the majority of patients with aortic stenosis. However, continuous research efforts for better determining valve durability among TAVR recipients, as well as reducing some of the genuine and frequent complications of TAVR (e.g. conduction disturbances) are important in this final effort for making TAVR the default treatment for aortic stenosis.
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Affiliation(s)
- Lucia Junquera
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Leonardo Guimaraes
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Lluis Asmarats
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - David Del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada -
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Efficacy and safety of new-generation transcatheter aortic valves: insights from the Israeli transcatheter aortic valve replacement registry. Clin Res Cardiol 2018; 108:430-437. [PMID: 30238186 DOI: 10.1007/s00392-018-1372-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/13/2018] [Indexed: 12/19/2022]
Abstract
AIM To compare procedural outcomes of transcatheter aortic valve replacement (TAVR) patients treated with new-generation valves. METHODS We performed a retrospective analysis on an Israeli multicenter registry comprised of four tertiary centers, comparing patient outcomes implanted with the Edwards SAPIEN S3 (ES3) vs. the Medtronic Evolut R (MER) valves. RESULTS The study population included 735 patients (ES3 n = 223; MER n = 512). The use of MER was significantly associated (p < 0.05) with higher rates of post-dilatation (35% vs. 10%), and the need for a second valve (2.7% vs. 0.5%). Procedural device success was comparable between groups (97% vs. 98%, p = 0.76); however, moderate angiographic paravalvular leak was higher (3.3% vs. 0.5%, p = 0.027) for MER vs. ES3, respectively. As compared to MER, 1 month echocardiography revealed higher peak and mean aortic valve gradients for ES3 (12/6 vs. 17/10 mmHg, p < 0.001, respectively). While the safety outcome at 1 month was lower for MER (8.8% vs. 13.9%, p = 0.035), similar 1-month, 1-year, and 3-year all-cause mortality were observed (1.9% vs. 1.3%; 8% vs. 8.5%, and 9.7 vs. 10.3%, for MER vs. ES3, respectively). In a propensity score matching analysis, there was no difference in major outcomes between the groups, including device success and the 1 month safety outcome. CONCLUSION Although favorable efficacy and safety clinical outcomes were observed in this large contemporary registry for both new-generation devices used, some procedural and post-procedural outcomes differ significantly between the two valves.
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Millan-Iturbe O, De Backer O, Bieliauskas G, Thonghong T, Chopra M, Ihlemann N, Søndergaard L. Transcatheter aortic valve implantation with the self-expanding Portico valve system in an all-comers population: procedural and clinical outcomes. EUROINTERVENTION 2018; 14:621-628. [DOI: 10.4244/eij-d-18-00488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Wang Y, Zhou Y, Zhang L, Zhu J. Midterm outcome of transcatheter versus surgical aortic valve replacement in low to intermediate risk patients: A meta-analysis of randomized controlled trials. J Cardiol 2018; 71:534-539. [DOI: 10.1016/j.jjcc.2017.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/16/2017] [Accepted: 10/20/2017] [Indexed: 12/17/2022]
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Handa N, Kumamaru H, Torikai K, Kohsaka S, Takayama M, Kobayashi J, Ogawa H, Shirato H, Ishii K, Koike K, Yokoyama Y, Miyata H, Motomura N, Sawa Y. Learning Curve for Transcatheter Aortic Valve Implantation Under a Controlled Introduction System - Initial Analysis of a Japanese Nationwide Registry. Circ J 2018; 82:1951-1958. [PMID: 29794375 DOI: 10.1253/circj.cj-18-0211] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The introduction of transcatheter aortic valve implantation (TAVI) into Japan was strictly controlled to optimize patient outcomes. The goal of this study was to assess if increasing experience during the introduction of this procedure was associated with outcomes.Methods and Results:The initial 1,752 patients registered in the Japanese national TAVI registry were included in the study. The association between operator procedure number and incidence of the early safety endpoint at 30 days (ESE30) as defined in the Valve Academic Research Consortium-2 consensus document was evaluated. Patients were divided into 4 groups by quartiles of procedure count (Groups I-IV in order of increasing number of procedures). Median patient age was 85 years, and 30.5% were male. The 30-day mortality rate was 1.4% (n=24), and 78 patients (7.9%) experienced 95 ESE30. Among the variables included in the model, ESE30 was associated with non-transfemoral approach (P=0.004), renal dysfunction (Cr >2.0 mg/dL) (P=0.01) and NYHA class III/IV (P=0.04). ESE30 incidence was not significantly different between Groups I-III and Group IV. Spline plots demonstrated that experience of 15-20 cases in total was needed to achieve a consistent low risk of ESE30. CONCLUSIONS Increasing experience was associated with better outcomes, but to a lesser degree than in previous reports. Our findings suggested that the risks associated with the learning curve process were appropriately mitigated.
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Affiliation(s)
- Nobuhiro Handa
- Office of Medical Devices, Pharmaceuticals and Medical Devices Agency.,Office of Safety, Pharmaceuticals and Medical Devices Agency
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, Faculty of Medicine, The University of Tokyo
| | - Kei Torikai
- Department of Cardiovascular Surgery, Osaka University Hospital
| | - Shun Kohsaka
- Department of Cardiology, School of Medicine, Keio University
| | | | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hisao Ogawa
- Department of Cardiology, National Cerebral and Cardiovascular Center
| | - Haruki Shirato
- Office of Medical Devices, Pharmaceuticals and Medical Devices Agency
| | - Kensuke Ishii
- Office of Medical Devices, Pharmaceuticals and Medical Devices Agency
| | - Kazuhisa Koike
- Office of Safety, Pharmaceuticals and Medical Devices Agency
| | | | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, Faculty of Medicine, The University of Tokyo
| | - Noboru Motomura
- Department of Cardiovascular Surgery, School of Medicine, Toho University Sakura Hospital
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Hospital
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Aljabbary T, Qiu F, Masih S, Fang J, Elbaz-Greener G, Austin PC, Rodés-Cabau J, Ko DT, Singh S, Wijeysundera HC. Association of Clinical and Economic Outcomes With Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement. JAMA Netw Open 2018; 1:e180088. [PMID: 30646053 PMCID: PMC6324315 DOI: 10.1001/jamanetworkopen.2018.0088] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE The literature is inconsistent regarding the impact of permanent pacemaker implantation after transcatheter aortic valve replacement. OBJECTIVE To evaluate clinical and economic outcomes in patients who required permanent pacemaker implantation during the index hospitalization after transcatheter aortic valve replacement. DESIGN, SETTING, AND PARTICIPANTS This retrospective, population-based cohort study using data from a multicenter registry included patients who underwent a transcatheter aortic valve replacement procedure from April 1, 2010, to March 31, 2015, in Ontario, Canada, with follow-up to March 31, 2017. Patients who had a previously implanted permanent pacemaker or who died during the index hospitalization were excluded. Inverse probability of treatment weighting using the propensity score was used to adjust for baseline differences between the pacemaker and nonpacemaker groups. EXPOSURES Patients received a permanent pacemaker during the index hospitalization after transcatheter aortic valve replacement. MAIN OUTCOMES AND MEASURES All-cause mortality, readmission, readmission for heart failure, emergency department visits, and cumulative 1-year health care costs. RESULTS The study cohort consisted of 1263 patients (mean [SD] age, 82.3 [7.2] years; 595 [47.1%] female; 137 [10.8%] rural), of whom 186 (14.7%) required permanent pacemaker insertion during the index hospitalization after transcatheter aortic valve replacement. Mean follow-up was 990 days. After propensity score weighting, over the entire follow-up period, pacemaker implantation was associated with significantly higher all-cause mortality (43.9% vs 31.7%; hazard ratio [HR], 1.40; 95% CI, 1.01-1.94; P = .04), all-cause readmission (80.9% vs 70.6%; HR, 1.28; 95% CI, 1.15-1.43; P < .001), and emergency department visits (95.5% vs 87.3%; HR, 1.28; 95% CI, 1.08-1.52; P = .004). Pacemaker implantation was also associated with significantly greater readmission for heart failure (33.9% vs 19.1%; HR, 1.90; 95% CI, 1.53-2.36; P < .001). There were no statistically significant differences between groups in adjusted cumulative health care costs 1 year after discharge. CONCLUSIONS AND RELEVANCE New permanent pacemaker implantation after transcatheter aortic valve replacement was associated with significantly greater morbidity and mortality at long-term follow-up. However, this did not translate to a difference in cumulative health care costs after hospital discharge.
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Affiliation(s)
- Talal Aljabbary
- Institute for Clinical Evaluation Sciences, Toronto, Ontario, Canada
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Feng Qiu
- Institute for Clinical Evaluation Sciences, Toronto, Ontario, Canada
| | - Shannon Masih
- Institute for Clinical Evaluation Sciences, Toronto, Ontario, Canada
| | - Jiming Fang
- Institute for Clinical Evaluation Sciences, Toronto, Ontario, Canada
| | - Gabby Elbaz-Greener
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Peter C Austin
- Institute for Clinical Evaluation Sciences, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Dennis T Ko
- Institute for Clinical Evaluation Sciences, Toronto, Ontario, Canada
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sheldon Singh
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Institute for Clinical Evaluation Sciences, Toronto, Ontario, Canada
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Rogers T, Thourani VH, Waksman R. Transcatheter Aortic Valve Replacement in Intermediate- and Low-Risk Patients. J Am Heart Assoc 2018; 7:JAHA.117.007147. [PMID: 29754127 PMCID: PMC6015326 DOI: 10.1161/jaha.117.007147] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.,Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute National Institutes of Health, Bethesda, MD
| | - Vinod H Thourani
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
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Martin JA, Mayhew CR, Morris AJ, Bader AM, Tsai MH, Urman RD. Using Time-Driven Activity-Based Costing as a Key Component of the Value Platform: A Pilot Analysis of Colonoscopy, Aortic Valve Replacement and Carpal Tunnel Release Procedures. J Clin Med Res 2018; 10:314-320. [PMID: 29511420 PMCID: PMC5827916 DOI: 10.14740/jocmr3350w] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 01/18/2018] [Indexed: 11/11/2022] Open
Abstract
Background Time-driven activity-based costing (TDABC) is a methodology that calculates the costs of healthcare resources consumed as a patient moves along a care process. Limited data exist on the application of TDABC from the perspective of an anesthesia provider. We describe the use of TDABC, a bottom-up costing strategy and financial outcomes for three different medical-surgical procedures. Methods In each case, a multi-disciplinary team created process maps describing the care delivery cycle for a patient encounter using the TDABC methodology. Each step in a process map delineated an activity required for delivery of patient care. The resources (personnel, equipment and supplies) associated with each step were identified. A per minute cost for each resource expended was generated, known as the capacity cost rate, and multiplied by its time requirement. The total cost for an episode of care was obtained by adding the cost of each individual resource consumed as the patient moved along a clinical pathway. Results We built process maps for colonoscopy in the gastroenterology suite, calculated costs of an aortic valve replacement by comparing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR) techniques, and determined the cost of carpal tunnel release in an operating room versus an ambulatory procedure room. Conclusions TDABC is central to the value-based healthcare platform. Application of TDABC provides a framework to identify process improvements for health care delivery. The first case demonstrates cost-savings and improved wait times by shifting some of the colonoscopies scheduled with an anesthesiologist from the main hospital to the ambulatory facility. In the second case, we show that the deployment of an aortic valve via the transcatheter route front loads the costs compared to traditional, surgical replacement. The last case demonstrates significant cost savings to the healthcare system associated with re-organization of staff required to execute a carpal tunnel release.
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Affiliation(s)
- Jacob A Martin
- Department of Anesthesiology, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Christopher R Mayhew
- Department of Anesthesiology, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Amanda J Morris
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Angela M Bader
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Mitchell H Tsai
- Department of Anesthesiology, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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[Serious adverse events in clinical trials with TAVR and SAVR]. Herz 2018; 44:526-533. [PMID: 29445840 DOI: 10.1007/s00059-018-4680-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/14/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The expansion of the transcatheter aortic valve replacement (TAVR) indication towards patients with intermediate surgical risk (Ref. Society of Thoracic Surgeons, STS, score) was analyzed. The aim was to investigate if the complication rates particularly with respect to TAVR and surgical aortic valve replacement (SAVR) concerning patients with intermediate risk are comparable. METHODS An analysis of serious adverse events (SAEs) and complication rates in clinical trials with TAVR and SAVR of these patients in comparison with high surgical risk patients was performed with the scientific literature and in the Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte, BfArM) database (2012-2017). RESULTS In several studies for intermediate-risk TAVR patients the published data showed that some complication rates (e. g. mortality) are comparable or better than for intermediate-risk SAVR patients. The analysis of the BfArM database in study 1 (TAVR) resulted in a lower all-cause mortality for intermediate-risk patients (0.9% at 30 days and 7.3% at 1 year post-procedure) than concerning high-risk patients (5.2% at 30 days and 15.7% at 1 year post-procedure). In study 1 the cardiovascular mortality was altogether 11.5% at 4 years post-procedure (9.2% for intermediate and 13.4% for high-risk patients), in study 2 (patients with high-risk) at 4 years it was 15.5% in the TAVR group with slightly lower cardiovascular mortality for SAVR patients with 14.8%. CONCLUSION In the analysis TAVR interventions have favorable incidences concerning mortality (all-cause and cardiovascular) for intermediate-risk patients. Recently, a transcatheter aortic heart valve with this expanded risk indication received a CE label for the first time in Europe; however, the results of larger clinical studies are relevant for the evaluation (e. g. long-term function over more than 5 years) of TAVR valves for intermediate-risk patients.
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Søndergaard L, Steinbrüchel DA, Ihlemann N, Nissen H, Kjeldsen BJ, Petursson P, Ngo AT, Olsen NT, Chang Y, Franzen OW, Engstrøm T, Clemmensen P, Olsen PS, Thyregod HGH. Two-Year Outcomes in Patients With Severe Aortic Valve Stenosis Randomized to Transcatheter Versus Surgical Aortic Valve Replacement: The All-Comers Nordic Aortic Valve Intervention Randomized Clinical Trial. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003665. [PMID: 27296202 DOI: 10.1161/circinterventions.115.003665] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 04/27/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Nordic Aortic Valve Intervention (NOTION) trial was the first to randomize all-comers with severe native aortic valve stenosis to either transcatheter aortic valve replacement (TAVR) with the CoreValve self-expanding bioprosthesis or surgical aortic valve replacement (SAVR), including a lower-risk patient population than previous trials. This article reports 2-year clinical and echocardiographic outcomes from the NOTION trial. METHODS AND RESULTS Two-hundred eighty patients from 3 centers in Denmark and Sweden were randomized to either TAVR (n=145) or SAVR (n=135) with follow-up planned for 5 years. There was no difference in all-cause mortality at 2 years between TAVR and SAVR (8.0% versus 9.8%, respectively; P=0.54) or cardiovascular mortality (6.5% versus 9.1%; P=0.40). The composite outcome of all-cause mortality, stroke, or myocardial infarction was also similar (15.8% versus 18.8%, P=0.43). Forward-flow hemodynamics were improved following both procedures, with effective orifice area significantly more improved after TAVR than SAVR (effective orifice area, 1.7 versus 1.4 cm(2) at 3 months). Mean valve gradients were similar after TAVR and SAVR. When patients were categorized according to Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) (<4% versus ≥4%), there was no statistically significant difference for TAVR and SAVR groups in the composite outcome for low-risk (14.7%, 95% confidence interval, 8.3-21.2 versus 16.8%; 95% confidence interval, 9.7-23.8; P=0.58) or intermediate-risk patients (21.1% versus 27.1%; P=0.59). CONCLUSIONS Two-year results from the NOTION trial demonstrate the continuing safety and effectiveness of TAVR in lower-risk patients. Longer-term data are needed to verify the durability of this procedure in this patient population. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01057173.
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Affiliation(s)
- Lars Søndergaard
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.).
| | - Daniel Andreas Steinbrüchel
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Nikolaj Ihlemann
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Henrik Nissen
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Bo Juel Kjeldsen
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Petur Petursson
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Anh Thuc Ngo
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Niels Thue Olsen
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Yanping Chang
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Olaf Walter Franzen
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Thomas Engstrøm
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Peter Clemmensen
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Peter Skov Olsen
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
| | - Hans Gustav Hørsted Thyregod
- From the Departments of Cardiology (L.S., N.I., A.T.N., N.T.O., O.W.F., T.E.) and Cardiothoracic Surgery (D.A.S., P.S.O., H.G.H.T.), The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark; Departments of Cardiology (H.N.) and Cardiothoracic and Vascular Surgery (B.J.K.), Odense University Hospital, Denmark; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (P.P.); Department of Statistics, Medtronic, Mounds View, MN (Y.C.); and Department of Medicine, Nykoebing F Hospital and University of Southern Denmark, Odense, Denmark (P.C.)
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Conduction disturbance after isolated surgical aortic valve replacement in degenerative aortic stenosis. J Thorac Cardiovasc Surg 2017; 154:1556-1565.e1. [DOI: 10.1016/j.jtcvs.2017.05.101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 05/07/2017] [Accepted: 05/24/2017] [Indexed: 11/18/2022]
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Singh K, Bhalla AS, Qutub MA, Carson K, Labinaz M. Systematic review and meta-analysis to compare outcomes between intermediate- and high-risk patients undergoing transcatheter aortic valve implantation. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2017; 3:289-295. [PMID: 29044396 DOI: 10.1093/ehjqcco/qcx014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/31/2017] [Indexed: 09/19/2023]
Abstract
Aims Recent studies have reported non-inferior outcomes for transcatheter aortic valve implantation (TAVI) compared with surgical aortic valve replacement (SAVR) in intermediate-risk patients. However, a comparison of outcomes among TAVI patients depending upon the surgical risk score has not been performed in a large study. Our aim was to compare the outcomes of TAVI in low-, intermediate-, and high-risk patients, to ascertain if the morbidity and mortality is related to the patient's risk profile or the procedure itself. Methods and results A thorough computer-based search was performed using Ovid MEDLINE, EMBASE, Google Scholar, and PubMed databases. We included original research studies reporting data on TAVI in the low-, intermediate-, and high-risk groups. Patients in intermediate-risk group were compared to the high-risk cohort for device success, mortality, and complications. A total of 2414 patients in the intermediate-risk group were compared with 1597 high-risk patients. On meta-analysis, intermediate-risk group demonstrated similar device success [odds ratio (OR) 1.29, 95% confidence interval (CI) 0.87-1.90, I2 = 0%, P = 0.2) but a lower 30-day mortality OR 0.54, 95% CI 0.34-0.86, I2 = 49%, P = 0.009). There was no difference in the incidence of stroke (OR 1.17, 95% CI 0.80-1.71, I2 = 36%, P = 0.42) or permanent pacemaker implantation between the two groups (OR 1.04, 95% CI 0.82-1.32, I2 = 41%, P = 0.74). Conclusion Transcatheter aortic valve implantation in intermediate-risk patients carries a low mortality and high success. Incidence of pacemaker and stroke remains high in the lower risk group.
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Affiliation(s)
- Kuljit Singh
- Department of Cardiology, Gold Coast University Hospital, 1 Hospital Blvd Southport, QLD 4215, Australia
- Griffith University, 58 Parklands Drive Gold Coast, QLD 4215, Australia
- University of Adelaide, North Terrace Adelaide, South Australia 5000, Australia
| | | | - Mohammad A Qutub
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kristin Carson
- University of Adelaide, North Terrace Adelaide, South Australia 5000, Australia
| | - Marino Labinaz
- University of Ottawa Heart Institute, 40 Ruskin St Ottawa, Ontario, Canada K1Y 4W7
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Yoon SH, Sharma R, Chakravarty T, Kawamori H, Maeno Y, Miyasaka M, Nomura T, Ochiai T, Israr S, Rami T, Nakamura M, Chen W, Makkar RR. Clinical outcomes and prognostic factors of transcatheter aortic valve implantation in bicuspid aortic valve patients. Ann Cardiothorac Surg 2017; 6:463-472. [PMID: 29062741 DOI: 10.21037/acs.2017.09.03] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the outcomes of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS). METHODS From April 2012 and December 2016, 108 patients with bicuspid AS underwent TAVR using the Sapien XT (34 patients) and Sapien 3 (74 patients) valves. Procedural and clinical outcomes were assessed according to VARC-2 criteria and compared between the two devices. RESULTS In the overall cohort, the majority of patients were male (71.3%) with an intermediate surgical risk and a mean Society of Thoracic Surgeons (STS) score of 5.2%. Compared to the Sapien XT group, the Sapien 3 group had a significantly lower STS score (3.3%±2.0% vs. 6.7%±3.6%; P=0.001). Compared to the Sapien XT group, the Sapien 3 group had a significantly lower rate of moderate or severe paravalvular leak (2.7% vs. 14.7%; P=0.03) and higher device success (97.3% vs. 82.4%; P=0.006). There were no significant differences between the two groups in terms of 30-day all-cause mortality, stroke, life-threatening bleeding, major vascular complication and acute kidney injury (stage 2 or 3). Cumulative all-cause mortality at 1-year follow-up was 6.9%. There were no significant differences in cumulative event rates for all-cause mortality at 1-year follow-up between the two groups (9.4% vs. 4.6%; log-rank P=0.47). By univariate analysis, major vascular complication was significantly associated with overall all-cause mortality [hazard ratios (HR): 7.57; 95% confidence interval (CI): 1.51-37.86; P=0.014]. CONCLUSIONS TAVR using the balloon-expandable valves provided acceptable procedural and clinical outcomes in patients with bicuspid AS. The new-generation Sapien 3 valves showed improved procedural outcomes compared to the early-generation Sapien XT valves.
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Affiliation(s)
- Sung-Han Yoon
- Department of Interventional Cardiology and Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Rahul Sharma
- Department of Interventional Cardiology and Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Tarun Chakravarty
- Department of Interventional Cardiology and Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Hiroyuki Kawamori
- Department of Interventional Cardiology and Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Yoshio Maeno
- Department of Interventional Cardiology and Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Masaki Miyasaka
- Department of Interventional Cardiology and Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Takahiro Nomura
- Department of Interventional Cardiology and Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Tomoki Ochiai
- Department of Interventional Cardiology and Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Sharjeel Israr
- Department of Interventional Cardiology and Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Tanya Rami
- Department of Interventional Cardiology and Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Mamoo Nakamura
- Department of Interventional Cardiology and Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Wen Chen
- Department of Interventional Cardiology and Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Raj R Makkar
- Department of Interventional Cardiology and Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
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Vaquerizo B, Bleiziffer S, Wottke M, Spaziano M, Eschenbach L, Lange R, Piazza N. Impact of transcatheter aortic valve implantation on surgical aortic valve. Int J Cardiol 2017; 243:145-149. [DOI: 10.1016/j.ijcard.2017.05.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/22/2017] [Accepted: 05/17/2017] [Indexed: 10/19/2022]
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Tarantini G, Nai Fovino L, Gersh BJ. Transcatheter aortic valve implantation in lower-risk patients: what is the perspective? Eur Heart J 2017; 39:658-666. [DOI: 10.1093/eurheartj/ehx489] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/02/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, Padova University Hospital, Via Giustiniani 2, 35128 Padova, Italy
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic and Vascular Science, Padova University Hospital, Via Giustiniani 2, 35128 Padova, Italy
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Ismail TF, Cheasty E, King L, Naaseri S, Lazoura O, Gartland N, Padley S, Rubens MB, Castellano I, Nicol ED. High-pitch versus conventional cardiovascular CT in patients being assessed for transcatheter aortic valve implantation: a real-world appraisal. Open Heart 2017; 4:e000626. [PMID: 28878951 PMCID: PMC5574431 DOI: 10.1136/openhrt-2017-000626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/19/2017] [Accepted: 06/13/2017] [Indexed: 01/07/2023] Open
Abstract
Objective High-pitch protocols are increasingly used in cardiovascular CT assessment for transcatheter aortic valve implantation (TAVI), but the impact on diagnostic image quality is not known. Methods We reviewed 95 consecutive TAVI studies: 44 (46%) high-pitch and 51 (54%) standard-pitch. Single high-pitch scans were performed regardless of heart rate. For standard-pitch acquisitions, a separate CT-aortogram and CT-coronary angiogram were performed with prospective gating, unless heart rate was ≥70 beats/min, when retrospective gating was used. The aortic root and coronary arteries were assessed for artefact (significant artefact=1; artefact not limiting diagnosis=2; no artefact=3). Aortic scans were considered diagnostic if the score was >1; the coronaries, if all three epicardial arteries scored >1. Results There was no significant difference in diagnostic image quality for either the aorta (artefact-free high-pitch: 31 (73%) scans vs standard-pitch: 40 (79%), p=0.340) or the coronary tree as a whole (10 (23%) vs 15 (29%), p=0.493). However, proximal coronary arteries were less well visualised using high-pitch acquisitions (16 (36%) vs 30 (59%), p=0.04). The median (IQR) radiation dose was significantly lower in the high-pitch cohort (dose-length product: 347 (318–476) vs 1227 (1150–1474) mGy cm, respectively, p<0.001), and the protocol required almost half the amount of contrast. Conclusions The high-pitch protocol significantly reduces radiation and contrast doses and is non-inferior to standard-pitch acquisitions for aortic assessment. For aortic root assessment, the high-pitch protocol is recommended. However, if coronary assessment is critical, this should be followed by a conventional standard-pitch, low-dose, prospectively gated CT-coronary angiogram if the high-pitch scan is non-diagnostic.
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Affiliation(s)
- Tevfik F Ismail
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Emma Cheasty
- Radiology Department, Royal Brompton Hospital, London, UK
| | - Laurence King
- Medical Physics Department, Royal Marsden Hospital, London, UK
| | - Sahar Naaseri
- Radiology Department, Royal Brompton Hospital, London, UK
| | - Olga Lazoura
- Radiology Department, Royal Brompton Hospital, London, UK
| | | | - Simon Padley
- Radiology Department, Royal Brompton Hospital, London, UK.,Department of Medicine, Imperial College London, London, UK
| | - Michael B Rubens
- Radiology Department, Royal Brompton Hospital, London, UK.,Department of Medicine, Imperial College London, London, UK
| | - Isabel Castellano
- Medical Physics Department, Royal Marsden Hospital, London, UK.,Department of Medicine, Imperial College London, London, UK
| | - Edward D Nicol
- Radiology Department, Royal Brompton Hospital, London, UK.,Department of Medicine, Imperial College London, London, UK
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Holy EW, Abdel-Wahab M. Shifting paradigms for treatment of symptomatic aortic stenosis in lower risk populations: role of a newer generation balloon-expandable transcatheter aortic valve implantation device. Cardiovasc Diagn Ther 2017; 7:S57-S62. [PMID: 28748148 DOI: 10.21037/cdt.2016.11.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Erik Walter Holy
- Heart Center, Segeberger Kliniken, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Heart Center, Segeberger Kliniken, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany
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Thourani VH, Borger MA, Holmes D, Maniar H, Pinto F, Miller C, Rodés-Cabau J, Mohr FW, Schröfel H, Moat NE, Beyersdorf F, Patterson GA, Weisel R. Transatlantic Editorial on Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2017. [DOI: 10.1016/j.athoracsur.2017.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Auffret V, Lefevre T, Van Belle E, Eltchaninoff H, Iung B, Koning R, Motreff P, Leprince P, Verhoye JP, Manigold T, Souteyrand G, Boulmier D, Joly P, Pinaud F, Himbert D, Collet JP, Rioufol G, Ghostine S, Bar O, Dibie A, Champagnac D, Leroux L, Collet F, Teiger E, Darremont O, Folliguet T, Leclercq F, Lhermusier T, Olhmann P, Huret B, Lorgis L, Drogoul L, Bertrand B, Spaulding C, Quilliet L, Cuisset T, Delomez M, Beygui F, Claudel JP, Hepp A, Jegou A, Gommeaux A, Mirode A, Christiaens L, Christophe C, Cassat C, Metz D, Mangin L, Isaaz K, Jacquemin L, Guyon P, Pouillot C, Makowski S, Bataille V, Rodés-Cabau J, Gilard M, Le Breton H, Le Breton H, Eltchaninoff H, Gilard M, Iung B, Le Breton H, Lefevre T, Van Belle E, Laskar M, Leprince P, Iung B, Bataille V, Chevalier B, Garot P, Hovasse T, Lefevre T, Donzeau Gouge P, Farge A, Romano M, Cormier B, Bouvier E, Bauchart JJ, Bodart JC, Delhaye C, Houpe D, Lallemant R, Leroy F, Sudre A, Van Belle E, Juthier F, Koussa M, Modine T, Rousse N, Auffray JL, Richardson M, Berland J, Eltchaninoff H, Godin M, Koning R, Bessou JP, Letocart V, Manigold T, Roussel JC, Jaafar P, Combaret N, Souteyrand G, D’Ostrevy N, Innorta A, Clerfond G, Vorilhon C, Auffret V, Bedossa M, Boulmier D, Le Breton H, Leurent G, Anselmi A, Harmouche M, Verhoye JP, Donal E, Bille J, Joly P, Houel R, Vilette B, Abi Khalil W, Delepine S, Fouquet O, Pinaud F, Rouleau F, Abtan J, Himbert D, Urena M, Alkhoder S, Ghodbane W, Arangalage D, Brochet E, Goublaire C, Barthelemy O, Choussat R, Collet JP, Lebreton G, Leprince P, Mastrioanni C, Isnard R, Dauphin R, Dubreuil O, Durand De Gevigney G, Finet G, Harbaoui B, Ranc S, Rioufol G, Farhat F, Jegaden O, Obadia JF, Pozzi M, Ghostine S, Brenot P, Fradi S, Azmoun A, Deleuze P, Kloeckner M, Bar O, Blanchard D, Barbey C, Chassaing S, Chatel D, Le Page O, Tauran A, Bruere D, Bodson L, Meurisse Y, Seemann A, Amabile N, Caussin C, Dibie A, Elhaddad S, Drieu L, Ohanessian A, Philippe F, Veugeois A, Debauchez M, Zannis K, Czitrom D, Diakov C, Raoux F, Champagnac D, Lienhart Y, Staat P, Zouaghi O, Doisy V, Frieh JP, Wautot F, Dementhon J, Garrier O, Jamal F, Leroux PY, Casassus F, Leroux L, Seguy B, Barandon L, Labrousse L, Peltan J, Cornolle C, Dijos M, Lafitte S, Bayet G, Charmasson C, Collet F, Vaillant A, Vicat J, Giacomoni MP, Teiger E, Bergoend E, Zerbib C, Darremont O, Louis Leymarie J, Clerc P, Choukroun E, Elia N, Grimaud JP, Guibaud JP, Wroblewski S, Abergel E, Bogino E, Chauvel C, Dehant P, Simon M, Angioi M, Lemoine J, Lemoine S, Popovic B, Folliguet T, Maureira P, Huttin O, Selton Suty C, Cayla G, Delseny D, Leclercq F, Levy G, Macia JC, Maupas E, Piot C, Rivalland F, Robert G, Schmutz L, Targosz F, Albat B, Dubar A, Durrleman N, Gandet T, Munos E, Cade S, Cransac F, Bouisset F, Lhermusier T, Grunenwald E, Marcheix B, Fournier P, Morel O, Ohlmann P, Kindo M, Hoang MT, Petit H, Samet H, Trinh A, Huret B, Lecoq G, Morelle JF, Richard P, Derieux T, Monier E, Joret C, Lorgis L, Bouchot O, Eicher JC, Drogoul L, Meyer P, Lopez S, Tapia M, Teboul J, Elbeze JP, Mihoubi A, Bertrand B, Vanzetto G, Wittenberg O, Bach V, Martin C, Sauier C, Casset C, Castellant P, Gilard M, Bezon E, Choplain JN, Kallifa A, Nasr B, Jobic Y, Blanchard D, Lafont A, Pagny JY, Spaulding C, Abi Akar R, Fabiani JN, Zegdi R, Berrebi A, Puscas T, Desveaux B, Ivanes F, Quilliet L, Saint Etienne C, Bourguignon T, Aupy B, Perault R, Bonnet JL, Cuisset T, Lambert M, Grisoli D, Jaussaud N, Salaun E, Delomez M, Laghzaoui A, Savoye C, Beygui F, Bignon M, Roule V, Sabatier R, Ivascau C, Saplacan V, Saloux E, Bouchayer D, Claudel JP, Tremeau G, Diab C, Lapeze J, Pelissier F, Sassard T, Matz C, Monsarrat N, Carel I, Hepp A, Sibellas F, Curtil A, Dambrin G, Favereau X, Jegou A, Ghorayeb G, Guesnier L, Khoury W, Kucharski C, Pouzet B, Vaislic C, Cheikh-Khelifa R, Hilpert L, Maribas P, Gommeaux A, Hannebicque G, Hochart P, Paris M, Pecheux M, Fabre O, Guesnier L, Leborgne L, Mirode A, Peltier M, Trojette F, Carmi D, Tribouilloy C, Christiaens L, Mergy J, Corbi P, Raud Raynier P, Carillo S, Christophe C, Hueber A, Moulin F, Pinelli G, Cassat C, Darodes N, Pesteil F, Metz D, Aludaat C, Torossian F, Belle L, Mangin L, Chavanis N, Akret C, Cerisier A, Isaaz K, Favre JP, Fuzellier JF, Pierrard R, Jacquemin L, Roth O, Wiedemann JY, Bischoff N, Gavra G, Bourrely N, Digne F, Guyon P, Najjari M, Stratiev V, Bonnet N, Mesnildrey P, Attias D, Dreyfus J, Karila Cohen D, Laperche T, Nahum J, Scheuble A, Pouillot C, Rambaud G, Brauberger E, Ah Hot M, Allouch P, Beverelli F, Makowski S, Rosencher J, Aubert S, Grinda JM, Waldman T. Temporal Trends in Transcatheter Aortic Valve Replacement in France. J Am Coll Cardiol 2017; 70:42-55. [DOI: 10.1016/j.jacc.2017.04.053] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 04/05/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
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Thourani VH, Borger MA, Holmes D, Maniar H, Pinto F, Miller C, Rodés-Cabau J, Mohr FW, Schröfel H, Moat NE, Beyersdorf F, Patterson AG, Weisel R. Transatlantic Editorial on transcatheter aortic valve replacement. Eur J Cardiothorac Surg 2017; 52:1-13. [PMID: 28874024 DOI: 10.1093/ejcts/ezx196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/11/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Vinod H Thourani
- Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, GA, USA
| | - Michael A Borger
- Division of Cardiac Surgery, Department of Surgery, Columbia University, New York, NY, USA
| | - David Holmes
- Department of Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Hersh Maniar
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, MO, USA
| | - Fausto Pinto
- Department of Cardiology, University Hospital Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Craig Miller
- Department of Cardiac Surgery, Stanford University, Palo Alto, CA, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | | | | | - Neil E Moat
- Cardiovascular Biomedical Research Unit, National Institute Health Research, Royal Brompton Hospital and Harefield National Health Service Foundation Trust, London, UK
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany
| | - Alec G Patterson
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Richard Weisel
- Division of Cardiovascular Surgery, Peter Munk Cardiovascular Center, Toronto General Research Institute, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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Thourani VH, Borger MA, Holmes D, Maniar H, Pinto F, Miller C, Rodés-Cabau J, Mohr FW, Schröfel H, Moat NE, Beyersdorf F, Patterson GA, Weisel R. Transatlantic editorial on transcatheter aortic valve replacement. J Thorac Cardiovasc Surg 2017. [DOI: 10.1016/j.jtcvs.2017.03.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Baldenhofer G, Laule M, Mockel M, Sanad W, Knebel F, Dreger H, Leonhardt F, Sander M, Grubitzsch H, Baumann G, Stangl K, Stangl V. Mid-regional pro-adrenomedullin (MR-proADM) and mid-regional pro-atrial natriuretic peptide (MR-proANP) in severe aortic valve stenosis: association with outcome after transcatheter aortic valve implantation (TAVI). Clin Chem Lab Med 2017; 55:275-283. [PMID: 27522619 DOI: 10.1515/cclm-2015-0419] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/27/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study aimed to assess the association of mid-regional (MR) pro-adrenomedullin (MR-proADM) and MR-pro-A-type natriuretic peptide (MR-proANP) in comparison to N-terminal pro-natriuretic peptide (NT-proBNP) with outcome in patients with aortic stenosis (AS) treated with transcatheter aortic valve implantation (TAVI). METHODS One hundred consecutive TAVI patients were included in this prospective study. Association of preinterventional levels of MR-proADM, MR-proANP, NT-proBNP, C-reactive protein (CrP), and high-sensitive cardiac Troponin T (hsTN) with 30-day and 1-year outcome was analyzed. RESULTS There was no association with 30-day outcome, but all markers were associated with 1-year cardiovascular events and all-cause mortality. The combined biomarker analysis further improved risk prediction. CONCLUSIONS In TAVI patients MR-proADM, MR-proANP, and NT-proBNP are promising predictors of adverse events within 1 year. Integration of these biomarkers into decision pathways may help to identify patients at higher risk.
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Barnhart GR, Accola KD, Grossi EA, Woo YJ, Mumtaz MA, Sabik JF, Slachman FN, Patel HJ, Borger MA, Garrett HE, Rodriguez E, McCarthy PM, Ryan WH, Duhay FG, Mack MJ, Chitwood WR. TRANSFORM (Multicenter Experience With Rapid Deployment Edwards INTUITY Valve System for Aortic Valve Replacement) US clinical trial: Performance of a rapid deployment aortic valve. J Thorac Cardiovasc Surg 2017; 153:241-251.e2. [DOI: 10.1016/j.jtcvs.2016.09.062] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 09/01/2016] [Accepted: 09/02/2016] [Indexed: 11/26/2022]
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Ngo A, Hassager C, Thyregod HGH, Søndergaard L, Olsen PS, Steinbrüchel D, Hansen PB, Kjærgaard J, Winther-Jensen M, Ihlemann N. Differences in left ventricular remodelling in patients with aortic stenosis treated with transcatheter aortic valve replacement with corevalve prostheses compared to surgery with porcine or bovine biological prostheses. Eur Heart J Cardiovasc Imaging 2017; 19:39-46. [DOI: 10.1093/ehjci/jew321] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 12/19/2016] [Indexed: 12/17/2022] Open
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Abdelghani M, Tateishi H, Miyazaki Y, Cavalcante R, Soliman OII, Tijssen JG, de Winter RJ, Baan J, Onuma Y, Campos CM, Leite RS, Mangione JA, Abizaid A, Lemos PA, de Brito FS, Serruys PW. Angiographic assessment of aortic regurgitation by video-densitometry in the setting of TAVI: Echocardiographic and clinical correlates. Catheter Cardiovasc Interv 2017; 90:650-659. [DOI: 10.1002/ccd.26926] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/19/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Mohammad Abdelghani
- Academic Medical Center; Amsterdam The Netherlands
- Cardiology Department; Al-Azhar University; Cairo Egypt
| | - Hiroki Tateishi
- Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
| | - Yosuke Miyazaki
- Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
| | | | - Osama I. I. Soliman
- Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
- Cardialysis Core Laboratories and Clinical Trial Management; Rotterdam The Netherlands
| | | | | | - Jan Baan
- Academic Medical Center; Amsterdam The Netherlands
| | - Yoshinobu Onuma
- Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
- Cardialysis Core Laboratories and Clinical Trial Management; Rotterdam The Netherlands
| | - Carlos M. Campos
- The Heart Institute (InCor), University of São Paulo Medical School; São Paulo Brazil
- Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Rogério S. Leite
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia; Porto Alegre Brazil
| | | | - Alexandre Abizaid
- The Heart Institute (InCor), University of São Paulo Medical School; São Paulo Brazil
- Instituto Dante Pazzanese de Cardiologia; São Paulo Brazil
| | - Pedro A. Lemos
- The Heart Institute (InCor), University of São Paulo Medical School; São Paulo Brazil
| | | | - Patrick W. Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London; London United Kingdom
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Bautista-Hernandez V, Cal-Purriños N, Arribas-Leal JM, Carnero-Alcazar M, Gutierrez-Diez JF, Cuenca-Castillo JJ. Rapid Deployment Aortic Replacement (RADAR) Registry in Spain: a protocol. BMJ Open 2017; 7:e011437. [PMID: 28073791 PMCID: PMC5253533 DOI: 10.1136/bmjopen-2016-011437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Rapid deployment valves (RDV) represent a newly introduced approach to aortic valve replacement which facilitates surgical implantation and minimally invasive techniques, shortens surgical times and shows excellent haemodynamic performance. However, evidence on their safety, efficacy and potential complications is mostly fitted with small-volume and retrospective studies. Moreover, no current guidelines exist. To improve our knowledge on this technology, The Rapid Deployment Aortic Replacement (RADAR) Registry will be established across Spain with the aim of assessing RDV outcomes in the real-world setting. METHODS AND ANALYSIS The RADAR Registry is designed as a product registry that would provide information on its use and outcomes in clinical practice. This multicentre, prospective, national effort will initially involve 4 centres in Spain. Any patient undergoing cardiac surgery for aortic valve replacement and receiving an RDV as an isolated operation or in combination with other cardiac procedures may be included. Participation is voluntary. Data collection is equal to information obtained during standard care and is prospectively entered by the participating physicians perioperatively and during subsequent follow-up visits. The primary outcome assessed is in-hospital and up to 5 years of follow-up, prosthetic valve functioning and clinical status. Secondary outcomes are to perform subgroup analysis, to compare outcomes with other existing approaches and to develop future clinical guidelines. The follow-up assessments are timed with routine clinical appointments. Dissociated data will be extracted and collectively analysed. Initial target sample size for the registry is 500 participants entered with complete follow-up information. Different substudies will be implemented within the registry to investigate specific populations undergoing aortic valve replacement. ETHICS AND DISSEMINATION The protocol is approved by all local institutional ethics committees. Findings will be shared by the participant hospitals, policymakers and the academic community to promote quality monitoring and efficient use of this technology.
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Affiliation(s)
- Victor Bautista-Hernandez
- Department of Cardiovascular Surgery, Xerencia de Xestión Integrada A Coruña (XXIAC), A Coruña, Spain
- Congenital and Structural Heart Disease, Instituto de Investigación Biomédica A Coruña (INIBIC), A Coruña, Spain
| | - Natalia Cal-Purriños
- Fundación Profesor Novoa Santos, Xerencia de Xestión Integrada A Coruña (XXIAC), A Coruña, Spain
| | - Jose M Arribas-Leal
- Department of Cardiovascular Surgery, Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | - Jose F Gutierrez-Diez
- Department of Cardiovascular Surgery, Hospital Marqués de Valdecilla, Santander, Spain
| | - Jose J Cuenca-Castillo
- Department of Cardiovascular Surgery, Xerencia de Xestión Integrada A Coruña (XXIAC), A Coruña, Spain
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Boureau AS, Trochu JN, Rouaud A, Hureau R, Jaafar P, Manigold T, Letocart V, Guerin P, Berrut G, de Decker L. Predictors of Health-Related Quality of Life Decline after Transcatheter Aortic Valve Replacement in Older Patients with Severe Aortic Stenosis. J Nutr Health Aging 2017; 21:105-111. [PMID: 27999856 DOI: 10.1007/s12603-016-0739-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Transcatheter aortic-valve implantation (TAVI) has been shown to improve survival and quality of life in patients with severe aortic stenosis. However, one-third of patients have poor outcome as death, functional decline or quality of life (QoL) decline. The aim of this study was to determine cardiac and geriatric predictors of physical and mental QoL decline 6 months after a TAVI procedure in patients aged 75 and older. METHODS Between January 2013 and June 2014, we did a prospective and multicenter study including patients ≥ 75 years old referred for TAVI. The primary outcome was the measure of QoL, assessed by the Short Form 36 survey (SF-36), before and 6 months after the intervention. Association between QoL decline and baseline characteristics including cardiac and geriatric factors was analysed by logistic regression models. RESULTS Mean age of the 150 patients studied was 83.7 years old and 56% were men. The primary end point, mean SF-36 physical summary score, significantly improved between baseline and 6-month (33.6 vs. 36.4, p=0.003) whereas mental component score significantly decreased (48.2 vs. 36.4, p-value<0.001). However, patients with presence of depressive symptoms before the intervention had mental QoL improvement at six months (OR 0.04 [0.01-0.19], p-value<0.001) and no significant geriatric predictors were associated with physical QoL decline. CONCLUSION The mental QoL significantly decreased and patients with preoperative depressive symptoms had mental QoL improvement at six months. Researches are needed to confirm that mental QoL of patients with depressive symptoms can be improved by TAVI.
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Affiliation(s)
- A S Boureau
- Anne Sophie Boureau, MD, Department of Geriatrics, Nantes University Hospital, boulevard Jacques Monod, 44093 Nantes Cedex 1, France; telephone number : + 33 2 40 16 50 46, fax number : +33 2 40 16 53 58, e-mail:
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O'Sullivan CJ, Wenaweser P. A Glimpse into the Future: In 2020, Which Patients will Undergo TAVI or SAVR? Interv Cardiol 2017; 12:44-50. [PMID: 29588730 DOI: 10.15420/icr.2016:24:2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has evolved into a safe and effective procedure to treat symptomatic patients with severe aortic stenosis (AS), with predictable and reproducible results. Rates of important complications such as vascular complications, strokes and paravalvular leaks are lower than ever, because of improved patient selection, systematic use of multidector computer tomography, increasing operator experience and device iteration. Accumulating data suggest that transfemoral TAVI with newer generation transcatheter heart valves and delivery systems is superior to conventional surgical aortic valve replacement among intermediate- and high-risk patients with severe symptomatic AS with regard to all-cause mortality and stroke. One can anticipate that by 2020, the majority of patients with severe symptomatic AS will undergo TAVI as first line therapy, regardless of surgical risk.
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Affiliation(s)
| | - Peter Wenaweser
- Department of Cardiology, University Hospital Bern, Inselspital, Switzerland.,Cardiovascular Center Zurich, Hirslanden Clinic im Park, Zurich, Switzerland
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49
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Rahmani B, Tzamtzis S, Sheridan R, Mullen MJ, Yap J, Seifalian AM, Burriesci G. In Vitro Hydrodynamic Assessment of a New Transcatheter Heart Valve Concept (the TRISKELE). J Cardiovasc Transl Res 2016; 10:104-115. [PMID: 28028692 PMCID: PMC5437138 DOI: 10.1007/s12265-016-9722-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/21/2016] [Indexed: 11/01/2022]
Abstract
This study presents the in vitro hydrodynamic assessment of the TRISKELE, a new system suitable for transcatheter aortic valve implantation (TAVI), aiming to mitigate the procedural challenges experienced with current technologies. The TRISKELE valve comprises three polymeric leaflet and an adaptive sealing cuff, supported by a novel fully retrievable self-expanding nitinol wire frame. Valve prototypes were manufactured in three sizes of 23, 26, and 29 mm by automated dip-coating of a biostable polymer, and tested in a hydrodynamic bench setup in mock aortic roots of 21, 23, 25, and 27 mm annulus, and compared to two reference valves suitable for equivalent implantation ranges: Edwards SAPIEN XT and Medtronic CoreValve. The TRISKELE valves demonstrated a global hydrodynamic performance comparable or superior to the controls with significant reduction in paravalvular leakage. The TRISKELE valve exhibits enhanced anchoring and improved sealing. The valve is currently under preclinical investigation.
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Affiliation(s)
- Benyamin Rahmani
- Cardiovascular Engineering Laboratory, UCL Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Spyros Tzamtzis
- Cardiovascular Engineering Laboratory, UCL Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Rose Sheridan
- Cardiovascular Engineering Laboratory, UCL Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Michael J Mullen
- Barts Health NHS Trust, University College London Hospital, London, UK
| | - John Yap
- Barts Health NHS Trust, University College London Hospital, London, UK
| | | | - Gaetano Burriesci
- Cardiovascular Engineering Laboratory, UCL Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK. .,Ri.MED Foundation, Bioengineering Group, Palermo, Italy.
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50
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Čanádyová J, Mokráček A, Kurfirst V, Pešl L. Transcatheter Aortic Valve Implantation: Review of Current Indications, Approaches, Future Insights, and Alternatives. EUROPEAN MEDICAL JOURNAL 2016. [DOI: 10.33590/emj/10314811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
The use of transcatheter aortic valve implantation is increasing worldwide, with rapid development of new generations of valves and the search for alternative access for implantation. The aim of this review is to summarise current approaches and indications, and to discuss some of the controversies surrounding this procedure.
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Affiliation(s)
- Júlia Čanádyová
- Cardiac Surgery Department, Hospital of České Budějovice, B. Němcové 54, České Budějovice, Czech Republic
| | - Aleš Mokráček
- Cardiac Surgery Department, Hospital of České Budějovice, B. Němcové 54, České Budějovice, Czech Republic; Faculty of Health and Social Studies, University of South Bohemia, Jírovcova, České Budějovice, Czech Republic
| | - Vojtěch Kurfirst
- Cardiac Surgery Department, Hospital of České Budějovice, B. Němcové 54, České Budějovice, Czech Republic; Faculty of Health and Social Studies, University of South Bohemia, Jírovcova, České Budějovice, Czech Republic
| | - Ladislav Pešl
- Department of Cardiology, Hospital of České Budějovice, B. Němcové 54, České Budějovice, Czech Republic
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