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Leviner DB, Ronai T, Abraham D, Eliad H, Schwartz N, Sharoni E. Minimal Learning Curve for Minimally Invasive Aortic Valve Replacement. Thorac Cardiovasc Surg 2024. [PMID: 38830605 DOI: 10.1055/a-2337-1978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND Minimally invasive aortic valve replacement (MiAVR) is an established technique for surgical aortic valve replacement (AVR). Although MiAVR was first described in 1993 and has shown good results compared with full sternotomy AVR (FSAVR) only a minority of patients undergo MiAVR. We recently started using MiAVR via an upper hemisternotomy. We aimed to examine the early results of our initial experience with this technique. METHODS We compared 55 MiAVR patients with a historical cohort of 142 isolated FSAVR patients (December 2016-December 2022). The primary outcome was in-hospital mortality. Secondary outcomes included cardiopulmonary bypass (CPB) and cross-clamp times, blood product intake, in-hospital morbidity, and length of intensive care unit and hospital stay. RESULTS There was no significant difference in preoperative characteristics, including age, laboratory values, and comorbidities. There was no significant difference between the groups regarding in-hospital mortality (FSAVR 3.52 vs. MiAVR 1.82%). There was no significant difference in CPB time (FSAVR 103.5 [interquartile range: 82-119.5] vs. MiAVR 107 min [92.5-120]), aortic cross-clamp time (FSAVR 81 [66-92] vs. MiAVR 90 min [73-99]), and valve size (FSAVR 23 [21-25] vs. MiAVR 23 [21-25]). The incidence of intraoperative blood products transfusion was significantly lower in the MiAVR group (10.91%) compared with the FSAVR group (25.35%, p = 0.03). CONCLUSION Our findings further establish the possibility of reducing invasiveness of AVR without compromising patient safety and clinical outcomes. This is true even in the learning curve period and without requiring any significant change in the operative technique and dedicated equipment.
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Affiliation(s)
- Dror B Leviner
- Department of Cardiothoracic Surgery, Carmel Medical Center Cardiovascular Center, Haifa, Israel
- Technion Israel Institute of Technology, Haifa, Haifa, Israel
| | - Tom Ronai
- Technion Israel Institute of Technology, Haifa, Haifa, Israel
| | - Dana Abraham
- Technion Israel Institute of Technology, Haifa, Haifa, Israel
| | - Hadar Eliad
- Department of Cardiothoracic Surgery, Carmel Medical Center Cardiovascular Center, Haifa, Israel
| | - Naama Schwartz
- Carmel Medical Center, Research Authority, Haifa, Haifa, Israel
| | - Erez Sharoni
- Department of Cardiothoracic Surgery, Carmel Medical Center Cardiovascular Center, Haifa, Israel
- Technion Israel Institute of Technology, Haifa, Haifa, Israel
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Leviner DB, Abraham D, Ronai T, Sharoni E. Mechanical Valves: Past, Present, and Future-A Review. J Clin Med 2024; 13:3768. [PMID: 38999334 PMCID: PMC11242849 DOI: 10.3390/jcm13133768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 06/24/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
The mechanical valve was first invented in the 1950s, and since then, a wide variety of prostheses have been developed. Although mechanical valves have outstanding durability, their use necessitates life-long treatment with anticoagulants, which increases the risk of bleeding and thromboembolic events. The current guidelines recommend a mechanical prosthetic valve in patients under 50-60 years; however, for patients aged 50-70 years, the data are conflicting and there is not a clear-cut recommendation. In recent decades, progress has been made in several areas. First, the On-X mechanical valve was introduced; this valve has a lower anticoagulant requirement in the aortic position. Second, a potential alternative to vitamin K-antagonist treatment, rivaroxaban, has shown encouraging results in small-scale trials and is currently being tested in a large randomized clinical trial. Lastly, an innovative mechanical valve that eliminates the need for anticoagulant therapy is under development. We attempted to review the current literature on the subject with special emphasis on the role of mechanical valves in the current era and discuss alternatives and future innovations.
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Affiliation(s)
- Dror B Leviner
- Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa 3436212, Israel
| | - Dana Abraham
- Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa 3436212, Israel
- The Ruth & Baruch Rappaport Faculty of Medicine, Technion, Haifa 3525433, Israel
| | - Tom Ronai
- Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa 3436212, Israel
- The Ruth & Baruch Rappaport Faculty of Medicine, Technion, Haifa 3525433, Israel
| | - Erez Sharoni
- Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa 3436212, Israel
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3
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Chan J, Narayan P, Fudulu DP, Dong T, Angelini GD. Trend in mitral valve prostheses of choice and early outcomes in the United Kingdom. Int J Cardiol 2024; 397:131607. [PMID: 38013051 DOI: 10.1016/j.ijcard.2023.131607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Despite the superiority of mitral valve repair, surgical mitral valve replacement (SMVR) remains an important intervention for patients with valve stenosis, infective endocarditis and complex mitral valve degeneration. There has been an increasing popularity in the worldwide use of biological valves due to the avoidance of long-term anti-coagulation and recent advancements in transcatheter techniques. We aim to evaluate the trend, early clinical outcomes and the choice of prostheses use in isolated SMVR over a 23 years period in the United Kingdom. METHODS All patients (n = 13,147) who underwent elective or urgent isolated SMVR from March 1996 to April 2019 were identified from the National Adult Cardiac Surgery Audit database. Trends in clinical outcomes, predicted/observed mortality of patients and the utilization of biological prostheses across 5 different age groups: <50, 50-59, 60-69, 70-79 and ≥80 years old were investigated. Early clinical outcomes associated with the use of mechanical and biological mitral valve prostheses in patients between the age of 60-70 years old were analysed. RESULTS The number of isolated SMVR performed has remained stable with approximately 600 cases annually since 2010. The in-hospital/30-day mortality rate has decreased from 7.41% (1996) to 3.92% (2018), despite the EuroScore II increasing from 1.42% in 1996 to 2.43% in 2018. Biological prostheses usage increased across all age group, and particularly in the 60-69 and 70-79 group, from 17.86% and 53.85% in 1996 to 48.85% and 82.38% in 2018, respectively. The use of mechanical prostheses was reduced in patients between the age of 50-59 from 100% in 1996 to 80.65% in 2018. There were no differences in short term outcomes among patients aged 60-70 years who received either a biological or mechanical prostheses. CONCLUSION There has been a significant reduction in surgical mitral valve replacement early in-hospital mortality, despite an observed increase in the risk profile of patients over 23 years. A shifting trend in valve replacement choices was observed with a rise in the use of biological prostheses, particularly within the 60-69 and 70-79 age group. Early in hospital outcomes for patients aged 60-70 were not determined by the implanted valve type.
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Affiliation(s)
- Jeremy Chan
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom
| | - Pradeep Narayan
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom
| | - Daniel P Fudulu
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom
| | - Tim Dong
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom
| | - Gianni D Angelini
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom.
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4
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Zamorano JL, Appleby C, Benamer H, Frankenstein L, Musumeci G, Nombela-Franco L. Improving access to transcatheter aortic valve implantation across Europe by restructuring cardiovascular services: An expert council consensus statement. Catheter Cardiovasc Interv 2023; 102:547-557. [PMID: 37431253 DOI: 10.1002/ccd.30760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/01/2023] [Accepted: 06/28/2023] [Indexed: 07/12/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is recommended for a growing range of patients with severe aortic stenosis in the European Society of Cardiology and European Association for Cardio-Thoracic Surgery (ESC/EACTS) 2021 Guidelines update. However, guideline implementation programs are needed to ensure the application of clinical recommendations which will favorably influence disease outcomes. An Expert Council was convened to identify whether cardiology services across Europe are set up to address the growing needs of patients with severe aortic stenosis for increased access to TAVI by identifying the key challenges faced in growing TAVI programs and mapping associated solutions. Wide variation exists across Europe in terms of TAVI availability and capacity to deliver the increased demand for TAVI in different countries. The recommendations of this Expert Council focus on the short-to-medium-term aspects where the most immediate, actionable impact can be achieved. The focus on improving procedural efficiency and optimizing the patient pathway via clinical practice and patient management demonstrates how to mitigate the current major issues of shortfall in catheterization laboratory, workforce, and bed capacity. Procedural efficiencies may be achieved through steps including streamlined patient assessment, the benchmarking of standards for minimalist procedures, standardized approaches around patient monitoring and conduction issues, and the implementation of nurse specialists and dedicated TAVI coordinators to manage organization, logistics, and early mobilization. Increased collaboration with wider stakeholders within institutions will support successful TAVI uptake and improve patient and economic outcomes. Further, increased education, collaboration, and partnership between cardiology centers will facilitate sharing of expertise and best clinical practice.
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Affiliation(s)
- José Luis Zamorano
- Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain
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5
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Adjibodou OB, Brinkert M, Haegeli L. Transcatheter Valve Implantation in Patients with Multivalvular Heart Disease. PRAXIS 2023; 112:53-54. [PMID: 36722111 DOI: 10.1024/1661-8157/a003983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
| | - Miriam Brinkert
- Department of Cardiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Laurent Haegeli
- Department of Cardiology, Cantonal Hospital Aarau, Aarau, Switzerland
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6
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Södergren A, Solbritt Rantapää-Dahlqvist, Ljung L. Time Trends of Cardiovascular Disease in the General Population and Inflammatory Arthritis. Rheum Dis Clin North Am 2023; 49:1-17. [PMID: 36424020 DOI: 10.1016/j.rdc.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cardiovascular diseases (CVDs) are the leading causes of death in the world, but declining trends for cardiovascular (CV) mortality and morbidity have been observed during the last decades. Reports on secular trends regarding the excess CV mortality and morbidity in rheumatoid arthritis show diverging results. Data support that also patients with inflammatory arthritis have benefited from improved treatment and prevention for CVD, which can be observed, for example, in decreased case fatality after CV event. However, several recent studies indicate a remaining excess CV risk in patients with inflammatory arthritis.
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Affiliation(s)
- Anna Södergren
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, 901 87 Umeå, Sweden; Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, Umeå, Sweden.
| | | | - Lotta Ljung
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, 901 87 Umeå, Sweden; Center for Rheumatology, Academic Specialist Center, Stockholm Health Services, Box 6357, Stockholm 102 35, Sweden. https://twitter.com/lotta_ljung
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Vogl B, Gadhave R, Wang Z, El Shaer A, Chavez Ponce A, Alkhouli M, Hatoum H. Effect of aortic curvature on bioprosthetic aortic valve performance. J Biomech 2023; 146:111422. [PMID: 36610388 DOI: 10.1016/j.jbiomech.2022.111422] [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: 03/28/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 12/25/2022]
Abstract
Transvalvular pressure gradient (ΔP) after aortic valve replacement is an important surrogate of aortic bioprostheses performance. Invasive ΔP is often measured after transcatheter aortic valve replacement to exclude patient-prosthetic mismatch. However, invasive aortic pressures are usually recorded in the pressure recovery (PR) zone downstream of the valve, potentially resulting in ΔP underestimation compared to noninvasive measurements. PR was extensively studied in straight ascending aortas. However, the impact of various aortic arch configurations on ΔP has not been explored. PR was assessed in a pulse duplicating simulator at various cardiac conditions of cardiac output, heart rates and pressures. Three different aortic geometries with identical root dimensions but with different aortic arches were used: (1) curvature 1, (2) curvature 2, and (3) straight aortic models. Instantaneous pressure and peak ΔP measurements were recorded incrementally along the models for each cardiac condition. The models with aortic arches produced two distinct PR zones (after the valve and after the aortic arch), whereas the model without an aortic arch produced only one PR zone (after the valve). The trend of the pressure and ΔP curves for each model was independent of the cardiac condition used, but the individually measured pressure magnitudes did change with different conditions. In this study, we illustrated the differences in PR between distinct aortic curvatures and straight aorta. PR affects pressure and ΔP measurements. These effects are clear when recording aortic pressures by catheterization and echocardiography.
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Affiliation(s)
- Brennan Vogl
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
| | - Rajat Gadhave
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
| | - Zhenyu Wang
- Department of Mechanical Engineering, The Ohio State University, Columbus, OH, USA; Simulation Innovation and Modeling Center, The Ohio State University, Columbus, OH, USA
| | - Ahmed El Shaer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hoda Hatoum
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA; Health Research Institute, Center of Biocomputing and Digital Health and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, USA.
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8
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Crea F. Challenges in the management of aortic stenosis, multiple valve disease, culture-negative endocarditis, and cardiac surgery during pregnancy. Eur Heart J 2022; 43:2715-2719. [PMID: 35908774 DOI: 10.1093/eurheartj/ehac381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Sulaiman S, Kawsara A, Mahayni AA, El Sabbagh A, Singh M, Crestanello J, Gulati R, Alkhouli M. Development and Validation of a Machine Learning Score for Readmissions After Transcatheter Aortic Valve Implantation. JACC. ADVANCES 2022; 1:100060. [PMID: 38938389 PMCID: PMC11198219 DOI: 10.1016/j.jacadv.2022.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 06/29/2024]
Abstract
Background Identifying predictors of readmissions after transcatheter aortic valve implantation (TAVI) is an important unmet need. Objectives We sought to explore the role of machine learning (ML) in predicting readmissions after TAVI. Methods We included patients who underwent TAVI between 2016 and 2019 in the Nationwide Readmission Database. A total of 917 candidate predictors representing all International Classification of Diseases, Tenth Revision, diagnosis and procedure codes were included. First, we used lasso regression to remove noninformative variables and rank informative ones. Next, we used an unsupervised ML model (K-means) to identify patterns/clusters in the data. Furthermore, we used Light Gradient Boosting Machine and Shapley Additive exPlanations to specify the impact of individual predictors. Finally, we built a parsimonious model to predict 30-day readmission. Results A total of 117,398 and 93,800 index TAVI hospitalizations were included in the 30- and 90-day analyses, respectively. Lasso regression identified 138 and 199 informative predictors for the 30- and 90-day readmission, respectively. Next, K-means recognized 2 distinct clusters: low risk and high risk. In the 30-day cohort, the readmission rate was 10.1% in the low risk group and 23.3% in the high risk group. In the 90-day cohort, the rates were 17.4% and 35.3%, respectively. The top predictors were the length of stay, frailty score, total discharge diagnoses, acute kidney injury, and Elixhauser score. These predictors were incorporated into a risk score (TAVI readmission score), which exhibited good performance in an external validation cohort (area under the curve 0.74 [0.7-0.78]). Conclusions ML methods can leverage widely available administrative databases to identify patients at risk for readmission after TAVI, which could inform and improve post-TAVI care.
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Affiliation(s)
- Samian Sulaiman
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Akram Kawsara
- Division of Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | - Abdulah Amr Mahayni
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Abdullah El Sabbagh
- Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, Florida, USA
| | - Mandeep Singh
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan Crestanello
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajiv Gulati
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
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10
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Tijmes FS, Karur GR. Imaging of Heritable Thoracic Aortic Disease. Semin Roentgenol 2022; 57:364-379. [DOI: 10.1053/j.ro.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 11/11/2022]
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Jain V, Minhas AMK, Kleiman NS, Arshad HB, Saleh Y, Pandat SS, Dani SS, Goel SS, Faza N, Butt SA, Blankstein R, Cainzos-Achirica M, Nasir K, Khan SU. Cardiac Arrest in Young Adults with Ischemic Heart Disease in the United States, 2004-2018. Curr Probl Cardiol 2022; 47:101312. [PMID: 35839933 DOI: 10.1016/j.cpcardiol.2022.101312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cardiac arrest (CA) among young adults (<45 y) with ischemic heart disease (IHD) remained understudied. OBJECTIVE To evaluate the trends in clinical profile, in-hospital mortality, and health care resource utilization in CA-related hospitalizations among young adults with IHD. METHODS National Inpatient Sample (2004-2018) was used to identify adults aged 18- 45 years. RESULTS Of 77,359 weighted CA-related hospitalizations (mean age: 39 [0.05] y; 34.3% women), 65% had a myocardial infarction (MI), and 58% had a shockable rhythm. Between 2004 and 2018, CA-related hospitalizations among young adults with IHD increased from 1.8% to 2.4%. Overall, in-hospital mortality was 36.4%, which was higher for women vs. men (40.4% vs. 34.2%; p<0.001) and Black vs. White adults (43.9% vs. 33.3%; p<0.001). In-hospital mortality increased from 33.5% to 38.1%, with a consistent upward trend in men, White adults, and both MI and non-MI cases. However, in STEMI (40%), in-hospital mortality decreased from 34.6% to 20.2% (p-trend <0.001), while it increased in NSTEMI (14.8%) from 34.3% to 47.5% (p-trend <0.001). Overall mean length of stay (LOS) (7 to 9 days) and mean inflation-adjusted care cost ($34,431 to $44,646) increased over the study duration. CONCLUSION CA-related hospitalizations and associated LOS and inflation-adjusted care costs have increased in the last 15 years. In-hospital mortality increased by ∼5% during the study period with a higher mortality in women and among black adults. While increased CA-related hospitalizations may reflect improved pre-hospital care, greater efforts are needed to address improve in-hospital survival in CA among young adults with IHD.
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Affiliation(s)
| | | | - Neal S Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Hassaan B Arshad
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Yehia Saleh
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Summit S Pandat
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital, and Medical Center, Beth Israel Lahey Health, Burlington, MA
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Nadeen Faza
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Sara Ayaz Butt
- Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Ron Blankstein
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | - Miguel Cainzos-Achirica
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX; Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX; Center for Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, TX; Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Khurram Nasir
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX; Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX; Center for Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, TX; Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX.
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12
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Sulaiman S, Kawsara A, Alkhouli M. Impact of the Change in Annual Volume on the Outcomes of Surgical Aortic Valve Replacement Between 2012 and 2019. Am J Cardiol 2022; 173:146-147. [PMID: 35428472 DOI: 10.1016/j.amjcard.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/15/2022] [Indexed: 11/01/2022]
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13
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Kim WK, Möllmann H. Neo to Neo2: A Tiny Detail With Considerable Impact. JACC Cardiovasc Interv 2022; 15:1111-1112. [PMID: 35680189 DOI: 10.1016/j.jcin.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Won-Keun Kim
- Departments of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, and the German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany; Department of Cardiology, Justus-Liebig University of Giessen, Giessen, Germany.
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
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Xu H, Liu Q, Cao K, Ye Y, Zhang B, Li Z, Hao J, Qi X, Zhao Q, Liu S, Gao R, Wu Y. Distribution, Characteristics, and Management of Older Patients With Valvular Heart Disease in China. JACC: ASIA 2022; 2:354-365. [PMID: 36338396 PMCID: PMC9627799 DOI: 10.1016/j.jacasi.2021.11.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/30/2021] [Accepted: 11/29/2021] [Indexed: 12/26/2022]
Abstract
Background The epidemiology and management of valvular heart disease (VHD) have changed with economic development and population aging in China in recent decades. Objectives This study sought to understand the distribution, etiology, and presentation and assess the current practice and outcomes of older patients with VHD in China. Methods The authors conducted the first nationwide survey of older patients with VHD between September and December 2016 from 69 hospitals in 28 provinces and municipalities throughout China. Hospitalized patients over 60 years of age with moderate-to-severe VHD, infective endocarditis, or previous valvular intervention were consecutively enrolled. Results Of 8,929 patients (median age of 69 years, 47.5% female), 8227 (92.1%) had native VHD. Mitral regurgitation was the most prevalent single VHD (26.9% of native VHD), followed by tricuspid regurgitation (16.5%), aortic regurgitation (10.6%), aortic stenosis (5.1%), and mitral stenosis (3.1%). Degenerative (37.2%), functional (21.8%), and rheumatic (15.0%) etiologies were the 3 most common causes. Among symptomatic patients with severe VHD, 37.3% underwent valvular intervention. The intervention rates decreased significantly with age across all types of VHD (Ptrend < 0.01). Valvular surgery covered 93.7% of interventions. The overall 1-year survival rate was 74.4% (95% CI: 63.4%-85.4%). Conclusions This study provides a unique national insight into the contemporary spectrum and management of older VHD patients in China. With the increase in the health care demand, more resources and efforts are required for early detection, effective intervention, and targeting innovation on advanced therapeutic techniques and devices to improve the outcomes.
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Affiliation(s)
- Haiyan Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qingrong Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Cao
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yunqing Ye
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhe Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Hao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiling Qi
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qinghao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sisi Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runlin Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongjian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Address for correspondence: Dr Yongjian Wu, Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Center for Cardiovascular Diseases of China, 167 Beilishi Road, Beijing 100037, People’s Republic of China.
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15
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Jain V, Minhas AMK, Khan SU, Greene SJ, Pandey A, Van Spall HGC, Fonarow GC, Mentz RJ, Butler J, Khan MS. Trends in HF Hospitalizations Among Young Adults in the United States From 2004 to 2018. JACC. HEART FAILURE 2022; 10:350-362. [PMID: 35483798 DOI: 10.1016/j.jchf.2022.01.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of this study was to assess trends in heart failure (HF) hospitalizations among young adults. BACKGROUND Data are limited regarding clinical characteristics and outcomes of young adults hospitalized for HF. METHODS The National Inpatient Sample database was analyzed to identify adults aged 18 to 45 years who were hospitalized for HF between 2004 and 2018. RESULTS In total, 767,180 weighted hospitalizations for HF in young adults were identified, equivalent to 4.32 (95% CI: 4.31-4.33) per 10,000 person-years. Overall HF hospitalizations per 10,000 U.S. population of young adults decreased from 2.43 in 2004 to 1.82 in 2012, followed by an increase to 2.51 in 2018. Black adults (50.1%) had a significantly higher proportion of HF hospitalizations compared with White (31.9%) and Hispanic adults (12.2%) throughout the study period. Nearly half of patients (45.8%) lived in zip codes in the lowest quartile of national household income. Overall, in-hospital mortality was 1.3%, which decreased over time; this trend was consistent by sex and race. The overall mean LOS (5.2 days) remained stable over time, while the mean inflation-adjusted cost increased from $12,449 in 2004 to $16,786 in 2018, with significant overall differences by race and sex. CONCLUSIONS This longitudinal examination of U.S. clinical practice revealed that HF hospitalizations among young adults have increased since 2013. Approximately half of these patients are Black and reside in zip codes in the lowest quartile of national household income. Temporal trends showed decreased in-hospital mortality, stable adjusted lengths of stay, and increased inflation-adjusted costs, with significant racial differences in hospitalization rates.
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Affiliation(s)
- Vardhman Jain
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Safi U Khan
- Houston Methodist Hospital, Houston, Texas, USA
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Harriette G C Van Spall
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine, University of California-Los Angeles, Medical Center, Los Angeles, California, USA
| | - Robert J Mentz
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Muhammad Shahzeb Khan
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA.
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16
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Siddiqi TJ, Usman MS, Ahmed J, Shahid I, Ahmed W, Alkhouli M. Evaluating the effect of multivalvular disease on mortality after transcatheter aortic valve replacement for aortic stenosis: a meta-analysis and systematic review. Future Cardiol 2022; 18:487-496. [PMID: 35485390 DOI: 10.2217/fca-2021-0061] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: To determine the prognosis of multivalvular disease in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. Methods: Patients undergoing TAVR for aortic stenosis with covariate-adjusted risk of mortality associated with concomitant valve disease (mitral regurgitation [MR], mitral stenosis [MS] or tricuspid regurgitation [TR]) were included. Results: Moderate-to-severe MR was associated with increased mortality at 30 days (hazard ratio [HR]: 1.60; 95% CI: 1.11-2.30; p = 0.01) and 1 year (HR: 1.87; 95% CI: 1.22-2.87; p = 0.004). The presence of all-grade MS did not impact 30-day or 1-year mortality (HR, 30 days: 1.60; 95% CI: 0.71-3.63; p = 0.26; and HR, 1 year: 1.90; 95% CI: 0.98-3.69; p = 0.06); however, an increased risk of 1-year mortality (HR: 1.67; 95% CI: 1.03-2.70; p = 0.04) was observed with severe MS compared with no MS. Moderate-to-severe TR had a higher risk of all-cause mortality at 1 year (HR: 1.49; 95% CI: 1.24-1.78; p < 0.001) compared with no or mild TR. Conclusion: Moderate-to-severe MR or TR, and severe MS, significantly increase mid-term mortality after TAVR.
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Affiliation(s)
| | | | - Jawad Ahmed
- Department of Medicine, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Izza Shahid
- Department of Medicine, Ziauddin Medical University, Karachi, 7500, Pakistan
| | - Warda Ahmed
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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17
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Isogai T, Dykun I, Agrawal A, Shekhar S, Saad AM, Verma BR, Abdelfattah OM, Kalra A, Krishnaswamy A, Reed GW, Kapadia SR, Puri R. Risk Stratification and Management of Advanced Conduction Disturbances Following TAVI in Patients With Pre-Existing RBBB. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100006. [PMID: 37273468 PMCID: PMC10236876 DOI: 10.1016/j.shj.2022.100006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/15/2021] [Accepted: 11/03/2021] [Indexed: 06/06/2023]
Abstract
Background Pre-existing right bundle branch block (RBBB) is a strong predictor of increased need for a permanent pacemaker (PPM) following transcatheter aortic valve implantation (TAVI). Yet, further risk stratification and management remain challenging in patients with pre-existing RBBB owing to limited data. Therefore, we sought to investigate the incidence, predictors, and management of advanced conduction disturbances after TAVI in patients with pre-existing RBBB. Methods We retrospectively reviewed 261 consecutive patients with pre-existing RBBB (median age 81 years; 28.0% female; 95.0% received a balloon-expandable valve) without a pre-existing PPM who underwent TAVI at our institution in 2015-2019. Outcomes were high-degree atrioventricular block/complete heart block (HAVB/CHB) and PPM requirement. Results Overall, the 30-day HAVB/CHB rate was 28.0%, of which 76.7% occurred during the TAVI procedure. The delayed HAVB/CHB rate was 8.3%. Implantation depth below aortic annulus (per 1-mm increase) was significantly associated with increased risk of procedural HAVB/CHB (adjusted odds ratio = 1.25, 95% confidence interval = 1.07-1.46), delayed HAVB/CHB (1.34 [1.01-1.79]), and 30-day PPM (1.32 [1.11-1.55]). Predilation was associated with delayed HAVB/CHB (4.02 [1.22-13.23]). The combination of no predilation and implantation depth of ≤2.0 mm had lower rates of procedural HAVB/CHB (11.2% vs. 26.7%-30.4%, p = 0.011), delayed HAVB/CHB (2.1% vs. 7.6%-28.1%, p < 0.001), and 30-day PPM (10.3% vs. 20.0%-43.5%, p < 0.001) than the other strategies of valve deployment. Complete HAVB/CHB recovery after PPM implantation was uncommon at 7.1%. Conclusions In patients with pre-existing RBBB, the majority of HAVB/CHB events occurred during the TAVI procedure. Avoidance of predilation coupled with high valve deployment may result in relatively low rates of procedural and delayed HAVB/CHB, along with 30-day PPM rates.
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Affiliation(s)
- Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Iryna Dykun
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anas M. Saad
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Beni Rai Verma
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Omar M. Abdelfattah
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Grant W. Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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18
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Isogai T, Dykun I, Agrawal A, Shekhar S, Tarakji KG, Wazni OM, Kalra A, Krishnaswamy A, Reed GW, Kapadia SR, Puri R. Early Resolution of New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Implantation With the SAPIEN 3 Valve. Am J Cardiol 2022; 168:117-127. [PMID: 35045936 DOI: 10.1016/j.amjcard.2021.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022]
Abstract
New-onset left bundle branch block (LBBB) is common after transcatheter aortic valve implantation (TAVI) but can resolve in the post-TAVI period. We sought to examine the incidence, predictors, and outcomes of early resolution of new-onset LBBB among TAVI recipients with a SAPIEN 3 (S3) valve. Among 1,203 S3-TAVI recipients without a pre-existing pacemaker or wide QRS complex at our institution between 2016 and 2019, we identified 143 patients who developed new-onset LBBB during TAVI and divided them according to the resolution or persistence of LBBB by the next day post-TAVI to compare high-degree atrioventricular block (HAVB) and permanent pacemaker (PPM) rates. Patients with resolved LBBB (n = 74, 52%), compared with those with persistent LBBB, were more often women and had a shorter QRS duration at baseline and post-TAVI, with a smaller S3 size and a shallower implantation depth. A multivariable logistic regression model demonstrated significant associations of post-TAVI QRS duration (per 10 ms increase, odds ratio = 0.60 [95% confidence interval = 0.44 to 0.82]) and implantation depth (per 1-mm-depth-increase, 0.77 [0.61 to 0.97]) with a lower likelihood of LBBB resolution. No patient with resolved LBBB developed HAVB within 30 days post-TAVI. Meanwhile, 8 patients (11.6%) with persistent LBBB developed HAVB. The 2-year PPM rate was significantly higher after persistent LBBB than after resolved LBBB (30.3% vs 4.5%, log-rank p <0.001), mainly driven by higher 30-day PPM rate (18.8% vs 0.0%). In conclusion, about half of new-onset LBBBs that occurred during S3-TAVI resolved by the next day post-TAVI without HAVB. In contrast, new-onset persistent LBBB may need follow-up with ambulatory monitoring within 30 days because of the HAVB risk.
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Affiliation(s)
- Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Iryna Dykun
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Khaldoun G Tarakji
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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19
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Krishnaswamy A, Isogai T, Agrawal A, Shekhar S, Puri R, Reed GW, Yun JJ, Unai S, Burns DJP, Vargo PR, Kapadia SR. Feasibility and Safety of Same-Day Discharge Following Transfemoral Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2022; 15:575-589. [PMID: 35331449 DOI: 10.1016/j.jcin.2022.01.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study evaluated the feasibility and safety of same-day discharge (SDD) following transfemoral transcatheter aortic valve replacement (TF-TAVR) compared with next-day discharge (NDD). BACKGROUND Reducing hospital length of stay is an important goal for patients and hospitals. Cleveland Clinic implemented a post-TAVR SDD pathway beginning in March 2020. METHODS The study retrospectively analyzed patients who underwent "minimalist" outpatient TF-TAVR in 2019 to 2020. SDD was applied to patients who met the predefined criteria. Outcomes included in-hospital and 30-day events and were compared between SDD and NDD (during and prior to availability of the SDD pathway). RESULTS In 2020, SDD and NDD accounted for 22.1% (n = 114 of 516) and 63.8% (n = 329 of 516) of outpatient TF-TAVR, respectively. SDD patients in 2020, compared with NDD patients in 2019 (n = 481), were younger, were more often male, and had a lower surgical risk. There were no significant differences in in-hospital events and 30-day readmissions (cardiovascular readmission: 3.5% vs 6.2%; P = 0.37; noncardiovascular readmission: 2.6% vs 4.0%; P = 0.78), and there were no deaths after SDD. These outcomes remained consistent after propensity score matching. Only 1 (0.9%) patient required pacemaker implantation after SDD (post-TAVR day 25). As expected based on SDD criteria, multivariable logistic regression analysis identified procedure end-time as the strongest predictor of SDD (adjusted OR: 7.74; 95% CI: 4.39-13.63), while male sex and baseline hemoglobin level were also associated with SDD. CONCLUSIONS SDD after TF-TAVR was feasible in this early experience without impairing post-discharge safety. Our SDD pathway may serve as a useful strategy to improve bed utilization and reduce hospital stay for TAVR recipients.
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Affiliation(s)
- Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. https://twitter.com/toshiaki_isogai
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. https://twitter.com/AnkitAgrawalMD
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. https://twitter.com/brownshekhar
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. https://twitter.com/GrantReedMD
| | - James J Yun
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel J P Burns
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick R Vargo
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. https://twitter.com/tavrkapadia
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20
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Khan S, Dargham S, Al Suwaidi J, Jneid H, Abi Khalil C. Trends and Outcomes of Aortic Valve Replacement in Patients With Diabetes in the US. Front Cardiovasc Med 2022; 9:844068. [PMID: 35369344 PMCID: PMC8971926 DOI: 10.3389/fcvm.2022.844068] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
AimsWe aimed to assess the trend and outcome of aortic valve replacement in patients with diabetes.BackgroundDiabetes is associated with higher cardiovascular events.MethodsData from the National Inpatient Sample was analyzed between 2012 and 2017. We compared hospitalizations and in-hospital cardiovascular outcomes in patients with diabetes to those without diabetes, hospitalized for aortic valve replacement.ResultsIn diabetes patients undergoing TAVR, the mean age of participants decreased from 79.6 ± 8 to 67.8 ± 8, hospitalizations increased from 0.97 to 7.68/100,000 US adults (p < 0.002 for both). There was a significant temporal decrease in mortality, acute renal failure (ARF), and stroke. Compared to non-diabetic patients, those with diabetes had a higher risk of stroke, ARF, and pacemaker requirement [adjusted OR = 1.174 (1.03–1.34), 1.294 (1.24–1.35), 1.153 (1.11–1.20), respectively], but a similar adjusted mortality risk. In diabetes patients undergoing sAVR, the mean age of participants decreased from 70.4 ± 10 to 68 ± 9 (p < 0.001), hospitalizations dropped from 7.72 to 6.63/100,000 US adults (p = 0.025), so did mortality, bleeding, and ARF. When compared to non-diabetes patients, those with diabetes were older and had a higher adjusted risk of mortality, stroke, and ARF [adjusted OR= 1.115 (1.06–1.17), 1.140 (1.05–1.23), 1.217 (1.18–1.26); respectively].ConclusionThe recent temporal trend of aortic valve replacement in patients with diabetes shows a significant increase in TAVR coupled with a decrease in sAVR. Mortality and other cardiovascular outcomes decreased in both techniques. sAVR, but not TAVR, was associated with higher in-hospital mortality risk.
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21
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Li SX, Patel NK, Flannery LD, Selberg A, Kandanelly RR, Morrison FJ, Kim J, Tanguturi VK, Crousillat DR, Shaqdan AW, Inglessis I, Shah PB, Passeri JJ, Kaneko T, Jassar AS, Langer NB, Turchin A, Elmariah S. Trends in Utilization of Aortic Valve Replacement for Severe Aortic Stenosis. J Am Coll Cardiol 2022; 79:864-877. [PMID: 35241220 DOI: 10.1016/j.jacc.2021.11.060] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/19/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Despite the rapid growth of aortic valve replacement (AVR) for aortic stenosis (AS), limited data suggest symptomatic severe AS remains undertreated. OBJECTIVES This study sought to investigate temporal trends in AVR utilization among patients with a clinical indication for AVR. METHODS Patients with severe AS (aortic valve area <1 cm2) on transthoracic echocardiograms from 2000 to 2017 at 2 large academic medical centers were classified based on clinical guideline indications for AVR and divided into 4 AS subgroups: high gradient with normal left ventricular ejection fraction (LVEF) (HG-NEF), high gradient with low LVEF (HG-LEF), low gradient with normal LVEF (LG-NEF), and low gradient with low LVEF (LG-LEF). Utilization of AVR was examined and predictors identified. RESULTS Of 10,795 patients, 6,150 (57%) had an indication or potential indication for AVR, of whom 2,977 (48%) received AVR. The frequency of AVR varied by AS subtype with LG groups less likely to receive an AVR (HG-NEF: 70%, HG-LEF: 53%, LG-NEF: 32%, LG-LEF: 38%, P < 0.001). AVR volumes grew over the 18-year study period but were paralleled by comparable growth in the number of patients with an indication for AVR. In patients with a Class I indication, younger age, coronary artery disease, smoking history, higher hematocrit, outpatient index transthoracic echocardiogram, and LVEF ≥0.5 were independently associated with an increased likelihood of receiving an AVR. AVR was associated with improved survival in each AS-subgroup. CONCLUSIONS Over an 18-year period, the proportion of patients with an indication for AVR who did not receive AVR has remained substantial despite the rapid growth of AVR volumes.
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Affiliation(s)
- Shawn X Li
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. https://twitter.com/ShawnXLiMD
| | - Nilay K Patel
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura D Flannery
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra Selberg
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ritvik R Kandanelly
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fritha J Morrison
- Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joonghee Kim
- Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Varsha K Tanguturi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniela R Crousillat
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ayman W Shaqdan
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ignacio Inglessis
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pinak B Shah
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan J Passeri
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Arminder S Jassar
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nathaniel B Langer
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Turchin
- Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sammy Elmariah
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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22
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Alkhouli M, Moussa I, Deshmukh A, Ammash NM, Klaas JP, Holmes DR. The Heart Brain Team and Patient-Centered Management of Ischemic Stroke. JACC. ADVANCES 2022; 1:100014. [PMID: 38939078 PMCID: PMC11198076 DOI: 10.1016/j.jacadv.2022.100014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 06/29/2024]
Abstract
The multifaceted connections between the heart and the brain have been extensively studied at the anatomy, pathophysiology, and clinical levels. Studies have suggested a vital role for both cardiologists and neurologists in the management of various cardiovascular and neurological disorders. However, a true heart-brain team-based approach remained confined to large, specialized centers. In this paper, we review the various intersection areas of cardiology and neurology with regard to ischemic stroke. We focus our discussion on the challenges and opportunity for a heart-team approach to stroke in the context of atrial fibrillation, carotid disease, and patent foramen ovale, and in the setting of strokes complicating transcatheter endovascular interventions.
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Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Issam Moussa
- Carle Illinois College of Medicine, University of Illinois, Carle Heart and Vascular Institute, Champaign, Illinois, USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nasser M. Ammash
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - James P. Klaas
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - David R. Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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23
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Ennezat PV, Malergue MC, Jemtel THL, Abergel E. Timing of surgery in asymptomatic severe aortic stenosis: An unresolved issue. Arch Cardiovasc Dis 2022; 115:190-191. [DOI: 10.1016/j.acvd.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 11/25/2022]
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24
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Minhas AMK, Ijaz SH, Jamal S, Dani SS, Khan MS, Greene SJ, Fudim M, Warraich HJ, Shapiro MD, Virani SS, Nasir K, Khan SU. Trends in Characteristics and Outcomes in Primary Heart Failure Hospitalizations Among Older Population in the United States, 2004-2018. Circ Heart Fail 2022; 15:e008943. [PMID: 35078346 DOI: 10.1161/circheartfailure.121.008943] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart failure (HF) accounts for a significant proportion of morbidity, mortality, and health care costs among older adults in the United States. We evaluated trends in clinical outcomes and the economic burden of HF hospitalizations in older patients (≥80 years). METHODS This analysis included data from the National Inpatient Sample between January 2004 and December 2018. We examined the trends of clinical characteristics, inpatient mortality, and health care cost utilization in older US adults for HF hospitalizations. RESULTS We identified 6 034 951 weighted HF hospitalizations for older adults (3527 per 100 000 person-years). After an initial decline in HF hospitalizations per 100 000 older US older adults from 4211 in 2004 to 3089 in 2014, there was increase to 3388 in 2018 (P trend <0.001 for both). There was an overall increase in cardiometabolic and chronic comorbidities during the study period. Overall, inpatient mortality was 4.7%; the adjusted inpatient mortality decreased from 6.1% in 2004 to 3.6% in 2018 (P trend <0.001). There was a decrease in adjusted mean length of stay (from 6.0 days in 2004 to 4.7 days in 2018) and adjusted inflation-adjusted care costs (from $11 865 in 2004 to $9677 in 2018) during the study period (P trend <0.001 for both). In comparison with younger adults (<80 years), older adults had higher inpatient mortality (4.7% versus 2.2%) but lower inflation-adjusted care costs ($10 587 versus $14 088). CONCLUSIONS This 15-year national data suggests that despite a higher comorbidity burden and the recent increase in hospitalizations for HF in older patients, there has been an encouraging trend towards lower inpatient mortality, health care cost, and hospital length of stay among older adults in the United States.
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Affiliation(s)
| | - Sardar Hassan Ijaz
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA (S.H.I., S.S.D.)
| | - Shakeel Jamal
- Central Michigan University, College of Medicine, Saginaw (S.J.)
| | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA (S.H.I., S.S.D.)
| | - Muhammad Shahzeb Khan
- Division of Cardiology, Duke University Medical Center, Durham, NC (M.S.K., S.J.G., M.F.)
| | - Stephen J Greene
- Division of Cardiology, Duke University Medical Center, Durham, NC (M.S.K., S.J.G., M.F.).,Duke Clinical Research Institute, Durham, NC (S.J.G., M.F.)
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, NC (M.S.K., S.J.G., M.F.).,Duke Clinical Research Institute, Durham, NC (S.J.G., M.F.)
| | - Haider J Warraich
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (H.J.W.).,Department of Medicine, Cardiology Section, VA Boston Healthcare System, MA (H.J.W.)
| | - Michael D Shapiro
- Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (M.D.S.)
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX (S.S.V.)
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX. (K.N.).,Center for Outcomes Research, Houston Methodist, TX (K.N.)
| | - Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX. (S.U.K.)
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Vavilis G, Bäck M, Bárány P, Szummer K. Epidemiology of Aortic Stenosis/Aortic Valve Replacement (from the Nationwide Swedish Renal Registry). Am J Cardiol 2022; 163:58-64. [PMID: 34799087 DOI: 10.1016/j.amjcard.2021.09.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022]
Abstract
Contemporary data on the prevalence and incidence of aortic stenosis (AS) and aortic valve replacement (AVR) in patients initiating dialysis are scarce. This observational cohort study aimed to estimate (1) the point prevalence of AS and AVR at dialysis start and (2) the AS incidence and associated factors prospective to dialysis initiation. The study included 14,550 patients initiating dialysis registered in the Swedish Renal Registry between 2005 and 2018. AS was defined by the International Statistical Classification of Diseases, Tenth Revision codes, and AVR by the surgical procedure codes. Associations between covariates and outcomes were assessed in Cox regression models. The median age was 68 (57 to 77), 66% were males, and the point prevalence of AS and AVR was 3.4% and 1.1%, respectively. In those without known AS/AVR at dialysis initiation (n = 14,050), AS was diagnosed in 595 patients (incidence 16.3/1000 person-years, 95% confidence interval [CI] 15.1 to 17.7/1,000 person-years) during a median follow-up of 2.7 years (interquartile range 1.1 to 5.7). In adjusted Cox regression models, higher age (hazard ratio [HR] 1.03, 95% CI 1.02 to 1.04), male gender (HR 1.51, 95% CI 1.25 to 1.83), atrial fibrillation (HR 1.32, 95% CI 1.06 to 1.64), and hypertension (HR 1.65, 95% CI 1.03 to 2.65) were associated with incident AS. Peritoneal dialysis patients had a nonsignificant trend toward higher AS risk compared with hemodialysis (HR 1.18, 95% CI 0.99 to 1.40). About 20% of patients (n = 113) diagnosed with incident AS underwent AVR (incidence 3.1/1000 person-years, 95% CI 2.6 to 3.7/1,000). Only the male gender was associated with AVR (HR 2.07, 95% CI 1.30 to 3.30). In conclusion, the prevalence and incidence of AS and AVR in patients initiating dialysis are high. A fifth of newly diagnosed AS underwent AVR after dialysis onset.
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Affiliation(s)
- Georgios Vavilis
- Department of Medicine, Huddinge; Heart and Vascular Theme, Division of Coronary and Valvular Heart Disease, Karolinska University Hospital, Stockholm, Sweden.
| | - Magnus Bäck
- Heart and Vascular Theme, Division of Coronary and Valvular Heart Disease, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Solna
| | - Peter Bárány
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karolina Szummer
- Department of Medicine, Huddinge; Heart and Vascular Theme, Division of Coronary and Valvular Heart Disease, Karolinska University Hospital, Stockholm, Sweden
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26
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Patel KP, Lim WY, Pavithran A, Assadi R, Wan D, Kennon S, Ozkor M, Earley M, Sporton S, Dhinoja M, Hayward C, Muthumala A, Hunter R, Lowe M, Lambiase P, Segal O, Mathur A, Schilling R, Baumbach A, Mullen MJ, Chow AW. Early pacemaker implantation for transcatheter aortic valve implantation is safe and effective. Pacing Clin Electrophysiol 2022; 45:103-110. [PMID: 34727374 DOI: 10.1111/pace.14397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/09/2021] [Accepted: 10/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Permanent pacemaker (PPM) implantation is a common complication of transcatheter aortic valve implantation (TAVI). The optimum timing of PPM implantation is still unclear as conduction abnormalities evolve and a balance needs to be struck between conservative delays in the hope of conduction recovery and overutilization of pacing. This study aimed to assess the safety and efficacy of early PPM implantation, without an observation period, among TAVI patients. METHODS This is a retrospective, observational study of 1398 TAVI patients. Clinical and pacing data were collected at baseline, 30 days and at a median of 15 (4-21) months post-TAVI. Study endpoints included PPM-related complications, pacing utilization and hospital length of stay. RESULTS One hundred five patients (8.2%) required a PPM, of which 13 were implanted pre and 92 post-TAVI. Seventy-six percent required pacing for either second- or third-degree heart block. Time to implantation for post-TAVI PPM was 1 (0-3) day. Six patients experienced a pacing-related complication- lead displacement (n = 3), hematoma (n = 2), and device infection (n = 1). Pacing utilization defined as pacing >10% of the time or a pacing requirement at the time of the pacing check was demonstrated in 83% of patients. Multivariate analysis revealed complete heart block (CHB) was the only independent predictor of pacing utilization. Hospital length of stay for the post-TAVI PPM group was longer than the group without PPM (4 [2-8] vs. 3 [2-4] days; p < .001). CONCLUSIONS Early PPM implantation in TAVI patients is safe and majority of patients require pacing in the short and mid-term.
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Affiliation(s)
- Kush P Patel
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- Institute of Cardiovascular Science, University College London, UK
| | - Wei Yao Lim
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Asha Pavithran
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Rangeena Assadi
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Daniel Wan
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Simon Kennon
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Mick Ozkor
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Mark Earley
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Simon Sporton
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Mehul Dhinoja
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Carl Hayward
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Amal Muthumala
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Ross Hunter
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK
| | - Martin Lowe
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Pier Lambiase
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK
| | - Oliver Segal
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Anthony Mathur
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK
| | - Richard Schilling
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK
| | - Andreas Baumbach
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK
- Yale University School of Medicine, New Haven, USA
| | - Michael J Mullen
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Anthony Wc Chow
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK
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27
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6528954. [DOI: 10.1093/ejcts/ezac105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/21/2022] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
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28
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Alkhouli M. Delayed Atrioventricular Block After Transcatheter Aortic Valve Replacement: The New Achilles' Heel? JACC Cardiovasc Interv 2021; 14:2733-2737. [PMID: 34949398 DOI: 10.1016/j.jcin.2021.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/09/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
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29
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Mori M, Gupta A, Wang Y, Vahl T, Nazif T, Kirtane AJ, George I, Yong CM, Onuma O, Kodali S, Geirsson A, Leon MB, Krumholz HM. Trends in Transcatheter and Surgical Aortic Valve Replacement Among Older Adults in the United States. J Am Coll Cardiol 2021; 78:2161-2172. [PMID: 34823659 DOI: 10.1016/j.jacc.2021.09.855] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/25/2021] [Accepted: 09/07/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recent trends, including survival beyond 30 days, in aortic valve replacement (AVR) following the expansion of indications for transcatheter aortic valve replacement (TAVR) are not well-understood. OBJECTIVES The authors sought to characterize the trends in characteristics and outcomes of patients undergoing AVR. METHODS The authors analyzed Medicare beneficiaries who underwent TAVR and SAVR in 2012 to 2019. They evaluated case volume, demographics, comorbidities, 1-year mortality, and discharge disposition. Cox proportional hazard models were used to assess the annual change in outcomes. RESULTS Per 100,000 beneficiary-years, AVR increased from 107 to 156, TAVR increased from 19 to 101, whereas SAVR declined from 88 to 54. The median [interquartile range] age remained similar from 77 [71-83] years to 78 [72-84] years for overall AVR, decreased from 84 [79-88] years to 81 [75-86] years for TAVR, and decreased from 76 [71-81] years to 72 [68-77] years for SAVR. For all AVR patients, the prevalence of comorbidities remained relatively stable. The 1-year mortality for all AVR decreased from 11.9% to 9.4%. Annual change in the adjusted odds of 1-year mortality was 0.93 (95% CI: 0.92-0.94) for TAVR and 0.98 (95% CI: 0.97-0.99) for SAVR, and 0.94 (95% CI: 0.93-0.95) for all AVR. Patients discharged to home after AVR increased from 24.2% to 54.7%, primarily driven by increasing home discharge after TAVR. CONCLUSIONS The advent of TAVR has led to about a 60% increase in overall AVR in older adults. Improving outcomes in AVR as a whole following the advent of TAVR with increased access is a reassuring trend.
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Affiliation(s)
- Makoto Mori
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Aakriti Gupta
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA; Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Yun Wang
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA; Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Torsten Vahl
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Tamim Nazif
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Ajay J Kirtane
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Isaac George
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Celina M Yong
- Department of Medicine (Cardiovascular Medicine), Stanford University School of Medicine, Stanford, California, USA; Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Oyere Onuma
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Susheel Kodali
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Martin B Leon
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA; Section of Cardiology, Yale School of Medicine, New Haven, Connecticut, USA; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA.
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30
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Kawsara A, Sulaiman S, Mohamed M, Paul TK, Kashani KB, Boobes K, Rihal CS, Gulati R, Mamas MA, Alkhouli M. Treatment Effect of Percutaneous Coronary Intervention in Dialysis Patients With ST-Elevation Myocardial Infarction. Am J Kidney Dis 2021; 79:832-840. [PMID: 34662690 DOI: 10.1053/j.ajkd.2021.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/27/2021] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Patients receiving maintenance dialysis have higher mortality following primary percutaneous coronary intervention (pPCI) than patients not receiving dialysis. Whether pPCI confers a similar benefit to patients receiving dialysis remains unknown. We compared the effect of pPCI on in-hospital outcomes among patients hospitalized for STEMI and receiving maintenance dialysis to the effect among patients hospitalized for STEMI but not receiving dialysis. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS We used the National-Inpatient-Sample (2016-2018) and included all adult hospitalizations with a primary diagnosis of STEMI. PREDICTORS Primary exposure was PCI. Confounders included dialysis status, demographics, insurance, household income, comorbidities, and the elective nature of the admission. OUTCOMES In-hospital mortality, stroke, AKI, new dialysis requirements, vascular complications, gastrointestinal bleeding, blood transfusion, mechanical ventilation, palliative care, and discharge destination. ANALYTICAL APPROACH The average treatment effect [ATE] of pPCI was estimated using propensity score matching within ESRD and non-ESRD groups independently to explore if the effect is modified by ESRD status. Additionally, the average marginal effect [AME] was calculated accounting for the clustering within hospitals. RESULTS 4,220 (1.07%) out of 413,500 hospitalizations were for patients receiving dialysis. The dialysis cohort was older (65.2±12.2 vs. 63.4±13.1, p<0.001), had more females (42.4% vs. 30.6%, p<0.001) and more comorbidities, but fewer White patients (41.1% vs. 71.7%, p<0.001). Patients receiving dialysis underwent less angiography (73.1% vs. 85.4%, p<0.001) or pPCI (57.5% vs. 79.8%, p<0.001). pPCI was associated with lower mortality in patients receiving dialysis (15.7% vs. 27.1%, p<0.001) as well as in those who were not (5.0% vs. 17.4%, p<0.001). The ATE on mortality did not differ significantly between patients receiving dialysis (-8.6% [-15.6%, -1.6%], p=0.02) and those who were not (-8.2% [-8.8%, -7.5%], p<0.001 (p-interaction=0.9). The AME method showed similar results (-9.4% [-14.8%, -4.0%], p<0.001) among patients receiving dialysis and those who were not (-7.9% [-8.5%, -7.4%], p<0.001) (p-interaction=0.59). Both the ATE and AME were comparable for other in-hospital outcomes in both groups. LIMITATIONS Administrative data, lack of pharmacotherapy and long-term outcome data, and residual confounding. CONCLUSION Compared with conservative management, pPCI for STEMI was associated with comparable reductions in short-term mortality among patients irrespective of their receipt of maintenance dialysis.
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Affiliation(s)
- Akram Kawsara
- Division of Cardiology, West Virginia University, Morgantown, WV
| | - Samian Sulaiman
- Division of Cardiology, West Virginia University, Morgantown, WV
| | - Mohamed Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Timir K Paul
- Division of Cardiology, East Tennessee State University, Johnson City, TN
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Khaled Boobes
- Division of Nephrology, Department of Internal Medicine, Ohio State University, Columbus, OH
| | | | - Rajiv Gulati
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Mohamad Alkhouli
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN.
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31
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Patlolla SH, Schaff HV, Dearani JA, Stulak JM, Crestanello JA, Greason KL. Aortic Stenosis and Coronary Artery Disease: Cost of Transcatheter versus Surgical Management. Ann Thorac Surg 2021; 114:659-666. [PMID: 34560043 DOI: 10.1016/j.athoracsur.2021.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/12/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surgical aortic valve replacement with coronary artery bypass grafting (SAVR+CABG) is the recommended treatment for aortic stenosis (AS) and coronary artery disease (CAD), however percutaneous coronary intervention at the time of transcatheter aortic valve replacement (TAVR+PCI) is used with increasing frequency. METHODS Using the National Inpatient Sample, we identified all adult admissions with a diagnosis of AS. Sub-groups of SAVR+CABG and TAVR+PCI formed the study group. Outcomes of interest included total hospitalization charges, temporal trends, in-hospital mortality, and complications. RESULTS Between 2012 and 2017, a total of 97,955 (95.9%) admissions received SAVR+CABG, and 4240 (4.1%) received TAVR+PCI; the proportion of TAVR+PCI increased from 1.0% in 2012 to 9.2% in 2017 (p<0.001). Compared to those receiving TAVR+PCI, admissions receiving SAVR+CABG were younger, more likely to be male, and had lower comorbidity (all p<0.001). Adjusted in-hospital mortality was comparable in both groups (OR 0.94, 95% CI 0.79-1.11, p=0.45). Higher rates of pacemaker implantation, cardiac arrest, and vascular complications were seen in the TAVR+PCI group, while SAVR+CABG was associated with a greater requirement of prolonged ventilation. Admissions receiving TAVR+PCI had shorter lengths of hospital stay and were more likely to be discharged home. Nevertheless, TAVR+PCI had higher hospitalization charges compared to SAVR+CABG group (all p<0.001). CONCLUSIONS There has been a steady increase in the utilization of percutaneous strategies for AS and CAD management. In-hospital mortality was comparable in SAVR+CABG and TAVR+PCI groups, but despite shorter in-hospital stays, TAVR+PCI was associated with higher cardiac and vascular complication rates and hospitalization charges.
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Affiliation(s)
| | | | | | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester
| | | | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester
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Zhao Q, Xu H, Liu Q, Ye Y, Zhang B, Li Z, Gao R, Wu Y. Therapeutic Decision-Making and Outcomes in Elderly Patients With Severe Symptomatic Aortic Stenosis: Prognostic Implications of Elderly Patients' Initial Decisions. Front Cardiovasc Med 2021; 8:696763. [PMID: 34381825 PMCID: PMC8350052 DOI: 10.3389/fcvm.2021.696763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Despite clear indications for intervention, therapeutic decision-making for elderly patients with severe symptomatic aortic stenosis (AS) remains a complex issue due to the wide variation in individual risk profiles and the involvement of patients' subjective preferences. We aimed to investigate the reasons leading to the decisions against intervention and the consequences thereof on survival. Methods: Data were derived from the China Elderly Valve Disease (China-DVD) Cohort Study on patients aged ≥60-year-old with severe symptomatic AS consecutively enrolled between September to December 2016. Patients were analyzed according to the initial therapeutic decisions made by consensus between patients and physicians at the time of the index evaluation: intervention group (patients who were evaluated as suitable for intervention and accepted the treatment proposal); patient-refusal group (patients who were evaluated as suitable for intervention but refused due to subjective preferences); physician-deny group (patients who were denied intervention by physicians after evaluation). The least absolute shrinkage and selection operator (LASSO)-penalized logistic regression model was used to identify the factors associated with physicians' decisions against intervention. Twelve-month survival was analyzed using Cox proportional hazards models, with multivariate adjustment using inverse probability weighting (IPW). Results: Among the enrolled 456 elderly patients with severe symptomatic AS, 52 (11.4%) patients refused intervention and 49 (10.7%) patients were denied intervention by their physicians. LASSO-penalized logistic regression model identified that reduced left ventricular ejection fraction and increased EuroSCORE-II were strongly associated with physicians' decisions against intervention. At 12-month follow-up, only 8 (15.4%) patients who initially refused the intervention proposal underwent the subsequent intervention, with an average delay of 195 days. Patients' initial decisions against intervention were significantly associated with 12-month mortality, even after IPW adjustment (Hazard ratio: 2.61; 95% confidence interval: 1.09-6.20; P = 0.031). Conclusions: The decision against intervention was taken in about one-fifth of elderly patients with symptomatic severe AS, half of which were due to patients' subjective preferences. Surgical risk remains the primary concern for physicians when making therapeutic decisions. Elderly patients' initial decisions against intervention have a profound impact on subsequent intervention rates and prognosis, and therefore should be treated as a "risk factor" at the subjective level. Clinical Trial Registration: clinicaltrials.gov/ct2/show/NCT02865798, China elDerly Valve Disease (China-DVD) cohort study (NCT02865798).
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Affiliation(s)
| | | | | | | | | | | | | | - Yongjian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kichloo A, Minhas AMK, Jamal S, Shaikh AT, Albosta M, Singh J, Khan MZ, Aljadah M, Wani F, Wazir MHK, Kanjwal K. Trends and Inpatient Outcomes of Primary Heart Failure Hospitalizations with a Concurrent Diagnosis of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (from The National Inpatient Sample Database from 2004 to 2014). Am J Cardiol 2021; 150:69-76. [PMID: 34001343 DOI: 10.1016/j.amjcard.2021.03.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
Heart failure (HF) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are considered significant causes of morbidity and mortality worldwide. Concurrent presentation of HF with AECOPD can pose a diagnostic challenge due to an overlap in symptomatology. We queried the National Inpatient Sample (NIS) database to assess outcomes of HF hospitalizations with a secondary diagnosis of AECOPD. We performed a retrospective analysis of discharge data from the Healthcare Cost Utilization Project NIS between January 1, 2004, and December 31, 2014, with a primary diagnosis of HF with and without a secondary diagnosis of AECOPD. Data was abstracted from the NIS using International Classification of Disease 9 codes. Primary outcomes included mortality, length of stay, and inflation-adjusted cost of stay. During 2004-2014, a total of (n = 10,392,628) HF hospitalizations were identified without a secondary diagnosis of AECOPD while (n = 989,713) HF hospitalizations were identified with a secondary diagnosis of AECOPD. We identified higher mortality (3.25% vs 3.56%, p <0.001), length of stay (5.2 vs 6.1 days, p <0.001) and inflation-adjusted cost of stay (12,562 vs 13,072 USD, p <0.001) in HF hospitalizations with AECOPD when compared to HF without AECOPD from 2004 to 2014. We presented AECOPD as an independent predictor of mortality in patients admitted for HF. In conclusion, further interdisciplinary collaboration between pulmonologists and cardiologists is needed for the identification and stratification of patients who present with concurrent HF and COPD for better outcomes.
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Shah K, Krinock M, Thyagaturu H, Munshi R, Pandya A, Falta S, Hippen J, Durkin M. Temporal Trend, Prevalence, Predictors, and Outcomes of Pericardial Diseases in Patients Undergoing Transcatheter Aortic Valve Repair. Cureus 2021; 13:e16083. [PMID: 34249583 PMCID: PMC8248747 DOI: 10.7759/cureus.16083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/05/2022] Open
Abstract
Background Pericardial disease (PD) - acute pericarditis (AP) and pericardial effusion (PE) - is a rare complication of transcatheter aortic valve repair (TAVR) although its prevalence, predictors, and outcomes are not well studied. Methods We used the National Inpatient Sample (NIS) database to find patients who received TAVR between 2011 and 2018. TAVR patients were divided into two groups: with and without PD (AP and/or PE). The baseline characteristics between the two groups were compared using the Chi-square test and student t-test. Variables with a p-value of 0.20 or less from the univariate logistic regression were included in the multivariate logistic regression to find independent predictors of PD in TAVR patients. Results Out of 218,340 TAVR hospitalizations, 4323 (1.2%) had a concurrent diagnosis of PD. TAVR patients with PD were older (81 ± 7 vs 80 ± 6 years, p < 0.05), more likely to be females (62 vs 46%, p < 0.001), white (84.2 vs 82.9%, p = 0.83), and had a higher burden of comorbidities (Table 3). TAVR patients with PD had higher in-hospital mortality rate (12.3 vs 1.9%, p < 0.001), mean length of stay (8.4 vs 5.3 days, p < 0.001), and mean total hospital cost ($283,389 vs $224,544, p < 0.001). Age > 75, female sex, atrial fibrillation (Afib), atrial flutter (Aflutter), peripheral vascular disease (PVD), coagulopathy, cirrhosis, malnutrition, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and pacemaker (PM) implantation were the independent predictors of PD in TAVR patients. Conclusion Older, white females with a higher burden of comorbidities and cardiovascular procedures are at higher risk of pericardial complications of TAVR procedure. Sex-based disparities in the prevalence of PD after TAVR is an area of further research. Careful selection of patients for TAVR is essential to reduce the burden of these complications.
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Affiliation(s)
- Kashyap Shah
- Internal Medicine, St. Luke's University Health Network, Bethlehem, USA
| | - Matthew Krinock
- Internal Medicine, St. Luke's University Health Network, Bethlehem, USA
| | | | - Rezwan Munshi
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Ayushi Pandya
- Public Health and Policy, Edward J. Bloustein School of Planning and Public Policy at Rutgers University, New Brunswick, USA
| | - Sarah Falta
- Medicine, Lewis Katz School of Medicine, Philadelphia, USA
| | - John Hippen
- Internal Medicine, St. Luke's University Health Network, Bethlehem, USA
| | - Michael Durkin
- Cardiology, St. Luke's University Health Network, Bethlehem, USA
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Elbaz-Greener G, Rozen G, Kusniec F, Marai I, Carasso S, Ko DT, Wijeysundera HC, Alcalai R, Planer D, Amir O. Comparing Trajectory of Surgical Aortic Valve Replacement in the Early vs. Late Transcatheter Aortic Valve Replacement Era. Front Cardiovasc Med 2021; 8:680123. [PMID: 34239904 PMCID: PMC8258156 DOI: 10.3389/fcvm.2021.680123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Traditionally, the only effective treatment for aortic stenosis was surgical aortic valve replacement (SAVR). Transcatheter aortic valve replacement (TAVR) was approved in the United States in late 2011 and provided a critical alternative therapy. Our aims were to investigate the trends in the utilization of SAVR in the early vs. late TAVR era and to assess SAVR and TAVR outcomes. Methods: Using the 2011-2017 National Inpatient Sample database, we identified hospitalizations for patients with a most responsible diagnosis of aortic stenosis during which an aortic valve replacement (AVR) was performed, either SAVR or TAVR. Patients' sociodemographic and clinical characteristics, procedure complications, length of stay, and mortality were analyzed. Multivariable analyses were performed to identify predictors of in-hospital mortality. Piecewise regression analyses were performed to assess temporal trends in SAVR and TAVR utilization. Results: A total of 542,734 AVR procedures were analyzed. The utilization of SAVR was steady until 2014 with a significant downward trend in the following years 2015-2017 (P = 0.026). In contrast, a steady upward trend was observed in the TAVR procedure with a significant increase during the years 2015-2017 (P = 0.006). Higher in-hospital mortality was observed in SAVR patients. The mortality rate declined from 2011 to 2017 in a significantly higher proportion in the TAVR compared with the SAVR group. Conclusion: Utilization of SAVR showed a downward trend during the late TAVR era (2015-2017), and TAVR utilization demonstrated a steady upward trend during the years 2011-2017. Higher in-hospital mortality was recorded in patients who underwent SAVR.
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Affiliation(s)
- Gabby Elbaz-Greener
- Department of Cardiology, The Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.,Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poria, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Guy Rozen
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poria, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,Cardiology Division, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Fabio Kusniec
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poria, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Ibrahim Marai
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poria, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Shemy Carasso
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poria, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Dennis T Ko
- Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Harindra C Wijeysundera
- Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Ronny Alcalai
- Department of Cardiology, The Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Planer
- Department of Cardiology, The Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Offer Amir
- Department of Cardiology, The Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.,Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poria, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
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Herry M, Laghlam D, Touboul O, Nguyen LS, Estagnasié P, Brusset A, Squara P. Pacemaker implantation after aortic valve replacement: rapid-deployment Intuity® compared to conventional bioprostheses. Eur J Cardiothorac Surg 2021; 58:335-342. [PMID: 32215660 PMCID: PMC7373323 DOI: 10.1093/ejcts/ezaa068] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Morgane Herry
- Department of Cardiology and Critical Care, Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Driss Laghlam
- Department of Cardiology and Critical Care, Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Olivier Touboul
- Department of Cardiology and Critical Care, Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Lee S Nguyen
- Department of Cardiology and Critical Care, Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Philippe Estagnasié
- Department of Cardiology and Critical Care, Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Alain Brusset
- Department of Cardiology and Critical Care, Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Pierre Squara
- Department of Cardiology and Critical Care, Clinique Ambroise Paré, Neuilly-sur-Seine, France
- Corresponding author. Department of Cardiology and Critical Care, CERIC, Clinique Ambroise Paré, 27 Boulevard Victor Hugo, 92200 Neuilly-sur-Seine, France. Tel: +33-6-07370425; e-mail: (P. Squara)
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Grines CL, Klein AJ, Bauser-Heaton H, Alkhouli M, Katukuri N, Aggarwal V, Altin SE, Batchelor WB, Blankenship JC, Fakorede F, Hawkins B, Hernandez GA, Ijioma N, Keeshan B, Li J, Ligon RA, Pineda A, Sandoval Y, Young MN. Racial and ethnic disparities in coronary, vascular, structural, and congenital heart disease. Catheter Cardiovasc Interv 2021; 98:277-294. [PMID: 33909339 DOI: 10.1002/ccd.29745] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022]
Abstract
Cardiovascular disease (CVD) remains the leading cause of death in the United States. However, percutaneous interventional cardiovascular therapies are often underutilized in Blacks, Hispanics, and women and may contribute to excess morbidity and mortality in these vulnerable populations. The Society for Cardiovascular Angiography and Interventions (SCAI) is committed to reducing racial, ethnic, and sex-based treatment disparities in interventional cardiology patients. Accordingly, each of the SCAI Clinical Interest Councils (coronary, peripheral, structural, and congenital heart disease [CHD]) participated in the development of this whitepaper addressing disparities in diagnosis, treatment, and outcomes in underserved populations. The councils were charged with summarizing the available data on prevalence, treatment, and outcomes and elucidating potential reasons for any disparities. Given the huge changes in racial and ethnic composition by age in the United States (Figure 1), it was difficult to determine disparities in rates of diagnosis and we expected to find some racial differences in prevalence of disease. For example, since the average age of patients undergoing transcatheter aortic valve replacement (TAVR) is 80 years, one may expect 80% of TAVR patients to be non-Hispanic White. Conversely, only 50% of congenital heart interventions would be expected to be performed in non-Hispanic Whites. Finally, we identified opportunities for SCAI to advance clinical care and equity for our patients, regardless of sex, ethnicity, or race.
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Affiliation(s)
- Cindy L Grines
- Cardiology, Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
| | - Andrew J Klein
- Cardiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Holly Bauser-Heaton
- Pediatric Cardiology, Sibley Heart Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | - Neelima Katukuri
- Cardiology, Orlando VA Medical Center, University of Central Florida, Orlando, Florida, USA
| | - Varun Aggarwal
- Pediatric Cardiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - S Elissa Altin
- Cardiovascular Disease, Yale University, New Haven, Connecticut, USA
| | - Wayne B Batchelor
- Interventional Cardiology, Inova Heart and Vascular Institute, Fairfax, Virginia, USA
| | - James C Blankenship
- Internal Medicine, Cardiology Division, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Foluso Fakorede
- Interventional Cardiology, Cardiovascular Solutions of Central Mississippi, Cleveland, Mississippi, USA
| | - Beau Hawkins
- Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Gabriel A Hernandez
- Cardiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Britton Keeshan
- Clinical Pediatrics, Yale New Haven Children's Hospital, New Haven, Connecticut, USA
| | - Jun Li
- Cardiology, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - R Allen Ligon
- Pediatric Cardiology, Joe DiMaggio Children's Hospital - Memorial Healthcare System, Hollywood, Florida, USA
| | - Andres Pineda
- Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | | | - Michael N Young
- Cardiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Alkhouli M, Alqahtani F, Simard T, Pislaru S, Schaff HV, Nishimura RA. Predictors of Use and Outcomes of Mechanical Valve Replacement in the United States (2008-2017). J Am Heart Assoc 2021; 10:e019929. [PMID: 33870704 PMCID: PMC8200758 DOI: 10.1161/jaha.120.019929] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Contemporary nationwide data on the use, predictors, and outcomes of mechanical valve replacement in patients less than 70 years of age are limited. Methods and Results We identified hospitalizations for aortic valve replacement (AVR) or mitral valve replacement (MVR) in the Nationwide Inpatient Sample between January 1, 2008, and December 31, 2017. The study's end points included predictors of mechanical valve replacement and risk‐adjusted in‐hospital mortality. Among 253 100 hospitalizations for AVR, the use rate of mechanical prosthesis decreased from 45.3% in 2008 to 17.0% in 2017. Among 284 962 hospitalizations for MVR, mechanical prosthesis use decreased from 59.5% in 2008 to 29.2% in 2017 (P for trend<0.001). In multilogistic regression analyses, female sex, prior sternotomy, prior defibrillator, and South/West geographic location were predictive of mechanical valve use. The presence of bicuspid valve was a negative predictor of mechanical AVR (odds ratio [OR], 0.68; 95% CI, 0.66–0.69; P<0.001), whereas mitral stenosis was associated with higher mechanical MVR (OR, 1.28; 95% CI, 1.22–1.33; P<0.001). Unadjusted in‐hospital mortality decreased over time with AVR but not with MVR, regardless of prosthesis choice. Using years 2008 and 2009 as a reference, risk‐adjusted mortality also decreased over time with AVR but did not decrease after MVR. Conclusions There is a substantial decline in the use of mechanical valve replacement among patients aged ≤70 years in the United States. Long‐term durability data on bioprosthetic valve replacement are needed to better define the future role of mechanical valves in this age group.
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Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Fahad Alqahtani
- Division of Cardiology West Virginia University Morgantown WV
| | - Trevor Simard
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Sorin Pislaru
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Hartzell V Schaff
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Rich A Nishimura
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
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Khan SU, Khan MZ, Khan MU, Khan MS, Mamas MA, Rashid M, Blankstein R, Virani SS, Johansen MC, Shapiro MD, Blaha MJ, Cainzos-Achirica M, Vahidy FS, Nasir K. Clinical and Economic Burden of Stroke Among Young, Midlife, and Older Adults in the United States, 2002-2017. Mayo Clin Proc Innov Qual Outcomes 2021; 5:431-441. [PMID: 33997639 PMCID: PMC8105541 DOI: 10.1016/j.mayocpiqo.2021.01.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective To assess trends of stroke hospitalization rates, inpatient mortality, and health care resource use in young (aged ≤44 years), midlife (aged 45-64 years), and older (aged ≥65 years) adults. Patients and Methods We studied the National Inpatient Sample database (January 1, 2002 to December 31, 2017) to analyze stroke-related hospitalizations. We identified data using the International Classification of Diseases, Ninth/Tenth Revision codes. Results Of 11,381,390 strokes, 79% (n=9,009,007) were ischemic and 21% (n=2,372,383) were hemorrhagic. Chronic diseases were more frequent in older adults; smoking, alcoholism, and migraine were more prevalent in midlife adults; and coagulopathy and intravenous drug abuse were more common in young patients with stroke. The hospitalization rates of stroke per 10,000 increased overall (31.6 to 33.3) in young and midlife adults while decreasing in older adults. Although mortality decreased overall and in all age groups, the decline was slower in young and midlife adults than older adults. The mean length of stay significantly decreased in midlife and older adults and increased in young adults. The inflation-adjusted mean cost of stay increased consistently, with an average annual growth rate of 2.44% in young, 1.72% in midlife, and 1.45% in older adults owing to the higher use of health care resources. These trends were consistent in both ischemic and hemorrhagic stroke. Conclusion Stroke-related hospitalization and health care expenditure are increasing in the United States, particularly among young and midlife adults. A higher cost of stay counterbalances the benefits of reducing stroke and mortality in older patients.
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Affiliation(s)
- Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, WV
| | | | - Muhammad U Khan
- Department of Medicine, West Virginia University, Morgantown, WV
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom.,Department of Medicine, Jefferson University, Philadelphia, PA
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
| | - Ron Blankstein
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center.,Department of Medicine, Baylor College of Medicine, Houston, TX
| | | | - Michael D Shapiro
- Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center.,Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Farhaan S Vahidy
- Division of Cardiovascular Prevention and Wellness, Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center.,Center for Outcomes Research, Houston Methodist, Houston, TX
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Alkhouli M, Alqahtani F, Kawsara A, Guerrero M, Eleid MF, Nkomo VT, Rihal CS, Crestanello JA. Association of Transcatheter Mitral Valve Repair Availability With Outcomes of Mitral Valve Surgery. J Am Heart Assoc 2021; 10:e019314. [PMID: 33754835 PMCID: PMC8174333 DOI: 10.1161/jaha.120.019314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Transcatheter mitral valve repair (TMVr) is currently offered at selected centers that meet certain operator and institutional requirements. We sought to explore the hypothesis that the availability of TMVr is associated with improved outcomes of MV surgery. Methods and Results We used the Nationwide Readmissions Database to identify patients who underwent MV surgery at centers with or without TMVr capabilities between January 1 and December 31, 2017. The primary end point was in‐hospital mortality. Secondary end points were postoperative complications, resource use, and 30‐day readmissions. A total of 24 477 patients from 595 centers (446 TMVr, 149 non‐TMVr) were included. There were modest but statistically significant differences in the prevalence of comorbidities between the groups. Patients at non‐TMVr centers had higher unadjusted in‐hospital mortality than those at TMVr centers (5.6% versus 3.6%, P<0.001). They also had higher rates of postoperative complications, longer hospitalizations, higher cost, and fewer home discharges but similar 30‐day readmission rates. After propensity matching, mortality remained higher at non‐TMVr centers (5.5% versus 4.0%, P<0.001). Rates of postoperative complications, prolonged hospitalizations, and nonhome discharges also remained higher. Postoperative mortality was consistently higher at non‐TMVr centers in multiple risk‐adjustment analyses incrementally accounting for differences in risk factors, surgical volume, availability of surgical repair, and excluding concomitant procedures. In the most comprehensive model, surgery at non‐TMVr centers was associated with higher odds of death (odds ratio, 1.41; 95% CI, 1.14–1.73; P=0.002). Conclusions Mitral valve surgery at TMVr centers is associated with improved in‐hospital outcomes compared with non‐TMVr centers.
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Affiliation(s)
| | - Fahad Alqahtani
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN.,Division of Cardiology Department of Medicine University of Kentucky Lexington KY
| | - Akram Kawsara
- Division of Cardiology Department of Medicine West Virginia University Morgantown WV
| | - Mayra Guerrero
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Mackram F Eleid
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | | | | | - Juan A Crestanello
- Department of Cardiovascular Surgery Mayo Clinic School of Medicine Rochester MN
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Alkhouli M, Alqahtani F, Kawsara A, Pislaru S, Schaff HV, Nishimura RA. National Trends in Mechanical Valve Replacement in Patients Aged 50 to 70 Years. J Am Coll Cardiol 2021; 76:2687-2688. [PMID: 33243387 DOI: 10.1016/j.jacc.2020.09.608] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/24/2020] [Accepted: 09/20/2020] [Indexed: 12/24/2022]
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Bermejo J, Postigo A, Baumgartner H. The year in cardiovascular medicine 2020: valvular heart disease. Eur Heart J 2021; 42:647-656. [PMID: 33388778 PMCID: PMC7878012 DOI: 10.1093/eurheartj/ehaa1060] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/11/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Dr Esquerdo 46, Madrid 28007, Spain
| | - Andrea Postigo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Dr Esquerdo 46, Madrid 28007, Spain
| | - Helmut Baumgartner
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
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Tschumper M, Weber L, Rickli H, Seidl S, Brenner R, Buser M, Ehl NF, Jäger-Rhomberg F, Ammann P, Maeder MT. Corrected QT Interval in Severe Aortic Stenosis: Clinical and Hemodynamic Correlates and Prognostic Impact. Am J Med 2021; 134:267-277. [PMID: 32621909 DOI: 10.1016/j.amjmed.2020.05.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The role of the electrocardiogram for risk stratification in patients with severe aortic stenosis is not established. We assessed the hemodynamic correlates and the prognostic value of the corrected QT interval (QTc) in patients with severe aortic stenosis undergoing aortic valve replacement. METHODS The QT interval was measured in a 12-lead electrocardiogram in 485 patients (age 74 ± 10 years, 57% male) with severe aortic stenosis (indexed aortic valve area 0.41 ± 0.13 cm2/m2, left ventricular ejection fraction 58 ± 12%) the day prior to cardiac catheterization. Prolonged QTc was defined as QTc >450 ms in men and QTc >470 ms in women. The outcome parameter was all-cause mortality. RESULTS Patients with prolonged QTc (n = 100; 77 men, 23 women) had similar indexed aortic valve area but larger left ventricular and left atrial size, lower left ventricular ejection fraction, more severe mitral regurgitation, lower cardiac index, and higher mean pulmonary artery pressure, mean pulmonary artery wedge pressure, and pulmonary vascular resistance, as compared with patients with normal QTc (n = 385). After a median follow-up of 3.7 years (interquartile range, 2.6-5.2) after surgical (n = 349) or transcatheter (n = 136) aortic valve replacement, patients with prolonged QTc had higher mortality than those with normal QTc (hazard ratio 2.81 [95% confidence interval, 1.51-5.20]; P < .001). Prolonged QTc was an independent predictor of death along with more severe mitral regurgitation and higher pulmonary vascular resistance. CONCLUSIONS In patients with severe aortic stenosis, prolonged QTc is a marker of an advanced disease stage associated with an adverse hemodynamic profile and increased long-term mortality after aortic valve replacement.
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Affiliation(s)
- Maja Tschumper
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Internal Medicine, Spital Affoltern, Affoltern am Albis, Switzerland
| | - Lukas Weber
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Hans Rickli
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Sebastian Seidl
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Roman Brenner
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marc Buser
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Niklas F Ehl
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - Peter Ammann
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Micha T Maeder
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland.
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Simard T, Alqahtani F, Hibbert B, Mamas MA, El‐Hajj S, Harris AH, Hohmann SF, Alkhouli M. Sex‐specific in‐hospital
outcomes of transcatheter aortic valve replacement with third generation transcatheter heart valves. Catheter Cardiovasc Interv 2021; 98:176-183. [DOI: 10.1002/ccd.29499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/07/2020] [Accepted: 12/27/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Trevor Simard
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester Minnesota USA
| | - Fahad Alqahtani
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester Minnesota USA
| | - Benjamin Hibbert
- CAPITAL Research Group University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research Keele University Keele UK
| | | | - Alyssa H. Harris
- Center for Advanced Analytics and Informatics Chicago Illinois USA
| | - Samuel F. Hohmann
- Center for Advanced Analytics and Informatics Chicago Illinois USA
- Department of Health Systems Management Rush University Chicago Illinois USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester Minnesota USA
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One-Year Costs Associated with Hospitalizations Due to Aortic Stenosis in Canada. CJC Open 2021; 3:82-90. [PMID: 33474547 PMCID: PMC7801225 DOI: 10.1016/j.cjco.2020.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/15/2020] [Indexed: 12/18/2022] Open
Abstract
Background There is a lack of data on the burden of patients hospitalized with aortic stenosis (AS) in Canada. The primary study objective was to document the index and 1-year costs of hospitalized patients with AS in Canada. Secondary objectives were to explore results by treatment modality and Canadian provinces. Methods Hospitalized patients with a most responsible diagnosis (MRD) of AS during fiscal year 2014/2015 were identified using Canadian administrative databases. Costs were calculated for the index admission and for up to 1 year. For our secondary analyses, patients were classified according to the intervention received: surgical aortic valve replacement (SAVR), SAVR with coronary artery bypass graft, or transfemoral or transapical transcatheter aortic valve implantation. Hospitalized AS patients who did not undergo SAVR or transcatheter aortic valve implantation were classified as the untreated group. The data were also analyzed by Canadian provinces. Results During fiscal year 2014/15, a total of 7217 Canadians were hospitalized with an MRD of AS. The mean (standard deviation) age of our population was 74.2 (11.5) years, and 39% were female. The 1-year hospital costs associated with an MRD of AS in Canada were calculated at $393 million. Our secondary analyses suggest that patient demographics (mean age ranging from 69 to 82 years) and outcomes (median length of stay ranging from 6 to 12 days) differ among treatment modalities and Canadian provinces. Conclusions AS hospitalizations result in a significant cost burden in Canada. Future research is needed to better understand variation among treatment modalities and Canadian provinces.
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Abe T, Kumamaru H, Nakano K, Motomura N, Miyata H, Takamoto S. Status of cardiovascular surgery in Japan between 2017 and 2018: A report based on the Japan Cardiovascular Surgery Database. 3. Valvular heart surgery. Asian Cardiovasc Thorac Ann 2021; 29:300-309. [PMID: 33426897 DOI: 10.1177/0218492320981459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We aimed to present data regarding the current status and trends of valvular heart surgeries in Japan from the Japan Cardiovascular Surgery Database for the 2017-2018. METHODS We extracted data on cardiac valve surgeries performed in 2017 and 2018 from the Japan Cardiovascular Surgery Database. We determined the trend in the number of aortic valve replacement procedures from 2013 to 2018. The operative mortality rates were calculated for representative valve procedures stratified by age group. Data regarding minimally invasive procedures and transcatheter aortic valve replacement in the Japan Cardiovascular Surgery Database are also presented. RESULTS In conjunction with the dramatic increase in the number of transcatheter aortic valve replacements in 2017 and 2018, surgical aortic valve replacement also increased from 26,054 to 28,202. The operative mortality rate in first-time valve procedures was 1.8% in isolated aortic valve replacement, 0.9% in isolated mitral valve repair, and 8.2% and 4.6% in mitral valve replacement with biological prostheses and with mechanical prostheses, respectively. Regarding minimally invasive procedures, 30.8% of first-time isolated mitral valve plasty procedures were performed by a right thoracotomy. Although patients who underwent surgery by a right thoracotomy had better clinical outcomes, it was also apparent that patients who underwent surgery by a right thoracotomy had lower operative risk profiles. The overall mortality rates after transcatheter aortic valve replacement and surgical aortic valve replacement were 1.5% and 1.8%, respectively. CONCLUSION We have reported benchmark data on heart valve surgery in 2017 and 2018 from the Japan Cardiovascular Surgery Database.
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Affiliation(s)
- Tomonobu Abe
- Division of Cardiovascular Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Noboru Motomura
- Department of Cardiovascular Surgery, Toho University, Sakura Medical Center, Sakura, Japan
| | - Hiroaki Miyata
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
| | - Shinichi Takamoto
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
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47
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Pulmonary hypertension in aortic valve stenosis. Trends Cardiovasc Med 2020; 32:73-81. [DOI: 10.1016/j.tcm.2020.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/26/2020] [Accepted: 12/12/2020] [Indexed: 01/09/2023]
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Ennezat PV, Malergue MC, Le Jemtel TH, Abergel E. Watchful waiting care or early intervention in asymptomatic severe aortic stenosis: Where we are. Arch Cardiovasc Dis 2020; 114:59-72. [PMID: 33153947 DOI: 10.1016/j.acvd.2020.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022]
Abstract
Aortic stenosis, the most common valvular heart disease in Western countries, affects predominantly older people. Prompt aortic valve replacement is undoubtedly indicated in symptomatic patients. Management of asymptomatic patients is nowadays shifting from a conservative approach to early aortic valve replacement, as multimodality imaging is increasingly available. However, multimodality imaging has led to multiple prognostic parameters and complex algorithms, as well as a new staging classification that has left patients and physicians somewhat puzzled. We highlight the value of thorough serial clinical examinations, Doppler echocardiography and exercise testing when caring for a growing aortic stenosis population, including that has no or limited access to multimodality imaging. Evidence for early aortic valve replacement versus conservative management in asymptomatic patients with severe aortic stenosis is biased by the lack of serial stress testing evaluation; 30% of so-called asymptomatic patients were in fact symptomatic, and thus were clear candidates for aortic valve replacement in the above-mentioned studies. Randomized trials of aortic valve replacement versus conservative management that include serial stress testing evaluation are needed to ascertain whether early aortic valve replacement actually improves clinical outcome in asymptomatic patients with severe aortic stenosis. Less interventional medicine and healthcare resource utilization can result in better health.
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Affiliation(s)
- Pierre Vladimir Ennezat
- Department of cardiology, centre hospitalier universitaire de Grenoble-Alpes, 38700 La Tronche, France
| | | | - Thierry H Le Jemtel
- Section of cardiology, department of medicine, Tulane university school of medicine, Tulane university heart and vascular institute, 70112 New Orleans, LA, USA
| | - Eric Abergel
- Department of cardiology and cardiovascular surgery, clinique Saint-Augustin, 114, avenue d'Ares, 33200 Bordeaux, France.
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Khan SU, Kalra A, Kapadia SR, Khan MU, Zia Khan M, Khan MS, Mamas MA, Warraich HJ, Nasir K, Michos ED, Alkhouli M. Demographic, Regional, and State-Level Trends of Mortality in Patients With Aortic Stenosis in United States, 2008 to 2018. J Am Heart Assoc 2020; 9:e017433. [PMID: 33070675 PMCID: PMC7763421 DOI: 10.1161/jaha.120.017433] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/21/2020] [Indexed: 01/08/2023]
Abstract
Background Aortic stenosis-related mortality might vary across demographic subsets, regions, and states in the United States. Methods and Results We reviewed the death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research database to examine aortic stenosis-related mortality trends from 2008 to 2018. Crude and age-adjusted mortality rates (AAMRs) per 100 000 people and annual percentage change with 95% CIs were calculated. Between 2008 and 2018, AAMR reduced from 12.7 to 11.5 (average annual percentage change, -1.0 [95% CI, -1.5 to -0.5]), because of an accelerated decline between 2015 and 2018 (annual percentage change, -4.4 [95% CI, -6.0 to -2.7]). Older (aged >85 years), male, and White patients had higher death rates than younger, female, and non-White patients, respectively. Although mortality reduction was similar across sexes, significant mortality reduction was limited to White patients only. The AAMRs were higher in rural than urban areas. States with AAMRs >90th percentile were distributed in the West and the Northeast, and <10th percentile in the South. The AAMRs for sex and race were highest in the West and lowest in the South. None of the states located in the Midwest showed a significant reduction in mortality. Mortality remained stable for hospital setting and nursing home/long-term care facility, except that the number of deaths increased at home and hospice facility since 2014. Conclusions The reduction in mortality in patients with aortic stenosis was not consistent among demographic subsets and states. The substantial public health and economic implications call for determination of underlying clinical and socioeconomic factors to narrow the gap.
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Affiliation(s)
- Safi U. Khan
- Department of MedicineWest Virginia UniversityMorgantownWV
| | - Ankur Kalra
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
- Section of Cardiovascular ResearchHeart, Vascular and Thoracic DepartmentCleveland Clinic Akron GeneralAkronOH
| | - Samir R. Kapadia
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | | | | | | | - Mamas A. Mamas
- Keele Cardiovascular Research GroupKeele UniversityStoke‐on‐TrentUK
- Department of MedicineJefferson UniversityPhiladelphiaPA
| | | | - Khurram Nasir
- Department of Cardiovascular MedicineHouston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | - Erin D. Michos
- Division of CardiologyDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMD
- The Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins School of MedicineBaltimoreMD
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Alqahtani F, Kawsara A, Alkhouli M. Trends in the Use of Isolated Surgical and Transcatheter Aortic Valve Replacement in Patients Younger Than 70 Years of Age. Mayo Clin Proc 2020; 95:2571-2572. [PMID: 33153649 DOI: 10.1016/j.mayocp.2020.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/14/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Fahad Alqahtani
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN
| | - Akram Kawsara
- Division of Cardiology, West Virginia University, Morgantown
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN
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