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Yifan D, Zhen F, Yue M, Xun S, Jiapei G, Li Z, Jing Z. Safety and efficacy of minimal transcatheter aortic valve replacement: A systematic review and meta-analysis. Heart Lung 2024; 67:158-168. [PMID: 38788303 DOI: 10.1016/j.hrtlng.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/10/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is a preferred treatment for patients with highly critical aortic stenosis (AS), which is a difficult and complicated procedure, leaving a heavy economical burden on patients and national health insurance. Minimalist TAVR can simplify a part of the operation procedures, but the surgical efficacy and safety are still under debated. OBJECTIVES Explore the effectiveness and safety of minimalist TAVR in the treatment of patients with aortic stenosis. METHODS A systematic search of PubMed, Web of Science, and Embase databases was conducted for studies involving application of minimalist TAVR in patients with severe aortic stenosis, two researchers independently screened the literature, extracted data and Meta-analysis was performed using STATA 16.0 software. RESULTS Nine studies, involving a total of 3,148 AS patients, were included. Minimalist TAVR has similar surgical success rates compared to standardized TAVR, intraoperative fluoroscopy time, dosage of contrast agent, and total operative time were superior to standard TAVR. Regarding surgical complications, the incidence of permanent pacemaker placement and moderate to severe paravalvular leakage were similar for both TAVR, the risk of major vascular complications and major bleeding events in the minimalist TAVR was significantly lower than the standard TAVR. The risk of overall death, stroke, and cardiovascular-related readmission within 30 days was similar in both procedures. CONCLUSION Patients with severe aortic stenosis treated with minimalist TAVR have similar short-term efficacy as well as 30-day clinical outcomes to standard TAVR, while minimalist TAVR could reduce the risk of major vascular complications and bleeding complications.
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Affiliation(s)
- Deng Yifan
- Clinical Medical College, Yangzhou University, Yangzhou 225001, PR China; Taizhou People's Hospital affiliated to Nanjing Medical University, Tai zhou 225300, PR China; Medical College of Yangzhou University, Yang zhou 225001, PR China
| | - Fang Zhen
- Clinical Medical College, Yangzhou University, Yangzhou 225001, PR China; Medical College of Yangzhou University, Yang zhou 225001, PR China
| | - Ma Yue
- Clinical Medical College, Yangzhou University, Yangzhou 225001, PR China; Medical School of Nanjing University, Nanjing, 21000, PR China
| | - Sun Xun
- Clinical Medical College, Yangzhou University, Yangzhou 225001, PR China; alian Medical University, Dalian 116000, PR China
| | - Gao Jiapei
- Clinical Medical College, Yangzhou University, Yangzhou 225001, PR China; Medical College of Yangzhou University, Yang zhou 225001, PR China
| | - Zhu Li
- Clinical Medical College, Yangzhou University, Yangzhou 225001, PR China; Taizhou People's Hospital affiliated to Nanjing Medical University, Tai zhou 225300, PR China; Medical College of Yangzhou University, Yang zhou 225001, PR China.
| | - Zhang Jing
- Clinical Medical College, Yangzhou University, Yangzhou 225001, PR China; Northern Jiangsu People's Hospital, Yangzhou 225001, PR China.
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Jaffar-Karballai M, Al-Tawil M, Roy S, Kayali F, Vankad M, Shazly A, Zeinah M, Harky A. Local versus General Anaesthesia for Transcatheter Aortic Valve Implantation (TAVI): A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomised and Propensity-Score Matched Studies. Curr Probl Cardiol 2024; 49:102360. [PMID: 38128636 DOI: 10.1016/j.cpcardiol.2023.102360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is a common practice for severe aortic stenosis, but the choice between general (GA) and local anesthesia (LA) remains uncertain. We conducted a comprehensive literature review until April 2023, comparing the safety and efficacy of LA versus GA in TAVI procedures. Our findings indicate significant advantages of LA, including lower 30-day mortality rates (RR: 0.69; 95% CI [0.58, 0.82]; p < 0.001), shorter in-hospital stays (mean difference: -0.91 days; 95% CI [-1.63, -0.20]; p = 0.01), reduced bleeding/transfusion incidents (RR: 0.64; 95% CI [0.48, 0.85]; p < 0.01), and fewer respiratory complications (RR: 0.56; 95% CI [0.42, 0.76], p<0.01). Other operative outcomes were comparable. Our findings reinforce prior evidence, presenting a compelling case for LA's safety and efficacy. While patient preferences and clinical nuances must be considered, our study propels the discourse towards a more informed anaesthesia approach for TAVI procedures.
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Affiliation(s)
| | | | - Sakshi Roy
- School of Medicine, Queen's University Belfast, Northern Ireland, UK
| | | | | | - Ahmed Shazly
- Essex Cardiothoracic Centre, Basildon University Hospital, Basildon, UK
| | - Mohamed Zeinah
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK; Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.
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Lee SH, Oh S, Ko YG, Lee YJ, Lee SJ, Hong SJ, Ahn CM, Kim JS, Kim BK, Ko KY, Cho I, Shim CY, Hong GR, Choi D, Hong MK. Comparison of Intracardiac Echocardiography Versus Transesophageal Echocardiography for Guidance During Transcatheter Aortic Valve Replacement. Korean Circ J 2024; 54:63-75. [PMID: 38111184 PMCID: PMC10864253 DOI: 10.4070/kcj.2023.0195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/18/2023] [Accepted: 10/11/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Evidence regarding the efficacy and safety of intracardiac echocardiography (ICE) for guidance during transcatheter aortic valve replacement (TAVR) is limited. This study aimed to compare the clinical efficacy and safety of ICE versus transesophageal echocardiography (TEE) for guiding TAVR. METHODS This prospective cohort study included patients who underwent TAVR from August 18, 2015, to June 31, 2021. Eligible patients were stratified by echocardiographic modality (ICE or TEE) and anesthesia mode (monitored anesthesia care [MAC] or general anesthesia [GA]). Primary outcome was the 1-year composite of all-cause mortality, rehospitalization for cardiovascular cause, or stroke, according to the Valve Academic Research Consortium-3 (VARC-3) definition. Propensity score matching was performed, and study outcomes were analyzed for the matched cohorts. RESULTS Of the 359 eligible patients, 120 patients were matched for the ICE-MAC and TEE-GA groups, respectively. The incidence of primary outcome was similar between matched groups (18.3% vs. 20.0%; adjusted hazard ratio, 0.94; 95% confidence interval [CI], 0.53-1.68; p=0.843). ICE-MAC and TEE-GA also had similar incidences of moderate-to-severe paravalvular regurgitation (PVR) (4.2% vs. 5.0%; adjusted odds ratio, 0.83; 95% CI, 0.23-2.82; p=0.758), new permanent pacemaker implantation, and VARC-3 types 2-4 bleeding. CONCLUSIONS ICE was comparable to TEE for guidance during TAVR for the composite clinical efficacy outcome, with similar incidences of moderate-to-severe PVR, new permanent pacemaker implantation, and major bleeding. These results suggest that ICE could be a safe and effective alternative echocardiographic modality to TEE for guiding TAVR.
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Affiliation(s)
- Sang-Hyup Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seunguk Oh
- Department of Cardiology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Yong-Joon Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Jun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Yong Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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Ko TY, Kao HL, Chen YC, Yeh CF, Huang CC, Chen YH, Chan CY, Lin LC, Wang MJ, Chen YS, Lin MS. Results of streamlining TAVR procedure towards a minimalist approach: a single center experience in Taiwan. Sci Rep 2023; 13:19134. [PMID: 37932391 PMCID: PMC10628271 DOI: 10.1038/s41598-023-46475-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/01/2023] [Indexed: 11/08/2023] Open
Abstract
Trans-femoral transcatheter aortic valve replacement (TF-TAVR) performed under conscious sedation (LACS) is not yet become routine practice in Taiwan. We aimed to compared the results between patients received general anesthesia (GA) versus LACS. Our cohort was divided into 3 groups: initial 48 patients received TF-TAVR under routine GA (GA group), subsequent 50 patients under routine LACS (LACS group 1), and recent 125 patients under LACS (LACS group 2). The baseline, procedural characteristics and all outcomes were prospectively collected and retrospectively compared. From Sep 2010 to July 2019, a total of 223 patients were included. The procedure time (157.6 ± 39.4 min vs 131.6 ± 30.3 vs 95.2 ± 40.0, < 0.0001), contrast medium consumption (245.6 ± 92.6 ml vs 207.8 ± 77.9 vs 175.1 ± 64.6, < 0.0001), length of intensive care unit (2 [1-5] days vs 2 [1-3] vs 1 [1-1], P = 0.0001) and hospital stay (9 [7-13] days vs 8 [6-11] vs 6 [5-9], P = 0.0001) decreased significantly with LACS, combined with a trend of less hospital acquired pneumonia (12.5% vs 6.0% vs 5.6%, P = 0.427). 1-year survival rate were also different among 3 groups (83.3% vs 90.0% vs 93.6%, P = 0.053). In our single center experience, a "minimalist" approach of TF-TAVR procedure resulted in less medical resources usage, along with more favorable clinical outcomes.
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Affiliation(s)
- Tsung-Yu Ko
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsien-Li Kao
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chang Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Fan Yeh
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Chang Huang
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Hsien Chen
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Yang Chan
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Lung-Chun Lin
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Jiuh Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Shin Lin
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.
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Yamamoto H, Nakayama T, Ishii N, Nakamura Y. Minimally Invasive Surgical Versus Transcatheter Aortic Valve Replacement: A Retrospective Observational Single-Center Study in Japan. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:547-556. [PMID: 37933787 PMCID: PMC10714700 DOI: 10.1177/15569845231205587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVE This study aimed to compare the outcomes of minimally invasive aortic valve replacement (MICS-AVR) versus transfemoral transcatheter aortic valve replacement (TF-TAVR) in Asian patients. METHODS We conducted a retrospective, observational, single-center study in Japan, including cases of MICS-AVR (n = 202) and TF-TAVR (n = 248) between 2014 and 2021. In a total of 450 cases, propensity score matching was performed at a ratio of 1:1, resulting in 96 pairs. Furthermore, we performed competing-risk regression and mediation analyses to determine the treatment effect on outcomes of interests, considering death as a competing risk, and to evaluate the mediation effect of paravalvular leak (PVL) severity. RESULTS There were similar incidences of all-cause death, cardiac death, stroke and cerebral hemorrhage, and aortic valve reintervention between the 2 groups. However, the TF-TAVR cohort had a longer hospital length of stay and higher rates of significant PVL compared with the MICS-AVR cohort. Multivariable-adjusted Cox regression analyses revealed that heart failure hospitalization (hazard ratio [HR] = 0.129, 95% confidence interval [CI]: 0.038 to 0.445, p = 0.001) and permanent pacemaker implantation (HR = 0.050, 95% CI: 0.006 to 0.409, p = 0.005) favored MICS-AVR. Competing-risk regression analyses confirmed similar findings. All outcomes were unrelated to PVL severity. CONCLUSIONS To our knowledge, this is the first comparative study of clinical outcomes in Asian patients undergoing MICS-AVR versus TF-TAVR, revealing that MICS-AVR could be a feasible and efficient alternative to TF-TAVR. Future larger-scale randomized controlled trials are needed to validate the present results.
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Affiliation(s)
- Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Japan
| | - Taisuke Nakayama
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Japan
| | - Naoki Ishii
- Department of Gastroenterology, Tokyo Shinagawa Hospital, Japan
| | - Yoshitsugu Nakamura
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Japan
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6
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Tagliari AP, Taramasso M. New Practices in Transcatheter Aortic Valve Implantation: How I Do It in 2023. J Clin Med 2023; 12:jcm12041342. [PMID: 36835878 PMCID: PMC9964275 DOI: 10.3390/jcm12041342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) went through a huge evolution in the last decades. Previously performed under general anesthesia, with transoperative transesophageal echocardiography guidance and using cutdown femoral artery access, the procedure has now evolved into a minimalist approach, with local anesthesia, conscious sedation, and the avoidance of invasive lines becoming the new standards. Here, we discuss the minimalist TAVI approach and how we incorporate it into our current clinical practice.
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Affiliation(s)
- Ana Paula Tagliari
- Cardiovascular Surgery Department, Hospital São Lucas da PUC-RS, Porto Alegre 90619-900, Brazil
- Cardiovascular Surgery Department, Hospital Mãe de Deus, Porto Alegre 90880-0481, Brazil
- Correspondence: ; Tel.: +55-(51)-33205186
| | - Maurizio Taramasso
- HerzZentrum Hirslanden Zurich, Clinic of Cardiac Surgery, 8008 Zurich, Switzerland
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Wang L, Liu Y, Gao H, Zhang B, Zhou S, Xie M, Sun X. Comparison of Safety and Effectiveness of Local or General Anesthesia after Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12020508. [PMID: 36675437 PMCID: PMC9866516 DOI: 10.3390/jcm12020508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/26/2022] [Accepted: 12/31/2022] [Indexed: 01/11/2023] Open
Abstract
It remains controversial to choose anesthesia for transcatheter aortic valve implantation (TAVI). A meta-analysis of cohort studies was conducted to assess the efficacy and safety of local anesthesia (LA) compared to general anesthesia (GA) in TAVI. All relevant studies published from 1 January 2002, to 31 June 2022, were searched in Ovid, PubMed, Embase, Web of Science, and Cochrane Library. A total of 34 studies involving 23,480 patients were included in the meta-analysis. TAVI with LA was associated with a significant reduction in hospital stay [WMD = −2.48, 95% CI (−2.80, −2.16), p < 0.00001], operative [WMD = −12.25, 95% CI (−13.73, −10.78), p < 0.00001] and fluoroscopy time [WMD = −3.30, 95% CI (−5.40, −1.19), p = 0.002], and an increased risk of acute kidney injury [OR = 1.31, 95% CI (1.01, 1.69), p = 0.04] and a reduced incidence of major bleeding [OR = 0.59, 95% CI (0.46, 0.75), p < 0.0001] and the use of cardiovascular drugs [OR = 0.17, 95% CI (0.05, 0.57), p = 0.004]. No differences were found between LA and GA for 30-day mortality, procedural success rate, myocardial infarction, permanent pacemaker implantation, paravalvular leak, shock, and cerebrovascular events. Overall, 4.4% of LA converted to GA. Based on current evidence, our results suggested that LA strategies reduced hospital stay, operative time, fluoroscopy time, cardiovascular drug consumption, and major bleeding rates in patients undergoing TAVI but led to increased acute kidney injury rates. Further studies and randomized trials are required to verify the presented findings and to identify patients who might benefit from LA.
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8
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Update on Minimalist TAVR Care Pathways: Approaches to Care in 2022. Curr Cardiol Rep 2022; 24:1179-1187. [PMID: 35767177 PMCID: PMC9244066 DOI: 10.1007/s11886-022-01737-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2022] [Indexed: 11/20/2022]
Abstract
Purpose of Review This review summarizes current data supporting a minimalist TAVR approach and identifies the need for additional study to optimize TAVR care. The authors discuss future directions of the TAVR landscape and how this necessitates evolution of minimalist care pathways. Recent Findings Transcatheter aortic valve replacement (TAVR) has become a mainstay in the treatment of aortic stenosis since the initial procedure in 2002. Recently, attention has shifted to TAVR optimization and the minimalist approach with a focus on minimizing procedural sedation, protocolization of perioperative management, and prioritization on early discharge. This approach has been shown to be safe and reduce procedure time, length of stay, and overall cost for hospital systems. Summary The minimalist care pathway avoids general anesthesia, shortens procedure time and length of stay, and reduces cost without changing mortality or readmission rates at 30 days. A variety of protocols have been proposed without a clear consensus on specific components or patient eligibility. There is a continued need for data regarding patient risk stratification, valve selection, and discharge strategy as TAVR becomes increasingly common.
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Zahid S, Rai D, Tanveer Ud Din M, Khan MZ, Ullah W, Usman Khan M, Thakkar S, Hussein A, Baibhav B, Rao M, Abtahian F, Bhatt DL, Depta JP. Same-Day Discharge After Transcatheter Aortic Valve Implantation: Insights from the Nationwide Readmission Database 2015 to 2019. J Am Heart Assoc 2022; 11:e024746. [PMID: 35621233 PMCID: PMC9238699 DOI: 10.1161/jaha.121.024746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background There is a paucity of data on the feasibility of same-day discharge (SDD) following transcatheter aortic valve implantation (TAVI) at a national level. Methods and Results This study used data from the Nationwide Readmission Database from the fourth quarter of 2015 through 2019 and identified patients undergoing TAVI using the claim code 02RF3. A total of 158 591 weighted hospitalizations for TAVI were included in the analysis. Of the patients undergoing TAVI, 961 (0.6%) experienced SDD. Non-SDDs included 65 814 (41.5%) patients who underwent TAVI who were discharged the next day, and 91 816 (57.9%) discharged on the second or third day. The 30-day readmission rate for SDD after TAVI was similar to non-SDD TAVI (9.8% versus 8.9%, P=0.31). The cumulative incidence of 30-day readmissions for SDD was higher compared with next-day discharge (log-rank P=0.01) but comparable to second- or third-day discharge (log-rank P=0.66). At 30 days, no differences were observed in major or minor vascular complications, heart failure, or ischemic stroke for SDD compared with non-SDD. Acute kidney injury, pacemaker implantation, and bleeding complications were lower with SDD. Predictors associated with SDD included age <85 years, male sex, and prior pacemaker placement, whereas left bundle-branch block, right bundle-branch block, second-degree heart block, heart failure, prior percutaneous coronary intervention, and atrial fibrillation were negatively associated with SDD. Conclusions SDD following TAVI is associated with similar 30-day readmission and complication rates compared with non-SDD. Further prospective studies are needed to assess the safety and feasibility of SDD after TAVI.
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Affiliation(s)
- Salman Zahid
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Devesh Rai
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | | | - Muhammad Zia Khan
- Division of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WV
| | - Waqas Ullah
- Department of Cardiovascular Medicine Jefferson University Hospitals Philadelphia PA
| | - Muhammad Usman Khan
- Division of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WV
| | | | - Ahmed Hussein
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Bipul Baibhav
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Mohan Rao
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Farhad Abtahian
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center Harvard Medical School Boston MA
| | - Jeremiah P Depta
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
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Bisceglia I, Gabrielli D, Canale ML, Gallucci G, Parrini I, Turazza FM, Russo G, Maurea N, Quagliariello V, Lestuzzi C, Oliva S, Di Fusco SA, Lucà F, Tarantini L, Trambaiolo P, Gulizia MM, Colivicchi F. ANMCO POSITION PAPER: cardio-oncology in the COVID era (CO and CO). Eur Heart J Suppl 2021; 23:C128-C153. [PMID: 34456641 PMCID: PMC8388610 DOI: 10.1093/eurheartj/suab067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The COVID-19 pandemic and its impact on patients with cancer and cardiovascular disease have confirmed the particular vulnerability of these populations. Indeed, not only a higher risk of contracting the infection has been reported but also an increased occurrence of a more severe course and unfavourable outcome. Beyond the direct consequences of COVID-19 infection, the pandemic has an enormous impact on global health systems. Screening programmes and non-urgent tests have been postponed; clinical trials have suffered a setback. Similarly, in the area of cardiology care, a significant decline in STEMI accesses and an increase in cases of late presenting heart attacks with increased mortality and complication rates have been reported. Health care systems must therefore get ready to tackle the 'rebound effect' that will likely show a relative increase in the short- and medium-term incidence of diseases such as heart failure, myocardial infarction, arrhythmias, and cardio- and cerebrovascular complications. Scientific societies are taking action to provide general guidance and recommendations aimed at mitigating the unfavourable outcomes of this pandemic emergency. Cardio-oncology, as an emerging discipline, is more flexible in modulating care pathways and represents a beacon of innovation in the development of multi-specialty patient management. In the era of the COVID-19 pandemic, cardio-oncology has rapidly modified its clinical care pathways and implemented flexible monitoring protocols that include targeted use of cardiac imaging, increased use of biomarkers, and telemedicine systems. The goal of these strategic adjustments is to minimize the risk of infection for providers and patients while maintaining standards of care for the treatment of oncologic and cardiovascular diseases. The aim of this document is to evaluate the impact of the pandemic on the management of cardio-oncologic patients with the-state-of-the-art knowledge about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease (COVID-19) in order to optimize medical strategies during and after the pandemic.
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Affiliation(s)
- Irma Bisceglia
- Integrated Cardiology Services, Cardio-Thoracic-Vascular Department, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Domenico Gabrielli
- Cardiology Unit, Cardio-Thoracic-Vascular Department, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Maria Laura Canale
- Cardiology Department, Nuovo Ospedale Versilia Lido Di Camaiore, LU, Italy
| | | | - Iris Parrini
- Cardiology Department, Ospedale Mauriziano Umberto I, Torino, Italy
| | | | - Giulia Russo
- Cardiovascular and Sports Medicine Department, ASUGI Trieste, Trieste, Italy
| | - Nicola Maurea
- Cardiology Department, Fondazione Pascale, Napoli, Italy
| | | | - Chiara Lestuzzi
- Cardiology Department, Centro di Riferimento Oncologico (CRO), Aviano, PN, Italy
| | - Stefano Oliva
- Cardio-Oncology Department, Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma, Italy
| | - Fabiana Lucà
- Cardiology Department, Grande Osp. Metropol-Bianchi Melacrino-Morelli, Reggio Calabria, Italy
| | - Luigi Tarantini
- Cardiology Department, Presidio Ospedaliero. Santa Maria Nuova—AUSL RE IRCCS, Reggio Emilia, Italy
| | | | - Michele Massimo Gulizia
- Cardiology Department, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
- Fondazione per il Tuo cuore—Heart Care Foundation, Firenze, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma, Italy
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Tay E, Khaing T, Yin WH, Posas EF, Kao PHL, Buddhari W, Hayashida K, Ho KW, Lin MS, Yap J, Zhang JJ, Chiam PTL, Rosli MA, Park SJ, Udayacherm W, Yanagisawa R, Tan HC, Lee MK. Asia Pacific TAVI registry (an APSIC initiative): initial report of early outcomes: Asia Pacific TAVI registry. ASIAINTERVENTION 2021; 7:54-59. [PMID: 34913003 PMCID: PMC8657041 DOI: 10.4244/aij-d-18-00053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 05/18/2021] [Indexed: 06/14/2023]
Abstract
AIMS The aim of the study was to report the clinical experience, 30-day mortality and acute outcomes of patients undergoing transcatheter aortic valve implantation (TAVI) in the Asia Pacific region. METHODS AND RESULTS The Asia Pacific TAVI registry is an international, multicentre, prospective, observational registry managed under the auspices of the Asian Pacific Society of Interventional Cardiology (APSIC). Patients undergoing TAVI in seven centres from Hong Kong, Japan, Philippines, Singapore and Taiwan, treated with TAVI devices for severe symptomatic aortic stenosis, were assessed. This first review presents the acute results and 30-day mortality. A multivariable analysis was also performed to identify independent predictors of early all-cause mortality. The enrolment was from 2009 to 2017 and a total of 1,125 patients were recruited. The 30-day mortality rate was 2.5%. Baseline logistic EuroSCORE more than 16 was independently associated with a 2.8-times increased risk of 30-day all-cause mortality (p=0.016). Post-procedural stroke (HR 4.9, p=0.008) was also associated with increased mortality. CONCLUSIONS This initial report of the Asia Pacific TAVI registry demonstrated good acute success and low 30-day mortality. The preprocedural logistic EuroSCORE and post-procedural stroke incidence were strongly associated with acute mortality. Further attempts to reduce post-procedural stroke should be explored.
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Affiliation(s)
- Edgar Tay
- Cardiology Department, National University Heart Centre, Singapore, Singapore
- National University Singapore, Singapore
| | - Thet Khaing
- National University Heart Centre, 5 Lower Kent Ridge Rd, Singapore 119074. E-mail:
| | - Wei Hsian Yin
- Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | - Paul Hsien-Li Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wacin Buddhari
- Division of Cardiovascular Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kentaro Hayashida
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Kay Woon Ho
- Duke-NUS Medical School, Singapore
- National Heart Centre Singapore, Singapore
| | - Mao Shin Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | | | | | | | | | | | - Ryo Yanagisawa
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Huay Cheem Tan
- Cardiology Department, National University Heart Centre, Singapore, Singapore
- National University Singapore, Singapore
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12
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Okoh AK, Siddiqui E, Soto C, Dhaduk N, Hirji S, Tayal R, Chen C, Lee LY, Russo MJ. Trends in Early Discharge and Associated Costs after Transcatheter Aortic Valve Replacement: A National Perspective. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:373-378. [PMID: 34134552 DOI: 10.1177/15569845211013355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The current study aims to report trends of early discharges and identify associated direct costs using a nationally representative database of real-world data experience. METHODS We used nationally weighted data on all patients who had transfemoral transcatheter aortic valve replacement (TAVR) from 2012 to 2017 and discharged alive from the National Inpatient Sample. Patients were divided into early (discharge ≤3 days of admission) and late discharge. Demographics and clinical characteristics were compared. Trends in early discharge and costs associated with admissions were analyzed over the study period. RESULTS Of the 125,188 patients identified, 59,424 (46.9%) were discharged early. The proportion of early discharge increased from 15% in early 2012 to 68% in late 2017 (P < 0.001), with the largest increase occurring from 2014 to 2015. Overall, the average cost of TAVR decreased from $58,408 in 2012 to $49,875 in 2017 (P < 0.001). Compared to late discharge, patients discharged early reported costs savings of ≥$20,000 over the study period. Among the early discharge group, no significant differences in costs were observed for patients discharged on 0 to 1, 2, or 3 days after the procedure. CONCLUSIONS Postoperative length of stay after TAVR has decreased dramatically within the last decade with an observed reduction in procedural costs. While discharge within 3 days appeared cost effective, no differences in costs were noted among patients discharged ≤3 days.
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Affiliation(s)
- Alexis K Okoh
- 43982 Heart and Lung Research Center, Rutgers Health, Department of Medicine, Newark Beth Israel Medical Center, Newark, NJ, USA.,459812287 Division of Cardiac Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Emaad Siddiqui
- 214907 Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Cassandra Soto
- 459812287 Division of Cardiac Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Nehal Dhaduk
- 43982 Heart and Lung Research Center, Rutgers Health, Department of Medicine, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Sameer Hirji
- 1861 Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rajiv Tayal
- 43982 Heart and Lung Research Center, Rutgers Health, Department of Medicine, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Chunguang Chen
- 43982 Heart and Lung Research Center, Rutgers Health, Department of Medicine, Newark Beth Israel Medical Center, Newark, NJ, USA.,459812287 Division of Cardiac Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Leonard Y Lee
- 459812287 Division of Cardiac Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Mark J Russo
- 459812287 Division of Cardiac Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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13
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Qureshi WT, Kundu A, Mir T, Khan A, Anwaruddin S, Sattar Y, Ogunsua A, Dutta A, Majeed CN, Walker J, Kakouros N. Meta-analysis of minimalist versus standard care approach for transcatheter aortic valve replacement. Expert Rev Cardiovasc Ther 2021; 19:565-574. [PMID: 33896312 DOI: 10.1080/14779072.2021.1920926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The change in practice of transcatheter aortic valve replacement (TAVR) to a minimalist approach is a debate. METHODS Online database search for studies that compared the minimalist approach with the standard approach for TAVR were searched from inception through September 2020. We calculated pooled odds ratios (ORs) and 95% confidence intervals (CIs) using the fixed or random-effects model. RESULTS A total of 9 studies with 2,880 TAVR patients (minimalist TAVR;1066 and standard TAVR; 1,814) were included. Compared to standard approach, there were no significant differences in in-hospital mortality, 30-day mortality, or hospital readmissions. However, there was a reduced risk of acute kidney injury (OR0.49;95%CI0.27-0.89), major bleeding (OR0.21;95%CI0.12-0.38) and major vascular complications (OR0.60,95%CI0.39-0.91) associated with the minimalist TAVR group. There was comparatively shorter hospital length of stay (mean difference -2.41;95%CI-2.99,-1.83) days, procedural time (mean difference -43.99;95%CI-67.25,-20.75) minutes, fluoroscopy time (mean difference -2.69;95%CI-3.44,-1.94) minutes and contrast volume (mean difference -26.98;95%CI-42.18,-11.79) ml in the minimalist TAVR group. CONCLUSIONS This meta-analysis demonstrated potential benefits of the minimalist TAVR approach over the standard approach regarding some adverse clinical outcomes as well as procedural outcomes without significant differences in mortality or readmission rates.
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Affiliation(s)
- Waqas T Qureshi
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Amartya Kundu
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Tanveer Mir
- Department of Internal Medicine, Detroit Medical Centre, Wayne State University, Detroit USA
| | - Amna Khan
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Saif Anwaruddin
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Yasar Sattar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst Hospital, Queens, NY, USA
| | - Adedotun Ogunsua
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Abhishek Dutta
- Department of Critical Care Medicine, Memorial Sloan Kettering, NY, USA
| | - Chaudry Nasir Majeed
- Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jennifer Walker
- Division of Cardiothoracic Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nikolaos Kakouros
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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14
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Ruggiero R, Ponticelli F, Giannini F, Galvani M. Transcatheter aortic valve implantation for severe pure aortic regurgitation due to active aortitis. Catheter Cardiovasc Interv 2021; 97:950-954. [PMID: 32865314 DOI: 10.1002/ccd.29249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/17/2020] [Indexed: 11/11/2022]
Abstract
Aortitis is an uncommon systemic inflammatory disease affecting the aorta and its main branches. Severe aortic regurgitation (AR) represents a fearsome complication of aortitis and is associated with an increased mortality rate. Surgical aortic valve replacement represents the only treatment choice for these patients. However, it is associated with a higher risk of medium to long-term complications such as prosthetic valve detachment. This is the first reported case where severe AR secondary to aortitis was managed with transcatheter aortic valve implantation (TAVI). TAVI was safe and effective in this clinical setting and may be considered a viable alternative to high-risk surgery in these complex patients.
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Affiliation(s)
- Rossella Ruggiero
- University of Ferrara, Ferrara, Italy.,Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Ponticelli
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy
| | - Marcello Galvani
- Unità Operativa di Cardiologia, Ospedale GB Morgagni, Forlì, Italy
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15
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Bodart LE, Ciske BR, Le J, Reilly NM, Deaño RC, Ewer SM, Tipnis P, Rahko PS, Wagner MG, Raval AN, Speidel MA. Technical and clinical study of x-ray-based surface echo probe tracking using an attached fiducial apparatus. Med Phys 2021; 48:2528-2542. [PMID: 33608930 DOI: 10.1002/mp.14790] [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: 09/11/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Several types of structural heart intervention (SHI) use information from multiple imaging modalities to complete an interventional task. For example, in transcatheter aortic valve replacement (TAVR), placement and deployment of a bioprosthetic aortic valve in the aorta is primarily guided by x-ray fluoroscopy (XRF), and echocardiography provides visualization of cardiac anatomy and blood flow. However, simultaneous interpretation of independent x-ray and echo displays remains a challenge for the interventionalist. The purpose of this work was to develop a novel echo/x-ray co-registration solution in which volumetric transthoracic echo (TTE) is transformed to the x-ray coordinate system by tracking the three-dimensional (3D) pose of a probe fiducial attachment from its appearance in two-dimensional (2D) x-ray images. METHODS A fiducial attachment for a commercial TTE probe consisting of rings of high-contrast ball bearings was designed and fabricated. The 3D pose (position and orientation) of the fiducial attachment is estimated from a 2D x-ray image using an algorithm in which a virtual point cloud model of the attachment is iteratively rotated, translated, and forward-projected onto the image until the average sum-of-squares of grayscale values at the projected points is minimized. Fiducial registration error (FRE) and target registration error (TRE) of this approach were evaluated in phantom studies using TAVR-relevant gantry orientations and four standard acoustic windows for the TTE probe. A patient study was conducted to assess the clinical suitability of the fiducial attachment prototype during TTE imaging of patients undergoing SHI. TTE image quality for the task of guiding a transcatheter procedure was evaluated in a reviewer study. RESULTS The 3D FRE ranged from 0.32 ± 0.03 mm (mean ± SD) to 1.31 ± 0.05 mm, depending on C-arm orientation and probe acoustic window. The 3D TRE ranged from 1.06 ± 0.03 mm to 2.42 ± 0.06 mm. Fiducial pose estimation was stable when >75% of the fiducial markers were visible in the x-ray image. A panel of reviewers graded the presentation of heart valves in TTE images from 48 SHI patients. While valve presentation did not differ significantly between acoustic windows (P > 0.05), the mitral valve did achieve a significantly higher image quality compared to the aortic and tricuspid valves (P < 0.001). Overall, reviewers perceived sufficient image quality in 76.5% of images of the mitral valve, 54.9% of images of the aortic valve, and 48.6% of images of the tricuspid valve. CONCLUSIONS Fiducial-based tracking of a commercial TTE probe is compatible with clinical SHI workflows and yields 3D target registration error of less than 2.5 mm for a variety of x-ray gantry geometries and echo probe acoustic windows. Although TTE image quality with respect to target valve anatomy was sufficient for the majority of cases examined, prescreening of patients for sufficient TTE quality would be helpful.
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Affiliation(s)
- Lindsay E Bodart
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, USA
| | - Benjamin R Ciske
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Jonathan Le
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Nicole M Reilly
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Roderick C Deaño
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Steven M Ewer
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Parag Tipnis
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Peter S Rahko
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
| | - Martin G Wagner
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, USA
| | - Amish N Raval
- Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin - Madison, Madison, WI, USA
| | - Michael A Speidel
- Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, USA.,Department of Medicine, University of Wisconsin - Madison, Madison, WI, USA
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16
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Dimitrova G, Meers JB. Con: The Length of Adult Cardiothoracic Anesthesiology Fellowship Training Should Not Be Extended Beyond One Year. J Cardiothorac Vasc Anesth 2021; 35:2517-2520. [PMID: 33773890 DOI: 10.1053/j.jvca.2021.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 02/04/2023]
Abstract
Fellowship training in adult cardiothoracic anesthesiology (ACTA) is a one-year postgraduate experience with formal accreditation by the Accreditation Council for Graduate Medical Education. ACTA is a competitive and evolving subspeciality. With expanding knowledge, clinical roles and technical skills required of the modern cardiothoracic anesthesiologists, the optimal structure and duration of the fellowship training are worth considering. This manuscript provides supporting rationale for fellowship training in ACTA to remain one year in duration. The expanding responsibilities of the cardiothoracic anesthesiologist and strategies to best train the future of the subspecialty within the current training structure are discussed. It also briefly examines the history and current status of the fellowship training, reviews considerations for increasing fellowship duration, and highlights personal and financial considerations during the training.
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Affiliation(s)
- Galina Dimitrova
- The Ohio State University Wexner Medical Center, Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Columbus, OH.
| | - J Bradley Meers
- University of Alabama at Birmingham, School of Medicine, Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Birmingham, AL
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17
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Lum MY, Wang SX, Wisneski AD, Liang NE, Zimmet J, Shunk KA, Stechert M, London MJ, Ge L, Tseng EE. Development of the Minimalist Approach for Transcatheter Aortic Valve Replacement at a Veterans Affairs Medical Center. THE JOURNAL OF INVASIVE CARDIOLOGY 2021; 33:E108-E114. [PMID: 33531442 PMCID: PMC8589465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES While a minimalist transcatheter aortic valve replacement (TAVR) approach has shown safety and efficacy at civilian hospitals, limited data exist regarding developing this approach at Veterans Affairs (VA) medical centers (VAMCs). We implemented TAVR with minimalist approach (MA) using conscious sedation (CS) with transthoracic echocardiography (TTE) and compared safety and outcomes with general anesthesia (GA) with transesophageal echocardiography (TEE) at a university-affiliated VAMC. METHODS A total of 258 patients underwent transfemoral TAVR at a VAMC between November 2013 and October 2019. Ninety-three patients underwent GA/TEE and 165 patients underwent CS/TTE with dexmedetomidine and remifentanil. Propensity-score matching with nearest-neighbor matching was used to account for baseline differences, yielding 227 participants (81 GA, 146 CS). RESULTS MA-TAVR had no effect on 30-day mortality or paravalvular leakage. No differences were found in permanent pacemaker implantation, major vascular complications, or postoperative hemodynamics. In this population, MA-TAVR did not reduce procedural time, hospital length of stay, or intensive care unit length of stay. CONCLUSIONS Unlike civilian hospitals, MA with CS/TTE did not reduce overall length of stay in the veteran population; however, it was safe and effective for transfemoral TAVR without impacting clinical outcomes of mortality, major vascular complications, and paravalvular leakage.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Elaine E Tseng
- University of California San Francisco Medical Center, Cardiothoracic Surgery, San Francisco VA Medical Center, 4150 Clement St. 112D, San Francisco, CA 94121 USA.
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18
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Chiam PTL, Hayashida K, Watanabe Y, Yin WH, Kao HL, Lee MKY, Posas FE, Chandavimol M, Buddhari W, Dy TC, Nguyen NQ, Kim WJ, Chang K, Lin MS, Lam YY, Pham HM, Yahaya SA, Ho KW, Pan W, Liu XB, Wang J, Kim HS, Chen M. Sex differences in patients undergoing transcatheter aortic valve replacement in Asia. Open Heart 2021; 8:openhrt-2020-001541. [PMID: 33419935 PMCID: PMC7798412 DOI: 10.1136/openhrt-2020-001541] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 02/05/2023] Open
Abstract
Objectives Transcatheter aortic valve replacement (TAVR) is increasingly performed. Physically small Asians have smaller aortic root and peripheral vessel anatomy. The influence of gender of Asian patients undergoing TAVR is unknown and may affect outcomes. The aim of this study was to assess sex differences in Asian patients undergoing TAVR. Methods Patients undergoing TAVR from eight countries were enrolled. In this retrospective analysis, we examined differences in characteristics, 30-day clinical outcomes and 1-year survival between female and male Asian patients. Results Eight hundred and seventy-three patients (54.4% women) were included. Women were older, smaller and had less coronary artery and lung disease but tended to have higher logistic EuroSCOREs. Smaller prostheses were used more often in women. Major vascular complications occurred more frequently in women (5.5% vs 1.8%, p<0.01); however, 30-day stroke and mortality (women vs men: 1.5% vs 1.6%, p=0.95% and 4.3% vs 3.4%, p=0.48) were similar. Functional status improvement was significant and comparable between the sexes. Conduction disturbance and permanent pacemaker requirements (11.2% vs 9.0%, p=0.52) were also similar as was 1-year survival (women vs men: 85.6% vs 88.2%, p=0.25). The only predictors of 30-day mortality were major vascular injury in women and age in men. Conclusions Asian women had significantly smaller stature and anatomy with some differences in clinical profiles. Despite more frequent major vascular complications, women had similar 30-day stroke or mortality rates. Functional status improvement was significant and comparable between the sexes. Conduction disturbance and permanent pacemaker requirements were similar as was 1-year survival.
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Affiliation(s)
- Paul T L Chiam
- The Heart and Vascular Centre, Mount Elizabeth Medical Centre, Singapore
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Wei-Hsian Yin
- Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Hsien-Li Kao
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Michael K Y Lee
- Department of Cardiology, Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | | | | | | | - Timothy C Dy
- Heart Institute, Chinese General Hospital and Medical Centre, Manila, Philippines
| | - Ngoc Quang Nguyen
- Department of Cardiology, Vietnam National Heart Institute, Hanoi, Vietnam
| | - Won Jang Kim
- Department of Cardiology, CHA Bundang Medical Centre, Seoul, Republic of Korea
| | - Kiyuk Chang
- Cardiology, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Mao-Shin Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yat-Yin Lam
- Hong Kong Asia Heart Centre, Canossa Hospital, Hong Kong, Hong Kong
| | - Hung Manh Pham
- Department of Cardiology, Vietnam National Heart Institute, Hanoi, Vietnam
| | | | - Kay Woon Ho
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Wenzhi Pan
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xian-Bao Liu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian'an Wang
- Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hyo Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Mao Chen
- Department of Cardiology, Sichuan University West China Hospital, Chengdu, China
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19
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Koga M, Izumo M, Tanabe Y, Akashi YJ. Cerebral infarction due to dispersal of aortic atheromas detected by transoesophageal echocardiography during transcatheter aortic valve implantation. BMJ Case Rep 2020; 13:13/12/e238337. [PMID: 33376091 PMCID: PMC7778744 DOI: 10.1136/bcr-2020-238337] [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: 12/31/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a rapidly evolving treatment option with an inherent risk of causing cerebral infarctions. The mechanism of cerebral infarction during TAVI mainly involves embolisms from the aortic wall and valve. Transoesophageal echocardiography (TEE) is useful for detecting aortic atheromas. We present the case of a patient in whom the dispersal of aortic atheromas was monitored by TEE during TAVI. This report demonstrates the importance of preoperatively predicting embolisms from aortic atheromas in patients with severe aortic stenosis.
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Affiliation(s)
- Masashi Koga
- Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yasuhiro Tanabe
- Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yoshihiro John Akashi
- Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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20
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TAVR: A Review of Current Practices and Considerations in Low-Risk Patients. J Interv Cardiol 2020; 2020:2582938. [PMID: 33447165 PMCID: PMC7781688 DOI: 10.1155/2020/2582938] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/30/2020] [Accepted: 09/08/2020] [Indexed: 11/17/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is an established treatment for severe, symptomatic, aortic stenosis (AS) in patients of all risk categories and now comprises 12.5% of all aortic valve replacements. TAVR is a less invasive alternative to traditional surgical aortic valve replacement (SAVR), with equivalent or superior outcomes. The use of TAVR has increased rapidly. The success and increase in use of TAVR are a result of advances in technology, greater operator experience, and improved outcomes. Indications have recently expanded to include patients considered to be at low risk for SAVR. While TAVR outcomes have improved, remaining challenges include the management of coexistent coronary artery disease, prevention of periprocedural stroke, and issue of durability. These issues are even more relevant for low-risk, younger patients.
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21
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Adamo M, Alos B, Metra M, Lefèvre T, Swaans MJ, Gheorghe L, Tschöpe C, Krackhardt F, Alfieri O, Bouleti C. Patient with heart failure: importance to treat valvular diseases. Eur Heart J Suppl 2020; 22:P38-P41. [PMID: 33390869 PMCID: PMC7757709 DOI: 10.1093/eurheartj/suaa184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
COVID-19 pandemic is causing an unprecedented burden on healthcare resources and this includes treatment of heart failure and valvular heart diseases (VHD). Percutaneous procedures have broadened the number of patients with VHD who could be treated. However, COVID-19 pandemic has challenged their implementation. The risk of in-hospital infection, resources reallocation, reduced access to hospital caused a substantial delay of VHD treatment with an increased risk of clinical worsening and mortality. Now, the pandemic is not ended and subsequent waves are likely. Reorganization of our healthcare resources is needed, including a proper algorithm for patients' prioritization, based on the severity of their valve disease, their life expectancy, complexity of the intervention, and the resources available. A wider use of telemedicine for patients' selection and follow-up and any measurement that can shorten the duration of the hospital stay must be adopted. Patients' and healthcare staff screening for COVID-19 and all needed procedures to prevent infection will continue to be mandatory. Percutaneous procedures, compared to surgery, are associated with a lower risk of infection and a lower need for in-hospital resources, including a shorter duration of hospital stay. This may favour their adoption when the risk of viral infection is high.
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Affiliation(s)
- Marianna Adamo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Benjamin Alos
- Department of Cardiology, University Hospital of Poitiers, Poitiers, France
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Thierry Lefèvre
- Department of Cardiology, Institut cardiovasculaire Paris Sud, Hopital privé Jacques Cartier, Ramsay Générale de santé, Massy, France
| | - Martins J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Livia Gheorghe
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Carsten Tschöpe
- Department of Cardiology, Charite, Campus Virchow, Berlin, Germany
- Department of Cardiology, Berlin Center for Regenerative Therapies/Berlin Institute of Health (BCRT/BIH), Charite, Berlin, Germany
| | | | - Ottavio Alfieri
- Department of Cardiology, S. Raffaele University Hospital Milano, Milan, Italy
| | - Claire Bouleti
- Department of Cardiology, University Hospital of Poitiers, Poitiers, France
- Department of Cardiology, Clinical Investigation Center (CIC) INSERM 1402, University of Poitiers, Poitiers, France
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Stachon P, Kaier K, Zirlik A, Bothe W, Heidt T, Zehender M, Bode C, von Zur Mühlen C. Risk-Adjusted Comparison of In-Hospital Outcomes of Transcatheter and Surgical Aortic Valve Replacement. J Am Heart Assoc 2020; 8:e011504. [PMID: 30897991 PMCID: PMC6509703 DOI: 10.1161/jaha.118.011504] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Transfemoral transcatheter aortic valve replacement (TF‐TAVR) is recommended for patients suffering from aortic valve stenosis at increased operative risk. Beyond that, patients with different comorbidities could benefit from TF‐TAVR. The present study compares real‐world in‐hospital outcomes of surgical aortic valve replacement and TF‐TAVR. Methods and Results For all 33 789 isolated TF‐TAVR and surgical aortic valve replacement procedures performed in Germany in 2014 and 2015, comorbidities and in‐hospital outcomes were identified by International Classification of Diseases (ICD)‐ and OPS (Operation and procedure key)‐codes. Patients undergoing TF‐TAVR were older and at increased estimated risk. Outcomes were risk‐adjusted to allow comparison. TF‐TAVR was associated with a lower risk for acute kidney injuries (odds ratio [OR] 0.62, P<0.001), for bleeding (OR 0.17, P<0.001), and for prolonged mechanical ventilation (>48 hours, OR 0.21, P<0.001). Risk for stroke was similar (OR 1.07, P=0.558). As expected, the risk for pacemaker implantations was higher after TF‐TAVR (OR 4.61, P<0.001). In all patients, none of the treatment strategies had a clear advantage on the risk for in‐hospital mortality (OR 0.83, P=0.068). However, in patients aged >80 years and at high operative risk undergoing TF‐TAVR in‐hospital mortality was lower (TF‐TAVR versus surgical aortic valve replacement 80–84, OR 0.55; P=0.002; ≥85 years, OR 0.42, P=0.006; EuroSCORE (European System for Cardiac Operative Risk Evaluation) >9: OR 0.62, P=0.001). TF‐TAVR was superior in patients with renal failure and in NYHA (New York Heart Association)‐Class III/IV. Other risk groups were not found to be factors favoring a treatment strategy. Conclusions The present study indicates a superiority of TF‐TAVR in clinical practice for patients at increased operative risk, aged >80 years, in NYHA‐Class III/IV, and with renal failure.
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Affiliation(s)
- Peter Stachon
- 1 University Heart Center Freiburg Department of Cardiology and Angiology I Faculty of Medicine University of Freiburg Freiburg Germany
| | - Klaus Kaier
- 1 University Heart Center Freiburg Department of Cardiology and Angiology I Faculty of Medicine University of Freiburg Freiburg Germany.,2 Institute of Medical Biometry and Medical Informatics University Medical Center Freiburg Faculty of Medicine University of Freiburg Freiburg Germany
| | - Andreas Zirlik
- 1 University Heart Center Freiburg Department of Cardiology and Angiology I Faculty of Medicine University of Freiburg Freiburg Germany.,3 Department of Cardiology University Hospital Graz Austria
| | - Wolfgang Bothe
- 4 Department of Cardiac and Vascular Surgery Heart Center Freiburg Faculty of Medicine University of Freiburg Freiburg Germany
| | - Timo Heidt
- 1 University Heart Center Freiburg Department of Cardiology and Angiology I Faculty of Medicine University of Freiburg Freiburg Germany
| | - Manfred Zehender
- 1 University Heart Center Freiburg Department of Cardiology and Angiology I Faculty of Medicine University of Freiburg Freiburg Germany
| | - Christoph Bode
- 1 University Heart Center Freiburg Department of Cardiology and Angiology I Faculty of Medicine University of Freiburg Freiburg Germany
| | - Constantin von Zur Mühlen
- 1 University Heart Center Freiburg Department of Cardiology and Angiology I Faculty of Medicine University of Freiburg Freiburg Germany
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Cubeddu RJ, Sarkar A, Navas V, Navia JL. 'Minimalist approach' for transcatheter mitral valve replacement using intracardiac echocardiography and conscious sedation: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32617475 PMCID: PMC7319820 DOI: 10.1093/ehjcr/ytaa058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/10/2019] [Accepted: 02/06/2020] [Indexed: 11/29/2022]
Abstract
Background Transcatheter aortic valve implantation operators have adapted to a less invasive technique by foregoing the use of general anaesthesia and transoesophageal echocardiography. This is known as a ‘minimalist approach’. This approach has yet to be explored in transcatheter mitral valve replacement (TMVR). Two patients with high perioperative risk underwent TMVR using only monitored conscious sedation (CS) and intracardiac echocardiography (ICE). Case summary The patients were symptomatic and required treatment of severe mitral regurgitation and severe mitral stenosis in a mitral valve ring and prosthetic mitral valve, respectively. With the use of an antegrade transseptal approach, the procedure was conducted under CS using ICE only. After placement of the prosthetic mitral valve, the valve was assessed by advancing the ICE catheter through the interatrial septal defect and no significant paravalvular leak occurred. In one case, ad hoc treatment of right to left shunting was successfully pursued. Valve function was excellent immediately and at 24 h after implantation and resulted in significant haemodynamic improvement. Conclusion With more TMVR cases being conducted, the ‘minimalist approach’ with CS and ICE may be considered in selected cases.
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Affiliation(s)
- Robert J Cubeddu
- Department of Cardiology, Heart & Vascular Institute, Cleveland Clinic Florida, 2590 Cleveland Clinic Blvd, Weston, FL 33331, USA
| | - Abdullah Sarkar
- Department of Cardiology, Heart & Vascular Institute, Cleveland Clinic Florida, 2590 Cleveland Clinic Blvd, Weston, FL 33331, USA
| | - Viviana Navas
- Department of Cardiology, Heart & Vascular Institute, Cleveland Clinic Florida, 2590 Cleveland Clinic Blvd, Weston, FL 33331, USA
| | - Jose L Navia
- Department of Cardiology, Heart & Vascular Institute, Cleveland Clinic Florida, 2590 Cleveland Clinic Blvd, Weston, FL 33331, USA
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Harjai KJ, Bules T, Berger A, Young B, Singh D, Carter R, Agarwal S, Crockett S, Mascarenhas V, Nawaz Y, Stella J, Burnside J, Skelding KA, Desciak M, Casale AS. Efficiency, Safety, and Quality of Life After Transcatheter Aortic Valve Implantation Performed With Moderate Sedation Versus General Anesthesia. Am J Cardiol 2020; 125:1088-1095. [PMID: 32046822 DOI: 10.1016/j.amjcard.2020.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 12/21/2022]
Abstract
There is growing interest in "minimalist" transcatheter aortic valve implantation (M-TAVI), performed with conscious sedation instead of general anesthesia (GA-TAVI). We assessed the impact of M-TAVI on procedural efficiency, long-term safety, and quality of life (QoL) in 477 patients with severe aortic stenosis (82 years, women 50%, STS 5.0), who underwent M-TAVI (n = 278) or GA-TAVI (n = 199). M-TAVI patients were less likely to have NYHA Class ≥3, valve-in-valve TAVI, and receive self-expanding valves. M-TAVI was completed without conversion to GA in 269 (97%) patients. M-TAVI was more efficient that GA-TAVI including shorter lengths of stay (2 vs 3 days, p <0.0001), higher likelihood of being discharged home (87% vs 72%, p <0.0001), less use of blood transfusions (10% vs 22%, p = 0.0008), inotropes (13% vs 32%, p <0.0001), contrast volume (50 vs 90 ml, p <0.0001), fluoroscopy time (20 vs 24 minute, p <0.0001), and need for >1 valves (0.4 vs 5.5%, p = 0.0004). At 1-month, death/stroke (M-TAVI vs GA-TAVI 4.0 vs 6.5%) and a "safety composite" end point (death, stroke, transient ischemic attack, myocardial infarction, new dialysis, major vascular complication, major or life-threatening bleeding, and new pacemaker: 17.6% vs 21.1%) were similar (p = NS for both). At a median follow-up of 365 days, survival curves showed similar incidence of death/stroke as well as the safety composite end point between the groups. QoL scores were similar at baseline and 1-month after TAVI. In multivariable analyses, M-TAVI showed significant improvements in all parameters of procedural efficiency. In conclusion, M-TAVI is more efficient than GA-TAVI, with similar safety at 1-month and long-term, and similar QoL scores at 1 month.
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26
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Kalogeras K, Ruparelia N, Kabir T, Jabbour R, Naganuma T, Vavuranakis M, Nakamura S, Wang B, Sen S, Hadjiloizou N, Malik IS, Mikhail G, Dalby M, Panoulas V. Comparison of the self-expanding Evolut-PRO transcatheter aortic valve to its predecessor Evolut-R in the real world multicenter ATLAS registry. Int J Cardiol 2020; 310:120-125. [PMID: 32139239 DOI: 10.1016/j.ijcard.2020.02.070] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/16/2020] [Accepted: 02/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Evolut PRO self-expanding transcatheter aortic valve has been designed to feature an outer pericardial wrap that aims to reduce paravalvular regurgitation (PVR) rates. Medium-term clinical outcomes, compared to its predecessor Evolut R, in a real-world setting, have not been investigated. The aim of the present study was to compare the two valves with regards to peri-procedural complications, early outcomes and mid-term survival. METHODS Consecutive patients, undergoing TAVI with either the Evolut PRO or Evolut R device, from the multicenter ATLAS registry were retrospectively studied. Outcomes studied included periprocedural complications, PVR at discharge, need for new pacemaker implantation and Kaplan-Meier estimated 1-year all-cause mortality. RESULTS Analysis included 673 patients (498 treated with Evolut R and 175 treated with Evolut PRO). At least moderate PVR was numerically lower amongst patients treated with Evolut PRO (7.4% vs 3.8% for Evolut R and Evolut PRO respectively, p = .108). Rates of new permanent pacemaker (PPM) implantation (21.1% vs. 11.9%, p = .023), and bail-out valve-in-valve (2.4% vs. 0%, p = .049) were significantly lower amongst the Evolut PRO group. No differences were demonstrated regarding bleeding, stroke or acute kidney injury. One-year Kaplan-Meier estimated survival was similar between groups (93% for Evolut R vs. 91.2% for Evolut PRO, plog-rank = 0.806). CONCLUSIONS The Evolut PRO self-expanding valve demonstrates similar mid-term survival rates and numerically, yet not significant, lower incidence of PVR compared to its predecessor. Interestingly this new generation valve is associated with a significantly reduced rate for new PPM implantation. Future studies are required to confirm this finding.
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Affiliation(s)
- Konstantinos Kalogeras
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Foundation Trust, London, UK; 1st Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece
| | - Neil Ruparelia
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Tito Kabir
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Foundation Trust, London, UK
| | - Richard Jabbour
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Manolis Vavuranakis
- 1st Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece; 3(rd) Department of Cardiology, Sotiria Hospital, National & Kapodistrian University of Athens, Greece
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Brian Wang
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Sayan Sen
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Nearchos Hadjiloizou
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
| | - Iqbal S Malik
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Ghada Mikhail
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Miles Dalby
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Foundation Trust, London, UK; Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
| | - Vasileios Panoulas
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Foundation Trust, London, UK; Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
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Maier A, Hammerich B, Humburger F, Brieschal T, Heidt T, Bothe W, Schröfel H, Kaier K, Zehender M, Reinöhl J, Bode C, von zur Mühlen C, Stachon P. A logistic regression analysis comparing minimalistic approach and intubation anaesthesia in patients undergoing transfemoral transcatheter aortic valve replacement. PLoS One 2020; 15:e0227345. [PMID: 32023258 PMCID: PMC7001937 DOI: 10.1371/journal.pone.0227345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 12/06/2019] [Indexed: 12/26/2022] Open
Abstract
Aims Patients with postoperative delirium (POD) after transcatheter aortic valve replacement (TAVR) are ventilated and hospitalized longer and suffer increased in-hospital mortality. This study hypothesized that a minimalistic approach with conscious sedation during transfemoral aortic valve replacement (TF-AVR) protects against delirium, time of mechanical ventilation, and increased length of stay in intensive care unit (ICU) compared to intubation anaesthesia. Methods and results 308 patients which underwent TF-AVR in our centre between 01/2013 and 08/2017 were retrospectively evaluated regarding postoperative delirium, time of mechanical ventilation, and days in ICU. TF-AVR was performed with intubation anaesthesia in 245 patients and with conscious sedation in 63. The operative risk estimated by the logEUROScore was similar in both groups (intubation: 13.28 +/-9.06%, conscious sedation: 12.24 +/-6.77%, p = 0.395). In the conscious sedation group procedure duration was shorter (0.61 +/-0.91h vs. 1.75 +/-0.96h, p<0.001). The risk for intraprocedural complications was not influenced by the anaesthesia method (OR conscious sedation instead of intubation 1.66, p = 0.117), but days on ICU (-2.21 days, p<0.0001) and minutes of mechanical ventilation (-531.2 min, p < 0.0001) were reduced. Furthermore, the risk of POD was decreased when TF-AVR was performed under conscious sedation (6.35% vs. 18.18%, OR 0.29, p = 0.021). Conclusions Time of mechanical ventilation, risk of POD, and days on ICU were substantially reduced in patients who underwent TF-AVR under conscious sedation. Our data suggest that TF-AVR with conscious sedation is safe with a beneficial postoperative course in clinical practice, and should be considered the favoured approach.
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Affiliation(s)
- Alexander Maier
- Department of Cardiology and Angiology I, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Benedikt Hammerich
- Department of Cardiology and Angiology I, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Frank Humburger
- Department of Anaesthesiology and Critical Care, University Hospital Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Brieschal
- Department of Anaesthesiology and Critical Care, University Hospital Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Timo Heidt
- Department of Cardiology and Angiology I, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Wolfgang Bothe
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Holger Schröfel
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Faculty of Medicine and Medical Centre-University of Freiburg, Institute of Medical Biometry and Statistics, Freiburg, Germany
| | - Manfred Zehender
- Department of Cardiology and Angiology I, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Jochen Reinöhl
- Department of Cardiology and Angiology I, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
- Edwards LifeScience, Nyon, Switzerland
| | - Christoph Bode
- Department of Cardiology and Angiology I, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Constantin von zur Mühlen
- Department of Cardiology and Angiology I, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Peter Stachon
- Department of Cardiology and Angiology I, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
- * E-mail:
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Burzotta F, Aurigemma C, Romagnoli E, Shoeib O, Russo G, Zambrano A, Verdirosi D, Leone AM, Bruno P, Trani C. A less‐invasive totally‐endovascular (LITE) technique for trans‐femoral transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 96:459-470. [DOI: 10.1002/ccd.28697] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/20/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Cristina Aurigemma
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Enrico Romagnoli
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Osama Shoeib
- Cardiology Department Tanta University Tanta Egypt
| | - Giulio Russo
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Aniello Zambrano
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Diana Verdirosi
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Antonio Maria Leone
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Piergiorgio Bruno
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Carlo Trani
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
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Determinants of prolonged hospitalization in patients who underwent trans-femoral transcatheter aortic valve implantation. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2019; 15:431-438. [PMID: 31933659 PMCID: PMC6956457 DOI: 10.5114/aic.2019.90217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/15/2019] [Indexed: 01/02/2023] Open
Abstract
Introduction Transcatheter aortic valve implantation (TAVI) has grown to be an alternative treatment for severe symptomatic aortic valve stenosis (AS) in elderly patients. Although TAVI is a less invasive surgery than surgical aortic valve replacement, some patients may require prolonged hospitalization. Aim To find the determinants of prolonged hospitalization in patients who underwent trans-femoral TAVI. Material and methods A total of 94 AS patients who underwent trans-femoral TAVI were included as the final study population, and divided into the conventional hospitalization group (≤ 21 days) (n = 74) and prolonged hospitalization group (> 21 days) (n = 20). We compared clinical characteristics between the two groups, and multivariate logistic regression analysis was performed to find the determinants of prolonged hospitalization. Results In multivariate logistic regression analysis, moderate or severe mitral regurgitation (OR = 4.49, 95% CI: 1.16-17.47, p = 0.03), taking statins or angiotensin converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB) on admission (statins: OR = 0.13, 95% CI: 0.02-0.71, p = 0.02, ACE inhibitors/ARB: OR = 0.25, 95% CI: 0.06-0.96, p = 0.04), estimated glomerular filtration rate (eGFR) (per 15 ml/min/1.73 m2 incremental) (OR = 0.49, 95% CI: 0.26-0.90, p = 0.02) and current chopsticks user (OR = 0.05, 95% CI: 0.01-0.41, p < 0.01) were significantly associated with prolonged hospitalization. Conclusions Moderate or severe mitral regurgitation was significantly associated with prolonged hospitalization, while current chopsticks user, eGFR (per 15 ml/min/1.73 m2 incremental), taking ACE inhibitors/ARB or statins before the procedure were inversely associated with prolonged hospitalization in patients who underwent trans-femoral TAVI.
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Akodad M, Lefèvre T, Lounes Y, Leclercq F. [TAVI simplification: A focus]. Ann Cardiol Angeiol (Paris) 2019; 68:418-422. [PMID: 31668597 DOI: 10.1016/j.ancard.2019.09.017] [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: 09/17/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022]
Abstract
After a first procedure carried out in 2002 by Pr Cribier's, Transcatheter Aortic Valve Replacement or TAVR revolutionized the management of aortic stenosis with a constant increase in the number of procedures performed worldwide. Experience of operators and teams and evolution of the technique has been accompanied by a drastic reduction in complications in patients at lower surgical risk. In parallel, the procedure was considerably simplified, carried out more and more under local anesthesia, with percutaneous femoral approach, secondary radial approach, prosthesis implantation without predilatation, rapid pacing on left ventricle wire and early discharge. Thus, the "simplified" TAVR adopted in most centers nowadays is a real revolution of the technique. However, simplified TAVR must be accompanied upstream by a rigorous selection of patients who can benefit from a minimalist procedure in order to guarantee its safety.
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Affiliation(s)
- M Akodad
- Service de cardiologie, centre hospitalier universitaire Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France; PhyMed Exp, université de Montpellier, Inserm U1046, CNRS UMR 9214, 34295 Montpellier cedex 5, France.
| | - T Lefèvre
- Ramsay générale de santé, institut cardiovasculaire Paris Sud, 91300 Massy, France
| | - Y Lounes
- Service de chirurgie vasculaire, centre hospitalier universitaire Arnaud-de-Villeneuve, 34295 Montpellier, France
| | - F Leclercq
- Service de cardiologie, centre hospitalier universitaire Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France; PhyMed Exp, université de Montpellier, Inserm U1046, CNRS UMR 9214, 34295 Montpellier cedex 5, France
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31
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Sangaraju S, Cox I, Dalrymple-Hay M, Lloyd C, Suresh V, Riches T, Melhuish S, Asopa S, Newcombe S, Deutsch C, Bramlage P. Effect of procedural refinement of transfemoral transcatheter aortic valve implantation on outcomes and costs: a single-centre retrospective study. Open Heart 2019; 6:e001064. [PMID: 31673385 PMCID: PMC6802979 DOI: 10.1136/openhrt-2019-001064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/16/2019] [Accepted: 09/12/2019] [Indexed: 11/28/2022] Open
Abstract
Objectives To determine the effect of introducing several procedural refinements of transfemoral transcatheter aortic valve implantation (TAVI) on clinical outcomes and costs. Design Retrospective analysis comparing two consecutive 1-year periods, before and after the introduction of procedural refinements. Setting Tertiary hospital aortic valve programme. Participants Consecutive patients undergoing transfemoral TAVI treated between April 2014 and August 2015 using the initial setup (n=70; control group) or between September 2015 and August 2016 after the introduction of procedural refinements (n=89). Interventions Introduction of conscious sedation, percutaneous access and closure, omission of transoesophageal echocardiography during the procedure, and an early discharge procedure. Outcome measures Procedural characteristics, complications and outcomes; length of stay in intensive care unit (ICU) and hospital; hospital-related direct costs associated with TAVI. Results There were no statistically significant differences in the incidence of complications or mortality between the two groups. The mean length of stay in the ICU was significantly shorter in the procedural-refinement group compared with the control group (5.1 vs 57.2 hours, p<0.001), as was the mean length of hospital stay (4.7 vs 6.6 days, p<0.001). The total cost per TAVI procedure was significantly lower, by £3580, in the procedural-refinement group (p<0.001). This was largely driven by lower ICU costs. Conclusions Among patients undergoing transfemoral TAVI, procedural refinement facilitated a shorter stay in ICU and earlier discharge from hospital and was cost saving compared with the previous setup.
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Affiliation(s)
| | - Ian Cox
- Cardiology, University Hospitals Plymouth NHS, Plymouth, Devon, UK
| | | | - Clinton Lloyd
- Cardiology, University Hospitals Plymouth NHS, Plymouth, Devon, UK
| | | | - Tania Riches
- Cardiology, University Hospitals Plymouth NHS, Plymouth, Devon, UK
| | | | - Sanjay Asopa
- Cardiology, University Hospitals Plymouth NHS, Plymouth, Devon, UK
| | | | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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Kochergin NA, Shilov AA, Ovcharenko EA, Klyshnikov KI, Ganiukov VI. [Evolution of transcatheter aortic valve implantation: from planning to robotic systems]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:80-85. [PMID: 31149993 DOI: 10.33529/angio2019207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Since its introduction in 2002, transcatheter aortic valve implantation (TAVI) has evolved dramatically and is now standard of care for intermediate risk patients with aortic stenosis. The development of innovative transcatheter heart valves and refinement of technical skills have contributed to the decrease in complication rates associated with TAVI. Increased experience, smaller sheaths, rigorous pre-procedural planning and improved vascular closing techniques have resulted in markedly lower rates of vascular complications. The next step was the simplification of the procedure, which contributed to a further decrease in complications, reduced procedural time, and shorter hospital stay. Change-over from general anaesthesia to conscious sedation, refusal from predilatation, and use of the radial approach instead of the contralateral femoral approach are all instrumental in achieving optimal results. Prospects for development include visual assist systems and robotic systems that can potentially optimize the transcatheter aortic valve implantation process, improve safety and effectiveness of the procedure.
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Affiliation(s)
- N A Kochergin
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - A A Shilov
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - E A Ovcharenko
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - K Iu Klyshnikov
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - V I Ganiukov
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
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Higuchi R, Tobaru T, Hagiya K, Saji M, Mahara K, Takamisawa I, Shimizu J, Iguchi N, Takanashi S, Takayama M, Isobe M. Outcomes of Transcatheter Aortic Valve Implantation in Patients with Cirrhosis. Int Heart J 2019; 60:352-358. [DOI: 10.1536/ihj.18-339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute
| | | | | | - Jun Shimizu
- Department of Anesthesiology, Sakakibara Heart Institute
| | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute
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Hybrid Operating Rooms for Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:2204-2206. [DOI: 10.1016/j.jcin.2018.07.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/18/2022]
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Transcatheter Aortic Valve Replacement in the Catheterization Laboratory Versus Hybrid Operating Room. JACC Cardiovasc Interv 2018; 11:2195-2203. [DOI: 10.1016/j.jcin.2018.06.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/14/2018] [Accepted: 06/26/2018] [Indexed: 11/23/2022]
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Akodad M, Lefèvre T. TAVI: Simplification Is the Ultimate Sophistication. Front Cardiovasc Med 2018; 5:96. [PMID: 30087900 PMCID: PMC6066956 DOI: 10.3389/fcvm.2018.00096] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/29/2018] [Indexed: 12/19/2022] Open
Abstract
Since its introduction in 2002, TAVI has evolved dramatically and is now standard of care for intermediate risk patients when the femoral approach can be implemented safely. The development of innovative transcatheter heart valves (THVs) and refinement of technical skills have contributed to the decrease in complication rates associated with TAVI4. Increased experience, smaller sheaths, rigorous pre-procedural planning and improved vascular closing techniques have resulted in markedly lower rates of vascular complications. The next step is the simplification of the procedure, which should contribute to a further decrease in complications, and also reduce procedural time, hospital stay as well as staff workload and costs. Moving to conscious sedation, no predilatation, no temporary pace maker and use of the radial approach as the contralateral approach are all instrumental in achieving this ultimate refinement.
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Affiliation(s)
- Mariama Akodad
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France.,Centre Hospitalier Universitaire Arnaud de Villeneuve, Montpellier, France
| | - Thierry Lefèvre
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
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Yamashita Y, Sonoda H, Ushijima T, Shiose A. Acute torrential mitral regurgitation during transcatheter aortic valve replacement: a case report. Surg Case Rep 2018; 4:35. [PMID: 29671237 PMCID: PMC5906411 DOI: 10.1186/s40792-018-0446-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/11/2018] [Indexed: 12/02/2022] Open
Abstract
Background Transcatheter aortic valve replacement (TAVR) is a minimally invasive approach to aortic valve replacement. However, critical cardiovascular collapse can occur during the procedure for various reasons. Case presentation A 90-year-old man with severe aortic stenosis and left circumflex artery stenosis developed acute torrential mitral regurgitation (MR) during TAVR. The valve deployment process induced left ventricular dyssynchrony due to left bundle-branch block and myocardial ischemia in the left circumflex artery region with torrential MR. Transesophageal echocardiography clearly demonstrated the mechanisms of MR, which was successfully bailed out by left ventricular pacing and intra-aortic balloon pumping. Conclusions MR can be seriously exaggerated by various and complicated mechanisms during TAVR and should be rapidly assessed and appropriately managed depending on its mechanisms. Electronic supplementary material The online version of this article (10.1186/s40792-018-0446-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yoshiyuki Yamashita
- Department of Cardiovascular Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Hiromichi Sonoda
- Department of Cardiovascular Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tomoki Ushijima
- Department of Cardiovascular Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Akira Shiose
- Department of Cardiovascular Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Villablanca PA, Mohananey D, Ramakrishna H. Comparison of local versus general anesthesia in patients undergoing transcatheter aortic valve replacement: An updated meta-analysis. Catheter Cardiovasc Interv 2018; 92:1018-1019. [DOI: 10.1002/ccd.27639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 03/27/2018] [Indexed: 11/07/2022]
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