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Will M, Schwarz K, Weiss T, Leibundgut G, Lamm G, Vock P, Mascherbauer J, Kwok CS. The impact of chronic total occlusions in patients undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2023; 101:806-812. [PMID: 36802136 DOI: 10.1002/ccd.30601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/30/2023] [Accepted: 02/05/2023] [Indexed: 02/21/2023]
Abstract
Coronary artery disease (CAD) is frequently encountered in patients evaluated for transcatheter aortic valve replacement (TAVR) due to severe aortic stenosis. The prognostic relevance of chronic total occlusions (CTOs) in this setting is poorly understood. We conducted a search of MEDLINE and EMBASE to identify studies evaluating patients who underwent TAVR and evaluated outcomes depending on the presence of coronary CTOs. Pooled analysis was performed to estimate the rate and risk ratio for mortality. Four studies involving 25,432 patients fulfilled the inclusion criteria. The follow up ranged from in-hospital outcomes to 8-years follow-up. Coronary artery disease was present in 67.8% to 75.5% of patients in 3 studies which reported this variable. The prevalence of CTOs varied between 2% and 12.6% in this cohort. The presence of CTOs was associated with increase in length of stay (8.1 ± 8.2 vs. 5.9 ± 6.5, p < 0.01), cardiogenic shock (5.1% vs. 1.7%, p < 0.01), acute myocardial infarction (5.8% vs. 2.8%, p = 0.02) and acute kidney injury (18.6% vs. 13.9%, p = 0.048). The pooled 1-year death rate revealed 41 deaths in 165 patients in the CTO group and 396 deaths in 1663 patients with no CTO ((24.8%) vs. (23.8%)). The meta-analysis of death with CTO versus no CTO showed a nonsignificant trend toward increased mortality with CTOs (risk ratio 1.11 95% CI 0.90-1.40, I2 = 0%). Our analysis suggests that concomitant CTO lesions in patients undergoing TAVR are common, and its presence was associated with increased in-hospital complications. However, CTO presence by itself was not associated with increased long-term mortality, only a nonsignificant trend toward an increased risk of death in patients with CTO was found. Further studies are warranted to assess the prognostic relevance of CTO lesion in TAVR patients.
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Affiliation(s)
- Maximilian Will
- Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria.,Karl Landsteiner Institute for Cardiometabolics, Karl Landsteiner Society, St Poelten, Austria
| | - Konstantin Schwarz
- Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Thomas Weiss
- Karl Landsteiner Institute for Cardiometabolics, Karl Landsteiner Society, St Poelten, Austria.,Medical School, Sigmund-Freud University, Vienna, Austria
| | - Gregor Leibundgut
- Klinik für Kardiologie, Universitätsspital Basel, Basel, Switzerland
| | - Gudrun Lamm
- Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Paul Vock
- Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Julia Mascherbauer
- Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Chun Shing Kwok
- Department of Post-Qualifying Healthcare Practice, School of Nursing and Midwifery, Birmingham City University, Birmingham, UK.,Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
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Marin F, Scarsini R, Kotronias RA, Printzios DT, Burrage MK, Bray JJH, Ciofani JL, Venturi G, Pighi M, De Maria GL, Banning AP. Aortic Valve Disease and Associated Complex CAD: The Interventional Approach. J Clin Med 2021; 10:946. [PMID: 33804391 PMCID: PMC7957505 DOI: 10.3390/jcm10050946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 01/09/2023] Open
Abstract
Coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis (AS). The management of CAD is a central aspect of the work-up of patients undergoing transcatheter aortic valve implantation (TAVI), but few data are available on this field and the best percutaneous coronary intervention (PCI) practice is yet to be determined. A major challenge is the ability to elucidate the severity of bystander coronary stenosis independently of the severity of aortic valve stenosis and subsequent impact on blood flow. The prognostic role of CAD in patients undergoing TAVI is being still debated and the benefits and the best timing of PCI in this context are currently under evaluation. Additionally, PCI in the setting of advanced AS poses some technical challenges, due to the complex anatomy, risk of hemodynamic instability, and the increased risk of bleeding complications. This review aims to provide a comprehensive synthesis of the available literature on myocardial revascularization in patients with severe AS undergoing TAVI. This work can assist the Heart Team in individualizing decisions about myocardial revascularization, taking into account available diagnostic tools as well as the risks and benefits.
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Affiliation(s)
- Federico Marin
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford OX3 9DU, UK; (F.M.); (R.A.K.); (D.T.P.); (M.K.B.); (G.L.D.M.)
| | - Roberto Scarsini
- Department of Cardiology, University of Verona, 37129 Verona, Italy; (R.S.); (G.V.); (M.P.)
| | - Rafail A. Kotronias
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford OX3 9DU, UK; (F.M.); (R.A.K.); (D.T.P.); (M.K.B.); (G.L.D.M.)
| | - Dimitrios Terentes Printzios
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford OX3 9DU, UK; (F.M.); (R.A.K.); (D.T.P.); (M.K.B.); (G.L.D.M.)
| | - Matthew K. Burrage
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford OX3 9DU, UK; (F.M.); (R.A.K.); (D.T.P.); (M.K.B.); (G.L.D.M.)
| | - Jonathan J. H. Bray
- Institute of Life Sciences 2, Swansea Bay University Health Board and Swansea University Medical School, SA2 8QA Swansea, UK;
| | - Jonathan L. Ciofani
- Department of Cardiology, Royal North Shore Hospital, 2065 Sydney, Australia;
| | - Gabriele Venturi
- Department of Cardiology, University of Verona, 37129 Verona, Italy; (R.S.); (G.V.); (M.P.)
| | - Michele Pighi
- Department of Cardiology, University of Verona, 37129 Verona, Italy; (R.S.); (G.V.); (M.P.)
| | - Giovanni L. De Maria
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford OX3 9DU, UK; (F.M.); (R.A.K.); (D.T.P.); (M.K.B.); (G.L.D.M.)
| | - Adrian P. Banning
- Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford OX3 9DU, UK; (F.M.); (R.A.K.); (D.T.P.); (M.K.B.); (G.L.D.M.)
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Impact of coronary artery disease on outcomes of severe aortic stenosis treatment with transcatheter aortic valve implantation. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2019; 15:167-175. [PMID: 31497049 PMCID: PMC6727222 DOI: 10.5114/aic.2019.84394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/10/2018] [Indexed: 01/12/2023] Open
Abstract
Introduction The presence of coronary artery disease (CAD) in patients who underwent transcatheter aortic valve implantation (TAVI) may increase in-hospital and long-term mortality. Aim To evaluate the impact of CAD in patients who underwent TAVI. Material and methods The study group consisted of the first 142 patients treated with TAVI between 26 November 2008 and 31 December 2015. The patients were divided into two groups: group I comprised 103 (72.5%) patients with CAD, and group II comprised 39 (27.5%) patients without CAD. Results Group I was characterized by a significantly higher risk according to EuroSCORE - 11.2 ±2.5 vs. 9 ±2.3 in group II (p < 0.001) and Logistic EuroSCORE - 25.4 ±13.4 vs. 16.3 ±8.7 (p < 0.001). 30-day mortality was 8 (7.8%) vs. 2 (5.1%) (p = NS) and 1-year mortality was 22 (21.4%) vs. 6 (15.4%) (p = NS) in group I and II respectively. The composite endpoint evaluating the efficacy of TAVI was achieved in 82 (79.6%) vs. 31 (79.5%) (p = NS) in group I and II respectively. The composite endpoint, which involved 30-day observation, occurred in 39 (37.86%) vs. 12 (30.77%) (p = NS) and the composite endpoint, which involved 1-year evaluation of the clinical efficacy of TAVI, occurred in 48 (57.8%) vs. 13 (48.1%) (p = NS) in patients with and without CAD respectively. Conclusions The short- and mid-term outcomes of TAVI patients with CAD, despite higher risk profile, did not differ from the outcomes of treatment in patients without CAD.
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Sankaramangalam K, Banerjee K, Kandregula K, Mohananey D, Parashar A, Jones BM, Jobanputra Y, Mick S, Krishnaswamy A, Svensson LG, Kapadia SR. Impact of Coronary Artery Disease on 30-Day and 1-Year Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement: A Meta-Analysis. J Am Heart Assoc 2017; 6:e006092. [PMID: 29021275 PMCID: PMC5721835 DOI: 10.1161/jaha.117.006092] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/28/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND The impact of coronary artery disease (CAD) on outcomes after transcatheter aortic valve replacement (TAVR) is understudied. Literature on the prognostic role of CAD in the survival of patients undergoing TAVR shows conflicting results. This meta-analysis aims to investigate how CAD impacts patient survival following TAVR. METHODS AND RESULTS We completed a comprehensive literature search of Embase, MEDLINE, and the Cochrane Library, and included studies reporting outcome of TAVR based on CAD status of patients for the analysis. From the initial 1631 citations, 15 studies reporting on 8013 patients were analyzed using a random-effects model. Of the 8013 patients undergoing TAVR, with a median age of 81.3 years (79-85.1 years), 46.6% (40-55.7) were men and 3899 (48.7%) had CAD (ranging from 30.8% to 78.2% in various studies). Overall, 3121 SAPIEN/SAPIEN XT/SAPIEN 3 (39.6%) and 4763 CoreValve (60.4%) prostheses were implanted, with transfemoral access being the most frequently used approach for the implantation (76.1%). Our analysis showed no significant difference between patients with and without CAD for all-cause mortality at 30 days post TAVR, with a cumulative odds ratio of 1.07 (95% confidence interval, 0.82-1.40; P=0.62). However, there was a significant increase in all-cause mortality at 1 year in the CAD group compared with patients without CAD, with a cumulative odds ratio of 1.21 (95% confidence interval, 1.07-1.36; P=0.002). CONCLUSIONS Even though coexisting CAD does not impact 30-day mortality, it does have an impact on 1-year mortality in patients undergoing TAVR. Our results highlight a need to revisit the revascularization strategies for concomitant CAD in patients with TAVR.
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Affiliation(s)
| | - Kinjal Banerjee
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | | | | | - Akhil Parashar
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Brandon M Jones
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Yash Jobanputra
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Stephanie Mick
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
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Bagienski M, Kleczynski P, Dziewierz A, Rzeszutko L, Sorysz D, Trebacz J, Sobczynski R, Tomala M, Stapor M, Dudek D. Incidence of Postoperative Delirium and Its Impact on Outcomes After Transcatheter Aortic Valve Implantation. Am J Cardiol 2017; 120:1187-1192. [PMID: 28826892 DOI: 10.1016/j.amjcard.2017.06.068] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 05/30/2017] [Accepted: 06/15/2017] [Indexed: 01/05/2023]
Abstract
There are limited data on the occurrence of postoperative delirium after transcatheter aortic valve implantation (TAVI). We sought to investigate the incidence of delirium after TAVI and its impact on clinical outcomes. A total of 148 consecutive patients who underwent TAVI were enrolled. Of these patients, 141 patients survived hospital stay. The incidence of delirium was assessed in these patients for the first 4 days after the index procedure. The patients were divided into 2 groups based on the presence of delirium. Baseline characteristics, procedural and long-term outcomes, and frailty and quality-of-life indexes were compared among the groups. Of the 141 patients analyzed, 29 patients developed delirium. The transapical access was more common in patients with delirium (51.7% vs 8.9%, p <0.001). A greater median contrast volume load in the delirium group was noted (75 vs 100 ml, p = 0.001). Significantly more patients with delirium were considered as frail before TAVI. Thirty-day and 12-month all-cause mortality rates were higher in the delirium group (0.0% vs 17.2%, p <0.001; and 3.6% vs 37.9%, p <0.001, respectively). Differences in mortality were significant even after adjustment for baseline characteristics. The quality of life at 12 months, assessed by the 3-level version of the EuroQol 5-dimensional questionnaire, was similar in both groups. Despite a relatively minimally invasive character of TAVI as compared with surgery, some patients experience delirium after TAVI. Importantly, the occurrence of delirium after TAVI may help to identify patients with worse short- and long-term outcomes.
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Affiliation(s)
- Maciej Bagienski
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - Pawel Kleczynski
- Institute of Cardiology, Jagiellonian University, Krakow, Poland.
| | - Artur Dziewierz
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - Lukasz Rzeszutko
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - Danuta Sorysz
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - Jaroslaw Trebacz
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | | | - Marek Tomala
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - Maciej Stapor
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
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Daniec M, Sorysz D, Dziewierz A, Kleczyński P, Rzeszutko Ł, Krawczyk-Ożóg A, Dudek D. In-hospital and long-term outcomes of percutaneous balloon aortic valvuloplasty with concomitant percutaneous coronary intervention in patients with severe aortic stenosis. J Interv Cardiol 2017; 31:60-67. [DOI: 10.1111/joic.12418] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/01/2017] [Accepted: 07/18/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Marzena Daniec
- Second Department of Cardiology; Jagiellonian University Medical College; Krakow Poland
| | - Danuta Sorysz
- Second Department of Cardiology; Jagiellonian University Medical College; Krakow Poland
| | - Artur Dziewierz
- Second Department of Cardiology; Jagiellonian University Medical College; Krakow Poland
| | - Paweł Kleczyński
- Second Department of Cardiology; Jagiellonian University Medical College; Krakow Poland
| | - Łukasz Rzeszutko
- Second Department of Cardiology; Jagiellonian University Medical College; Krakow Poland
| | - Agata Krawczyk-Ożóg
- Department of Interventional Cardiology; Jagiellonian University Medical College; Krakow Poland
| | - Dariusz Dudek
- Department of Interventional Cardiology; Jagiellonian University Medical College; Krakow Poland
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Twelve-Month Quality of Life Improvement and All-Cause Mortality in Elderly Patients Undergoing Transcatheter Aortic Valve Replacement. Int J Artif Organs 2016; 39:444-449. [DOI: 10.5301/ijao.5000521] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 11/20/2022]
Abstract
Purpose Restoration of quality of life (QoL) and improvement of clinical outcomes is crucial in elderly patients undergoing transcatheter aortic valve implantation (TAVI). We sought to evaluate changes in QoL and all-cause mortality 12 months after TAVI. Methods A total of 101 patients who underwent TAVI were included. Patients were followed for 12 months. QoL was assessed at baseline and at 1, 6 and 12 months after TAVI using EQ-5D-3L with a visual analog scale (VAS). Results Patients who reported some problems with mobility at baseline showed better mobility after 12 months (p = 0.001). On the other hand, those who reported issues with self-care, usual activity or pain did not show significant improvement (p = 0.41; p = 0.12; p = 0.27, respectively). Patients reporting anxiety at baseline improved 12 months later (p = 0.003). VAS score showed an incremental increase during follow-up (p<0.001). Transfemoral access was associated with higher VAS score values after 1 month (median (IQR): 65.0 (50.0–75.0) vs. 54.0 (50.0–60.0); p = 0.019) but not after 12 months (70.0 (62.5–80.0) vs. 67.5 (55.0–70.0); p = 0.07) as compared to non-transfemoral access. In multivariable regression analysis, only age and the presence of coronary chronic total occlusion were independently associated with VAS score at 12 months. In-hospital, 1-, 6- and 12-month mortality rates were 6.9%, 10.9%, 15.8 and 17.8%, respectively. Conclusions TAVI provides improved QoL with relatively good clinical outcomes. However, not all components of QoL may be improved. Patients treated with transfemoral access might have better QoL than those who had non-transfemoral access, especially early after TAVI.
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