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Bihan DCDSL, Barretto RBDM, Mathias W. Transcatheter Aortic Valve Implantation: What has Happened and What is Yet to Come. Arq Bras Cardiol 2023; 120:e20230401. [PMID: 37585898 PMCID: PMC10421602 DOI: 10.36660/abc.20230401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Affiliation(s)
- David Costa de Souza Le Bihan
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
- Fleury Medicina e SaúdeSão PauloSPBrasilFleury Medicina e Saúde, São Paulo, SP – Brasil
| | - Rodrigo Bellio de Mattos Barretto
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Wilson Mathias
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
- Fleury Medicina e SaúdeSão PauloSPBrasilFleury Medicina e Saúde, São Paulo, SP – Brasil
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Evbayekha EO, Alugba G, Akewe TO, Obadare OO, Agberien VO, Omogunwa AE, Willie A, Nwafor JN, Okafor AT, Okobi OE. Impact of Long-Term Steroid Use on the Disposition of Patients Undergoing Transcatheter Aortic Valve Replacement: A Retrospective Nationwide Sample Analysis. Cureus 2023; 15:e38048. [PMID: 37228551 PMCID: PMC10207841 DOI: 10.7759/cureus.38048] [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] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Background Chronic steroid use is debilitating to health, but, in some cases, it is necessary. We examined the effect of chronic steroid use on the discharge disposition of people undergoing transcatheter aortic valve replacement (TAVR). Methods We queried the National Inpatient Sample Database (NIS) from 2016 to 2019. We identified patients with current chronic steroid use with the International Classification of Diseases for the Tenth (ICD-10) code Z7952. Furthermore, we used the ICD-10 procedure codes for TAVR 02RF3. Outcomes were the length of hospitalization (LOS), Charlson Comorbidity Index (CCI), disposition, in-hospital mortality, and total hospital charges (THC). Results Between 2016 and 2019, we identified 44,200 TAVR hospitalizations, and 382,497 were on current long-term steroid therapy. Of these, 934 had current chronic steroid use and underwent TAVR (STEROID) with a mean age of 78 (SD=8.4). About 50% were female, 89% were Whites, 3.7% were Blacks, 4.2% were Hispanics, and 1.3% were Asians. Disposition was 'home,' 'home with home health' (HWHH), 'skilled nursing home' (SNF), 'short-term inpatient therapy' (SIT), 'discharged against medical advice' (AMA), and 'died.' A total of 602 (65.5%) were discharged home, 206 ( 22%) were discharged to HWHH, 109 (11.7%) to SNF, and 12 (1.28%) died. In the SIT and AMA groups, there were only three and two patients, respectively, p=0.23. The group that underwent TAVR and was not on chronic steroid therapy (NOSTEROID) had a mean age of 79 (SD=8.5), with 28731 (66.4%) being discharged home, 8399 (19.4%) to HWHH, 5319 (12.3%) to SNF, and 617 (1.43%) died p=0.17. Comparing the STEROID vs. NONSTEROID group, according to the CCI, the STEROID group scored higher than the NOSTEROID group; 3.5 (SD=2) vs. 3 (SD=2) p=0.0001, while for LOS, it was 3.7 days (SD=4.3) vs. 4.1 days (SD=5.3), p=0.28, and the THC was $203,213 (SD=$110,476) vs. $215,858 (SD=$138,540), p=0.15. Conclusion The comorbidity burden of individuals on long-term steroids undergoing TAVR was slightly higher than those not on steroids undergoing TAVR. Despite this, there was no statistically significant difference in their hospital outcomes following TAVR with respect to dispositions.
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Affiliation(s)
| | | | - Theresa O Akewe
- Family Medicine, University of Benin, Benin City, NGA
- Family and Community Medicine, Milk River Community Health Center, Milk River, CAN
| | | | | | | | | | - Jane N Nwafor
- Internal Medicine, The University of District of Columbia, Silverspring, USA
| | - Adetoro T Okafor
- Epidemiology and Public Health, University of Minnesota School of Public Health, Minneapolis, USA
| | - Okelue E Okobi
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
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Avelar FG, Emmerick I, Alves J. Spatial analysis and factors associated with transcatheter aortic valve implantation in Portugal: a retrospective analysis from 2015 to 2017. BMJ Open 2023; 13:e070715. [PMID: 36746542 PMCID: PMC9906166 DOI: 10.1136/bmjopen-2022-070715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES To identify the factors associated with transcatheter aortic valve implantation (TAVI) use of TAVI in inpatients with aortic stenosis (AS) in Portugal and its geographical distribution. METHODS A quantitative, observational and retrospective study using the Portuguese National Health Service inpatient discharge database from 2015 to 2017. Surgical aortic valve replacement (SAVR) and TAVI procedures were selected using the International Classification of Diseases. First, we mapped the yearly age-standardised rate for each procedure using QGIS. Then, we performed χ2 tests, independent t-tests and logistic regressions to study the factors associated with TAVI use. RESULTS From 2015 to 2017, 8398 hospitalisations were selected, 88.5% SAVR and 11.5% TAVI. From 2015 to 2017, SAVR use increased in the Northern region and decreased in the Lisbon region, while the opposite was observed for TAVI. TAVI was performed among the most complex (p<0.001) and older patients (the mean (SD) age for SAVR was 70 (±11) years old and 81 (±7) years old for TAVI, p<0.001). The results for the logistic regressions showed that, more recent hospitalisations, being older, living in the Lisbon region and having a higher Charlson Comorbidity Index was associated with an increased likelihood of undergoing TAVI (p<0.001). CONCLUSIONS TAVI increased over the years. TAVI is more often performed in more severe patients as an alternative to SAVR with similar discharge outcomes. These results suggest the existence of geographic disparities in the availability and access to healthcare services and technologies.
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Affiliation(s)
- Fernando Genovez Avelar
- NOVA National School of Public Health, NOVA University Lisbon, Lisbon, Portugal
- NOVA National School of Public Health, Public Health Research Center, CISP, NOVA University Lisbon, Lisbon, Portugal
| | - Isabel Emmerick
- Department of Surgery, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Joana Alves
- NOVA National School of Public Health, Public HealthResearch Centre, Comprehensive Health Research Center, CHRC, NOV University Lisbon, Lisbon, Portugal
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Evaluation of the Potential Risk of Mortality from SARS-CoV-2 Infection in Hospitalized Patients According to the Charlson Comorbidity Index. Healthcare (Basel) 2022; 10:healthcare10020362. [PMID: 35206976 PMCID: PMC8872141 DOI: 10.3390/healthcare10020362] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/25/2022] [Accepted: 02/10/2022] [Indexed: 12/15/2022] Open
Abstract
Background: The pandemic of COVID-19 has represented a major threat to global public health in the last century and therefore to identify predictors of mortality among COVID-19 hospitalized patients is widely justified. The aim of this study was to evaluate the possible usefulness of Charlson Comorbidity Index (CCI) as mortality predictor in patients hospitalized because COVID-19. Methods: This study was carried out in Zacatecas, Mexico, and it included 705 hospitalized patients with suspected of SARS-CoV-2 infection. Clinical data were collected, and the CCI score was calculated online using the calculator from the Sociedad Andaluza de Medicina Intensiva y Unidades Coronarias; the result was evaluated as mortality predictor among the patients with COVID-19. Results: 377 patients were positive for SARS-COV-2. Obesity increased the risk of intubation among the study population (odds ratio (OR) = 2.59; 95 CI: 1.36–4.92; p = 0.003). The CCI values were higher in patients who died because of COVID-19 complications than those observed in patients who survived (p < 0.001). Considering a CCI cutoff > 31.69, the area under the ROC curve was 0.75, with a sensitivity and a specificity of 63.6% and 87.7%, respectively. Having a CCI value > 31.69 increased the odds of death by 12.5 times among the study population (95% CI: 7.3–21.4; p < 0.001). Conclusions: The CCI is a suitable tool for the prediction of mortality in patients hospitalized for COVID-19. The presence of comorbidities in hospitalized patients with COVID-19 reflected as CCI > 31.69 increased the risk of death among the study population, so it is important to take precautionary measures in patients due to their condition and their increased vulnerability to SARS-CoV-2 infection.
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Sanjoy S, Choi YH, Holmes D, Herrman H, Terre J, Alraies C, Ando T, Tzemos N, Mamas M, Bagur R. Comorbidity burden in patients undergoing left atrial appendage closure. Heart 2021; 107:1246-1253. [PMID: 33229360 DOI: 10.1136/heartjnl-2020-317741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/11/2020] [Accepted: 10/16/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To estimate the risk of in-hospital complications after left atrial appendage closure (LAAC) in relationship with comorbidity burden. METHODS Cohort-based observational study using the US National Inpatient Sample database, 1 October 2015 to 31 December 2017. The main outcome of interest was the occurrence of in-hospital major adverse events (MAE) defined as the composite of bleeding complications, acute kidney injury, vascular complications, cardiac complications and postprocedural stroke. Comorbidity burden and thromboembolic risk were assessed by the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Score (ECS) and CHA2DS2-VASc score. MAE were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. The associations of comorbidity with in-hospital MAE were evaluated using logistic regression models. RESULTS A total of 3294 hospitalisations were identified, among these, the mean age was 75.7±8.2 years, 60% were male and 86% whites. The mean CHA2DS2-VASc score was 4.3±1.5 and 29.5% of the patients had previous stroke or transient ischaemic attack. The mean CCI and ECS were 2.2±1.9 and 9.7±5.8, respectively. The overall composite rate of in-hospital MAE after LAAC was 4.6%. Females and non-whites had about 1.5 higher odds of in-hospital AEs as well participants with higher CCI (adjusted OR (aOR): 1.19, 95% CI: 1.13 to 1.24, p<0.001), ECS (aOR: 1.06, 95% CI: 1.05 to 1.08, p<0.001) and CHA2DS2-VASc score (aOR: 1.08, 95% CI: 1.02 to 1.15, p=0.01) were significantly associated with in-hospital MAE. CONCLUSION In this large cohort of LAAC patients, the majority of them had significant comorbidity burden. In-hospital MAE occurred in 4.6% and female patients, non-whites and those with higher burden of comorbidities were at higher risk of in-hospital MAE after LAAC.
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Affiliation(s)
- Shubrandu Sanjoy
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Yun-Hee Choi
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - David Holmes
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Howard Herrman
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Juan Terre
- Division of Cardiology, Albert Einstein College of Medicine, New York, New York, USA
| | - Chadi Alraies
- Division of Cardiology, Wayne State University, Detroit, Michigan, USA
| | - Tomo Ando
- Division of Cardiology, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Nikolaos Tzemos
- Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University; London Health Sciences Centre, London, Ontario, Canada
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Rodrigo Bagur
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University; London Health Sciences Centre, London, Ontario, Canada
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
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Tobe A, Tanaka A, Tokuda Y, Miki Y, Furusawa K, Akita S, Fujii T, Tsutsumi Y, Ishii H, Iwano S, Naganawa S, Usui A, Murohara T. Incidental findings on computed tomography for preoperative assessment before transcatheter aortic valve implantation in Japanese patients. Heart Vessels 2021; 36:1911-1922. [PMID: 34081162 DOI: 10.1007/s00380-021-01875-2] [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: 03/01/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
Extra-cardiovascular incidental findings (IFs) on preoperative computed tomography (CT) are frequently observed in transcatheter aortic valve implantation (TAVI) candidates. However, the backgrounds of TAVI candidates and comorbidities differ based on the race and/or country, and data on IFs in a specific population are not always applicable to another. The aim of this study was to assess the prevalence, type, and clinical impact of IFs in Japanese TAVI candidates. This was a retrospective, single-center, observational study. CT reports of 257 TAVI candidates were reviewed, and IFs were classified as (a) insignificant: findings that did not require further investigation, treatment, or follow-up; (b) intermediate: findings that needed to be followed up or were considered for further investigation but did not affect the planning of TAVI; and (c) significant: findings that required further investigation immediately or affected the planning of TAVI. At least one IF was found in 254 patients (98.8%). Insignificant, intermediate, and significant IFs were found in 253 (98.4%), 153 (59.5%), and 34 (13.2%) patients, respectively. Newly indicated significant IFs were found in 19 patients (7.4%). In 2 patients (0.8%), TAVI was canceled because of significant IFs. In patients who consequently underwent TAVI, the presence of significant IFs was not associated with the duration from CT performance to TAVI [28 (19-40) days vs. 27 (19-43) days, p = 0.74] and all-cause mortality during the median follow-up period of 413 (223-805) days (p = 0.44). Almost all Japanese TAVI candidates had at least one IF, and the prevalence of significant IFs was not negligible. Although the presence of significant IFs was not associated with mid-term mortality, appropriate management of IFs was considered important.
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Affiliation(s)
- Akihiro Tobe
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yoshiyuki Tokuda
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Miki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sho Akita
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taro Fujii
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Tsutsumi
- Department of Radiological Technology, Nagoya University Hospital, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Shingo Iwano
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Min KD, Kour A, Sano S, Walsh K. The role of clonal haematopoiesis in cardiovascular diseases: epidemiology and experimental studies. J Intern Med 2020; 288:507-517. [PMID: 32715520 PMCID: PMC8375669 DOI: 10.1111/joim.13130] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/27/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022]
Abstract
Clonal haematopoiesis results from acquired mutations in haematopoietic stem and progenitor cells (HSPCs). These mutations can confer the HSPC with a competitive advantage, leading to their clonal expansion within the limiting bone marrow niche. This process is often insufficient to produce a haematologic malignancy; however, the expanding HSPC clones increasingly give rise to progeny leucocytes whose phenotypes can be altered by the somatic mutations that they harbour. Key findings from multiple human studies have shown that clonal haematopoiesis in the absence of overt haematologic alterations is common amongst the ageing population and associated with mortality and cardiovascular disease. Key findings from experimental studies have provided evidence for a causative role for clonal haematopoiesis in cardiovascular diseases, and aspects of these mechanisms have been elucidated. Whilst our understanding of the impact and biology of clonal haematopoiesis is in its infancy, analyses of some of the most commonly mutated driver genes suggest promising clinical scenarios involving the development of personalized therapies with immunomodulatory drugs that exploit the perturbation caused by the particular mutation. Herein, we review the accumulating epidemiological and experimental evidence, and summarize our current understanding of the importance of clonal haematopoiesis as a new causal risk factor for atherosclerotic cardiovascular disease and heart failure.
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Affiliation(s)
- K D Min
- From the, Hematovascular Biology Center, Robert M. Berne Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - A Kour
- From the, Hematovascular Biology Center, Robert M. Berne Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - S Sano
- From the, Hematovascular Biology Center, Robert M. Berne Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - K Walsh
- From the, Hematovascular Biology Center, Robert M. Berne Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, VA, USA
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Lantelme P, Lacour T, Bisson A, Herbert J, Ivanes F, Bourguignon T, Quilliet L, Angoulvant D, Harbaoui B, Babuty D, Etienne CS, Deharo P, Bernard A, Fauchier L. Futility Risk Model for Predicting Outcome After Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 130:100-107. [PMID: 32622502 DOI: 10.1016/j.amjcard.2020.05.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 12/13/2022]
Abstract
Risk-benefit assessment for transcatheter aortic valve implantation (TAVI) is still a matter of debate. We aimed to identify patients with a bad outcome within 1 year after TAVI, and to develop a Futile TAVI Simple score (FTS). Based on the administrative hospital-discharge database, all consecutive patients treated with percutaneous TAVI in France between 2010 and 2018 were included. A prediction model was derived and validated for 1-year all-cause death after TAVI (considered as futility) by using split-sample validation: 20,443 patients were included in the analysis (mean age 83 ± 7 years). 7,039 deaths were recorded (yearly incidence rate 15.5%), among which 3,702 (53%) occurred in first year after TAVI procedure. In the derivation cohort (n = 10,221), the final logistic regression model included male sex, history of hospital stay with heart failure, history of pulmonary oedema, atrial fibrillation, previous stroke, vascular disease, renal disease, liver disease, pulmonary disease, anaemia, history of cancer, metastasis, depression and denutrition. The area under the curve (AUC) for the FTS was 0.674 (95%CI 0.660 to 0.687) in the derivation cohort and 0.651 (95%CI 0.637 to 0.665) in the validation cohort (n = 10,222). The Hosmer-Lemeshow test had a p-value of 0.87 suggesting an accurate calibration. The FTS score outperformed EuroSCORE II, Charlson comorbidity index and frailty index for identifying futility. Based on FTS score, 7% of these patients were categorized at high risk with a 1-year mortality at 43%. In conclusion, the FTS score, established from a large nationwide cohort of patients treated with TAVI, may provide a relevant tool for optimizing healthcare decision.
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Poupin P, Bouleti C, Degand B, Paccalin M, Le Gal F, Bureau ML, Alos B, Roumegou P, Christiaens L, Ingrand P, Garcia R. Prognostic value of Charlson Comorbidity Index in the elderly with a cardioverter defibrillator implantation. Int J Cardiol 2020; 314:64-69. [PMID: 32291172 DOI: 10.1016/j.ijcard.2020.03.060] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Elderly patients are often underrepresented in implantable cardioverter defibrillator (ICD) trials, and ICD implantation in patients ≥75 years consequently remains controversial. We aimed to evaluate mortality, appropriate ICD therapy rates and survival gain in an elderly population after risk stratification according to the Charlson Comorbidity Index (CCI). METHODS This monocentric retrospective study included elderly ICD patients ≥75 years. They were subdivided according to their CCI score into 3 categories (0-1, 2-3 or ≥4 points). Elderly patients were matched 1:2 with younger control ICD patients on gender, type of prevention (primary or secondary) and type of device (associated cardiac resynchronization therapy or not). RESULTS Between January 2009 and July 2017, 121 elderly patients (mean age 78 ± 3; 83% male) matched with 242 controls (mean age 66 ± 5) were included. At 5 year follow-up after ICD implantation, overall survival was 78%, 57%, and 29% (P = 0.002) in the elderly with a CCI score of 0-1, 2-3 and ≥4 respectively, and 72% in controls. There was no significant difference regarding ICD appropriate therapy between the 3 subgroups despite a trend towards lower rates of therapy in CCI ≥ 4 points patients (34.2%, 39.7% and 22.8% respectively; P = 0.45). Median potential survival gain after an appropriate therapy was >5, 4.7 and 1.4 years, with a CCI score of 0-1, 2-3 and ≥4 respectively (P = 0.01). CONCLUSION Elderly patients with CCI score ≥ 4 had the lowest survival after ICD implantation and little survival gain in case of appropriate defibrillator therapy. More than age alone, the burden of comorbidities assessed by the CCI could be helpful to better select elderly patients for ICD implantation.
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Affiliation(s)
- Pierre Poupin
- CHU Poitiers, Unité Médico-Chirurgicale Pôle Montmorillon, 2 rue de la Milétrie, F-86021 Poitiers, France
| | - Claire Bouleti
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France; Univ Poitiers, Faculté de Médecine et Pharmacie, F-86021 Poitiers, France; INSERM CIC 1402, CHU Poitiers, 2 rue de la Milétrie, F-86021 Poitiers, France
| | - Bruno Degand
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France.
| | - Marc Paccalin
- Univ Poitiers, Faculté de Médecine et Pharmacie, F-86021 Poitiers, France; CHU Poitiers, Service de Gériatrie, 2 rue de la Milétrie, F-86021 Poitiers, France.
| | - François Le Gal
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France.
| | - Marie-Laure Bureau
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France; Univ Poitiers, Faculté de Médecine et Pharmacie, F-86021 Poitiers, France.
| | - Benjamin Alos
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France; Univ Poitiers, Faculté de Médecine et Pharmacie, F-86021 Poitiers, France; INSERM CIC 1402, CHU Poitiers, 2 rue de la Milétrie, F-86021 Poitiers, France
| | - Pierre Roumegou
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France.
| | - Luc Christiaens
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France; Univ Poitiers, Faculté de Médecine et Pharmacie, F-86021 Poitiers, France; INSERM CIC 1402, CHU Poitiers, 2 rue de la Milétrie, F-86021 Poitiers, France.
| | - Pierre Ingrand
- Univ Poitiers, Faculté de Médecine et Pharmacie, F-86021 Poitiers, France; Epidemiology and Biostatistics, INSERM CIC 1402, CHU Poitiers, 2 rue de la Milétrie, F-86021 Poitiers, France.
| | - Rodrigue Garcia
- CHU Poitiers, Service de Cardiologie, 2 rue de la Milétrie, F-86021 Poitiers, France; Univ Poitiers, Faculté de Médecine et Pharmacie, F-86021 Poitiers, France; INSERM CIC 1402, CHU Poitiers, 2 rue de la Milétrie, F-86021 Poitiers, France.
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10
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Lysell E, Wolf A. Patients' experiences of everyday living before and after transcatheter aortic valve implantation. Scand J Caring Sci 2020; 35:788-795. [PMID: 32781491 DOI: 10.1111/scs.12893] [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: 02/13/2020] [Revised: 04/21/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Aortic stenosis (AS) is the most common valvular disease in western countries. Unless treated, it is associated with a poor prognosis. Surgical aortic valve replacement, the gold-standard approach, aims to increase survival and improve quality of life. In recent years, though, transcatheter aortic valve implantation (TAVI) has become the treatment of choice in elderly, high-risk patients who are denied open surgery. To date, however, little is known about their personal psychological experience after undergoing TAVI. AIM This study aimed to explore patients' experiences during everyday life before and after TAVI. METHOD Altogether, 14 elderly Swedish patients (9 women, 5 men), treated with TAVI, were interviewed between 2 and 6 months after the implantation. The interviews were analysed using qualitative content analysis. RESULTS Analysis of the participants' experiences was divided into two domains: before and after, that is, life with AS vs. life after TAVI. From these domains, four categories were derived: (1) adapting to the deteriorating self; (2) feeling disconnected; (3) reconstruction of self; and (4) processing disappointment. CONCLUSIONS Transcatheter aortic valve implantation involves not only adding years to life but also adding life to years. The urge to live an autonomous life in a social context with others is an important argument for undergoing a TAVI procedure. Despite severe illness and demanding rehabilitation, elderly TAVI patients have the ability to regain independence and rebuild their lives when they base their decision to undergo TAVI on personal goals. These findings might be helpful when implementing person-centred care.
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Affiliation(s)
- Eva Lysell
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Region VästraGötaland, Gothenburg, Sweden
| | - Axel Wolf
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital/Östra, Region VästraGötaland, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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11
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Naeim HA, Abuelatta R, Alatawi FO, Khedr L. Assessment of Left Ventricular Mechanics in Patients with Severe Aortic Stenosis after Transcatheter Aortic Valve Implantation: 2-D Speckle Tracking Imaging Study. J Saudi Heart Assoc 2020; 32:248-255. [PMID: 33154925 PMCID: PMC7640549 DOI: 10.37616/2212-5043.1065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 11/20/2022] Open
Abstract
Background Chronic pressure overload secondary to severe aortic stenosis causes impairment of left ventricular myocardial deformation and associated with adverse outcome. The present study aimed to assess the response of myocardial mechanics after transcatheter aortic valve implantation (TAVI). Methods Assessment of myocardial mechanics by quantification of LV longitudinal, circumferential strain and rotational deformation (apical, basal rotation and twist) by 2-D Speckle-tracking echocardiography at baseline and at midterm follow-up post-TAVI. The patients were divided into 2 groups based on baseline left ventricular ejection fraction. 46 patients had preserved LV EF ≥50% preserved ejection fraction (PEF) and 34 patients had reduced left ventricular ejection (REF) < 50%. Results 80 patients with severe AS and high surgical risk were evaluated. At a mean follow-up of 8 ± 3 months after TAVI, left ventricular longitudinal strain (LS) significantly improved in reduced ejection fraction (REF) group from -9.88 ± 3.93% to 11.89 ± 3.15% (P = 0.001). In preserved ejection fraction (PEF) group, longitudinal strain improved from -13.8 ± 3.1% to -15.2 ± 3.3% (P < 0.001). Longitudinal strain rate (LSR) improved significantly in REFgroup, -0.48 ± 0.20sec−1 to -0.62 ± 0.16 sec−1 (P < 0.001) and in PEF group,-0.73 ± 0.19 sec−1 to-0.77 ± 0.16 sec −1 (P < 0.005). In PEF group, LV twist angle was supra-physiological at baseline and decreased after TAVI towards normal values (P = 0.006). In REF group LV twist angle was reduced at baseline with significant increase towards normal value after transcatheter aortic valve implantation (TAVI),P = 0.005. That was attributed to severe LV dysfunction associated with reduction of left ventricular twist at baseline which improved in response to TAVI alongside with improvement of left ventricular systolic function. In reduced ejection fraction (REF) group circumferential strain and strain rate improved significantly after TAVI. Conclusions Myocardial mechanics of the left ventricle including strain, strain rate and twist are deformed in severe aortic stenosis. TAVI restores myocardial mechanics towards physiological values in patients with preserved and reduced ejection fraction.
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Affiliation(s)
- Hesham A Naeim
- Madinah Cardiac Center, Madinah, Saudi Arabia.,Hesham A. Naeim is affiliated with Cardiology Department, AlAzhar University, Egypt
| | | | - Faisal O Alatawi
- Madinah Cardiac Center, Madinah, Saudi Arabia.,Department of Medicine, Taiba University, Saudi Arabia
| | - Lamiaa Khedr
- Madinah Cardiac Center, Madinah, Saudi Arabia.,Lamiaa Khedr is affiliated with Cardiology Department, Tanta University Hospitals, Egypt
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12
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Role for Vascular Factors in Long-Term Outcomes After Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 125:1884-1889. [PMID: 32317099 DOI: 10.1016/j.amjcard.2020.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/07/2020] [Accepted: 03/10/2020] [Indexed: 01/01/2023]
Abstract
Despite major technological advances, 1-year morbi-mortality after transcatheter aortic valve implantation (TAVI) is still high. Further outcome improvements may be obtained provided proper identification of prognostic factors. A change of prognostic value over time should be the hallmark of an outcome-implicated factor. In 1,425 patients treated by TAVI, the examined prognostic factors were: demographic factors and co-morbidities (age, male gender, glomerular filtration rate, and chronic obstructive pulmonary disease), cardiac function (left ventricular ejection fraction, pulmonary pressure, aortic gradient, dyspnea, and mitral regurgitation), and vascular factors (coronary artery disease, peripheral vascular disease (PVD), previous stroke, and thoracic aortic calcium-TAC-as assessed by CT scan). Cox models were used to analyze cardiovascular and all-cause mortalities over 3 years of follow-up. The time-dependent effects of the factors were analyzed using the distribution of Schoenfeld residuals. During the study period, 375 (26.3%) deaths occurred of whom 248 (17.4%) from cardiovascular causes. Only 2 factors associated with cardiovascular or all-cause mortality showed significant changes over time: dyspnea and PVD. The effect of dyspnea on cardiovascular mortality decreased over time (first- and third-year hazard ratios [95% confidence intervals]: 1.47 [1.10; 1.96] and 0.94 [0.55; 1.63], respectively), whereas the effect of PVD increased (first- and third-year hazard ratios: 0.87 [0.56; 1.35] and 2.58 [1.25; 5.33], respectively). TAC had a stable effect. In conclusion, the detrimental effects of vascular factors remained stable (TAC) or increased (PVD) over time. These factors should be targeted by specific measures to improve post-TAVI outcomes.
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13
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Bidar E, Folliguet T, Kluin J, Muneretto C, Parolari A, Barili F, Suwalski P, Bonaros N, Punjabi P, Sadaba R, De Bonis M, Al-Attar N, Obadia JF, Czerny M, Shrestha M, Zegdi R, Natour E, Lorusso R. Postimplant biological aortic prosthesis degeneration: challenges in transcatheter valve implants. Eur J Cardiothorac Surg 2019; 55:191-200. [PMID: 30541101 DOI: 10.1093/ejcts/ezy391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/15/2018] [Indexed: 12/29/2022] Open
Abstract
Surgical aortic valve replacement (SAVR) is highly effective and can be achieved with relatively low risk in patients with severe aortic stenosis. Bioprostheses have been used most frequently during the past 60 years. However, the function of biological valves usually declines after 10-15 years from implant when structural valve degeneration occurs often mandating a reoperation once valve dysfunction becomes haemodynamically significant. Known for many years by surgeons and cardiologists taking care of patients with SAVR, the issue of postimplant structural valve degeneration has been recently highlighted also in patients with transcatheter aortic valve implant (TAVI). There is growing concern that TAVI valves exhibit structural valve degeneration due to inherent challenges of the deployment mode. The impact on postimplant degeneration of TAVI valves compared to SAVR has still to be understood and defined. Based on the ongoing process of expanding TAVI indications, several potential shortcomings and caveats, learned during the last 60 years of SAVR experience, should be taken into consideration to refine this technique.
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Affiliation(s)
- Elham Bidar
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Thierry Folliguet
- Centre Hospitalo-Universitaire Brabois ILCV, Hôpital Henri Mondor, Division of Cardio Thoracic Surgery and Transplantation, Université Paris 12 UPEC, France
| | - Jolanda Kluin
- Department of Cardio-Thoracic Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - Claudio Muneretto
- Cardiac Surgery Unit, University of Brescia Medical School, Brescia, Italy
| | - Alessandro Parolari
- Cardiac Surgery and Translational Research Units, IRCCS, Policlinico S. Donato, University of Milan, Milan, Italy
| | - Fabio Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
| | - Piotr Suwalski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Prakash Punjabi
- Department of Cardio-Thoracic Surgery, Imperial College Healthcare NHS Trust, Imperial College School of Medicine, London, UK
| | - Rafa Sadaba
- Department of Cardiac Surgery, Hospital de Navarra, Pamplona, Spain
| | - Michele De Bonis
- Department of Cardiac Surgery, S. Raffaele University Hospital, Milan, Italy
| | - Nawwar Al-Attar
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK
| | - Jean Francois Obadia
- Department of Cardio-Thoracic Surgery, Hôpital Cardiothoracique Louis Pradel, Lyon, France
| | - Martin Czerny
- Department of Cardio-Vascular Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Malakh Shrestha
- Department of Cardio-Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Rachid Zegdi
- Hôpital Européen Georges Pompidou, Paris, France
| | - Ehsan Natour
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
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14
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George S, Kwok CS, Martin GP, Babu A, Shufflebotham A, Nolan J, Ratib K, Bagur R, Gunning M, Mamas M. The Influence of the Charlson Comorbidity Index on Procedural Characteristics, VARC-2 Endpoints and 30-Day Mortality Among Patients Who Undergo Transcatheter Aortic Valve Implantation. Heart Lung Circ 2019; 28:1827-1834. [DOI: 10.1016/j.hlc.2018.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/27/2018] [Accepted: 11/13/2018] [Indexed: 12/31/2022]
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15
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Pluchinotta FR, Piekarski BL, Milani V, Kretschmar O, Burch PT, Hakami L, Meyer DB, Jacques F, Ghez O, Trezzi M, Carotti A, Qureshi SA, Michel-Behnke I, Hammel JM, Chai P, McMullan D, Mettler B, Ferrer Q, Carminati M, Emani SM. Surgical Atrioventricular Valve Replacement With Melody Valve in Infants and Children. Circ Cardiovasc Interv 2019; 11:e007145. [PMID: 30571200 DOI: 10.1161/circinterventions.118.007145] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Pediatric patients with atrioventricular valve disease have limited options for prosthetic valve replacement in sizes <15 mm. Based on successful experience with the stented bovine jugular vein graft (Melody valve) in the right ventricular outflow tract, the prosthesis has been modified for surgical valve replacement in pediatric patients with atrioventricular dysfunction with the intention of subsequent valve expansion in the catheterization laboratory as the child grows. Methods and Results A multicenter, retrospective cohort study was performed among patients who underwent atrioventricular valve replacement with Melody valve at 17 participating sites from North America and Europe, including 68 patients with either mitral (n=59) or tricuspid (n=9) replacement at a median age of 8 months (range, 3 days to 13 years). The median size at implantation was 14 mm (range, 9-24 mm). Immediately postoperatively, the valve was competent with low gradients in all patients. Fifteen patients died; 3 patients underwent transplantation. Nineteen patients required reoperation for adverse outcomes, including valve explantation (n=16), left ventricular outflow tract obstruction (n=1), permanent pacemaker implantation (n=1), and paravalvular leak repair (n=1). Twenty-five patients underwent 41 episodes of catheter-based balloon expansion, exhibiting a significant decrease in median gradient ( P<0.001) with no significant increase in grade of regurgitation. Twelve months after implantation, cumulative incidence analysis indicated that 55% of the patients would be expected to be free from death, heart transplantation, structural valve deterioration, or valve replacement. Conclusions The Melody valve is a feasible option for surgical atrioventricular valve replacement in patients with hypoplastic annuli. The prosthesis shows acceptable short-term function and is amenable to catheter-based enlargement as the child grows. However, patients remain at risk for mortality and structural valve deterioration, despite adequate early valvular function. Device design and implantation techniques must be refined to reduce complications and extend durability. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02505074.
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Affiliation(s)
- Francesca R Pluchinotta
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Milan, Italy (F.R.P., M.C.)
| | | | - Valentina Milani
- Department of Cardiology and Cardiac Surgery, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Milan, Italy (V.M., S.M.E.)
| | - Oliver Kretschmar
- Department of Pediatric Cardiology, University Children's Hospital Zurich, Switzerland (O.K.)
| | - Phillip T Burch
- Department of Cardiothoracic Surgery, Cook Children's Medical Center, Fort Worth, TX (P.T.B.)
| | - Lale Hakami
- Department of Heart Surgery, Medical Center of the University of Munich, Germany (L.H.)
| | - David B Meyer
- Division of Cardiothoracic Surgery, Cohen Children's Medical Center, New Hyde Park, NY (D.B.M.)
| | - Frederic Jacques
- Department of Cardiology and Cardiac Surgery, Centre mère-enfant Soleil, CHU de Québec, Service of Cardiac Surgery, Canada (F.J.)
| | - Olivier Ghez
- Department of Cardiac Surgery, Royal Brompton Hospital, London, England (O.G.)
| | - Matteo Trezzi
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy (M.T., A.C.)
| | - Adriano Carotti
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy (M.T., A.C.)
| | - Shakeel A Qureshi
- Department of Cardiology and Cardiac Surgery, Evelina London Children's Hospital, England (S.A.Q.)
| | - Ina Michel-Behnke
- Division of Pediatric Cardiology, Pediatric Heart Center Vienna, University Clinic for Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria (I.M.-B.)
| | - James M Hammel
- Department of Cardiothoracic Surgery, Children's Hospital and Medical Center, Omaha, NE (J.M.H.)
| | - Paul Chai
- Department of Cardiac Surgery, New York-Presbyterian Morgan Stanley Children's Hospital (P.C.)
| | - David McMullan
- Department of Cardiac Surgery, Seattle Children's Hospital, WA (D.M.)
| | - Bret Mettler
- Division of Pediatric Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN (B.M.)
| | - Queralt Ferrer
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, University Hospital Vall d'Hebron, Barcelona, Spain (Q.F.)
| | - Mario Carminati
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Milan, Italy (F.R.P., M.C.)
| | - Sitaram M Emani
- Department of Cardiology and Cardiac Surgery, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Milan, Italy (V.M., S.M.E.)
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16
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Jogu HR, Arora S, Strassle PD, Patel C, Patil N, Venkatesh S, Alkhaimy H, Ramm CJ, Qamar A, Kim SM, Yeung M, Vavalle JP. Impact of age and comorbidities on the effect of transcatheter versus surgical mitral valve repair on inpatient outcomes. Catheter Cardiovasc Interv 2019; 95:1195-1201. [DOI: 10.1002/ccd.28479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 08/08/2019] [Accepted: 08/20/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Hanumantha R. Jogu
- Department of Internal MedicineWake Forest School of Medicine Winston‐Salem North Carolina
| | - Sameer Arora
- Center for Research and Population Health Apex North Carolina
| | - Paula D. Strassle
- Department of EpidemiologyUniversity of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Chinmay Patel
- Division of NephrologyPikeville Medical Center Pikeville Kentucky
| | - Nikita Patil
- Division of CardiologyUniversity of North Carolina School of Medicine Chapel Hill North Carolina
| | - Sanjay Venkatesh
- Division of CardiologyUniversity of North Carolina School of Medicine Chapel Hill North Carolina
| | - Haytham Alkhaimy
- Hospital MedicineLogan Regional Medical Center Logan West Virginia
| | - Cassandra J. Ramm
- Division of CardiologyUniversity of North Carolina School of Medicine Chapel Hill North Carolina
| | - Arman Qamar
- Brigham and Women's Hospital Heart and Vascular CenterHarvard Medical School Boston Massachusetts
| | - Sun M. Kim
- Division of CardiologyUniversity of North Carolina School of Medicine Chapel Hill North Carolina
| | - Michael Yeung
- Division of CardiologyUniversity of North Carolina School of Medicine Chapel Hill North Carolina
| | - John P. Vavalle
- Division of CardiologyUniversity of North Carolina School of Medicine Chapel Hill North Carolina
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17
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Vollenbroich R, Wenaweser P, Macht A, Stortecky S, Praz F, Rothenbühler M, Roost E, Hunziker L, Räber L, Windecker S, Pilgrim T. Long-term outcomes with balloon-expandable and self-expandable prostheses in patients undergoing transfemoral transcatheter aortic valve implantation for severe aortic stenosis. Int J Cardiol 2019; 290:45-51. [DOI: 10.1016/j.ijcard.2019.03.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/09/2019] [Accepted: 03/24/2019] [Indexed: 01/05/2023]
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18
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Muratori M, Fusini L, Tamborini G, Gripari P, Ghulam Ali S, Mapelli M, Fabbiocchi F, Trabattoni P, Roberto M, Agrifoglio M, Alamanni F, Bartorelli AL, Pepi M. Five-year echocardiographic follow-up after TAVI: structural and functional changes of a balloon-expandable prosthetic aortic valve. Eur Heart J Cardiovasc Imaging 2019; 19:389-397. [PMID: 28379513 DOI: 10.1093/ehjci/jex046] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/23/2017] [Indexed: 02/02/2023] Open
Abstract
Aims Scarce data are available on the long-term structural and functional changes of prosthetic valves after transcatheter aortic valve implantation (TAVI). The objective was to evaluate with echocardiography the long-term structural and functional changes of prosthetic valves after TAVI. Methods and results Structural valve deterioration (SVD) was defined as leaflet thickening ≥3mm, presence of calcification and abnormal leaflet motion. Five-year echocardiographic follow-up was available in 96 out of 318 patients who underwent TAVI with a balloon-expandable device between April 2008 and December 2011. At 1-year follow-up, no patient showed SVD. At 5-year follow-up, SVD were observed in 29 (30%) patients who showed also a significant reduction of aortic valve area (AVA) together with an increase of mean and peak aortic pressure gradients at the latest echocardiography evaluation. Moreover, rate of central aortic valve regurgitation ≥2 was higher in SVD patients as compared to those without SVD, while there was no difference in terms of paravalvular regurgitation. Despite SVD, one patient only reached the criteria for severe stenosis and no reintervention was needed at 5-year follow-up. Variables independently associated with SVD were female sex, small body surface area, use of a 23 mm valve, and small AVA at pre-discharge echocardiogram. Conclusion At 5-year follow-up, 30% of patients who underwent TAVI with a balloon-expandable valve showed initial SVD. However, SVD was not associated with severe stenosis in most of the patients and had no significant impact on and clinical outcome.
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Affiliation(s)
- Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
| | - Laura Fusini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
| | - Paola Gripari
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
| | - Sarah Ghulam Ali
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
| | - Massimo Mapelli
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
| | - Franco Fabbiocchi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
| | - Piero Trabattoni
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
| | - Maurizio Roberto
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
| | - Marco Agrifoglio
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, via Commenda 9/12, 20122 Milan, Italy
| | - Francesco Alamanni
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, via Commenda 9/12, 20122 Milan, Italy
| | - Antonio L Bartorelli
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, via G.B. Grassi 74, 20157 Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
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19
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Association of comorbid burden with clinical outcomes after transcatheter aortic valve implantation. Heart 2018; 104:2058-2066. [DOI: 10.1136/heartjnl-2018-313356] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/18/2018] [Accepted: 07/02/2018] [Indexed: 11/03/2022] Open
Abstract
ObjectivesTo investigate the association of the CharlsonComorbidity Index (CCI) with clinical outcomes after transcatheter aortic valve implantation (TAVI).BackgroundPatients undergoing TAVI have high comorbid burden; however, there is limited evidence of its impact on clinical outcomes.MethodsData from 1887 patients from the UK, Canada, Spain, Switzerland and Italy were collected between 2007 and 2016. The association of CCI with 30-day mortality, Valve Academic Research Consortium-2 (VARC-2) composite early safety, long-term survival and length of stay (LoS) was calculated using logistic regression and Cox proportional hazard models, as a whole cohort and at a country level, through a two-stage individual participant data (IPD) random effect meta-analysis.ResultsMost (60%) of patients had a CCI ≥3. A weak correlation was found between the total CCI and four different preoperative risks scores (ρ=0.16 to 0.29), and approximately 50% of patients classed as low risk from four risk prediction models still presented with a CCI ≥3. Per-unit increases in total CCI were not associated with increased odds of 30-day mortality (OR 1.09, 95% CI 0.96 to 1.24) or VARC-2 early safety (OR 1.04, 95% CI 0.96 to 1.14) but were associated with increased hazard of long-term mortality (HR 1.10, 95% CI 1.05 to 1.16). The two-stage IPD meta-analysis indicated that CCI was not associated with LoS (HR 0.97, 95% CI 0.93 to 1.02).ConclusionIn this multicentre international study, patients undergoing TAVI had significant comorbid burden. We found a weak correlation between the CCI and well-established preoperative risks scores. The CCI had a moderate association with long-term mortality up to 5 years post-TAVI.
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20
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Salaun E, Clavel MA, Rodés-Cabau J, Pibarot P. Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation. Heart 2018; 104:1323-1332. [DOI: 10.1136/heartjnl-2017-311582] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/02/2018] [Accepted: 03/06/2018] [Indexed: 02/02/2023] Open
Abstract
The main limitation of bioprosthetic valves is their limited durability, which exposes the patient to the risk of aortic valve reintervention. Transcatheter aortic valve implantation (TAVI) is considered a reasonable alternative to surgical aortic valve replacement (SAVR) in patients with intermediate or high surgical risk. TAVI is now rapidly expanding towards the lower risk populations. Although the results of midterm durability of the transcatheter bioprostheses are encouraging, their long-term durability remains largely unknown. The objective of this review article is to present the definition, mechanisms, incidence, outcome and management of structural valve deterioration of aortic bioprostheses with specific emphasis on TAVI. The structural valve deterioration can be categorised into three stages: stage 1: morphological abnormalities (fibrocalcific remodelling and tear) of bioprosthesis valve leaflets without hemodynamic valve deterioration; stage 2: morphological abnormalities and moderate hemodynamic deterioration (increase in gradient and/or new onset of transvalvular regurgitation); and stage 3: morphological abnormalities and severe hemodynamic deterioration. Several specifics inherent to the TAVI including valve oversizing, manipulation, delivery, positioning and deployment may cause injuries to the valve leaflets and increase leaflet mechanical stress, which may limit the long-term durability of transcatheter bioprostheses. The selection of the type of aortic valve replacement and bioprosthesis should thus take into account the ratio between the demonstrated durability of the bioprostheses versus the life expectancy of the patient. Pending the publication of robust data on long-term durability of transcatheter bioprostheses, it appears reasonable to select SAVR with a bioprosthesis model that has well-established long-term durability in patients with low surgical risk and long life expectancy.
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21
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Vollema EM, Kong WKF, Katsanos S, Kamperidis V, van Rosendael PJ, van der Kley F, de Weger A, Ajmone Marsan N, Delgado V, Bax JJ. Transcatheter aortic valve thrombosis: the relation between hypo-attenuated leaflet thickening, abnormal valve haemodynamics, and stroke. Eur Heart J 2018; 38:1207-1217. [PMID: 28369242 DOI: 10.1093/eurheartj/ehx031] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/16/2017] [Indexed: 12/21/2022] Open
Abstract
Aims The presence of hypo-attenuated leaflet thickening (HALT) and/or reduced leaflet motion on multi-detector row computed tomography (MDCT) has been proposed as a possible marker for early transcatheter aortic valve thrombosis. However, its association with abnormal valve haemodynamics on echocardiography (another potential marker of thrombosis) and clinical outcomes (stroke) remains unclear. The present study evaluated the prevalence of HALT on MDCT and abnormal valve haemodynamics on echocardiography. In addition, the occurrence of ischemic stroke and/or transient ischemic attack (TIA) was assessed. Methods and results A total of 434 patients (mean age 80 ± 7 years, 51% male) who underwent transcatheter aortic valve replacement (TAVR) were evaluated. Transcatheter valve haemodynamics were assessed on echocardiography at discharge, 6 months, and thereafter yearly (up to 3 years post-TAVR). The presence of HALT and/or reduced leaflet motion was assessed on MDCT performed 35 days [interquartile range 19-210] after TAVR in 128 of these 434 patients. Possible TAVR valve thrombosis was defined by mean transvalvular gradient ≥20 mmHg and aortic valve area (AVA) ≤1.1cm2 on echocardiography or by the presence of HALT or reduced leaflet motion on MDCT. The occurrence of ischemic stroke/TIA at follow-up was recorded. HALT and/or reduced leaflet motion was present in 12.5% of 128 patients undergoing MDCT, and was associated with a slightly higher mean transvalvular gradient (12.4 ± 8.0 mmHg vs. 9.4 ± 4.3 mmHg; P = 0.026) and smaller AVA (1.49 ± 0.39 cm2 vs. 1.78 ± 0.45 cm2, P = 0.017). Only one patient with HALT on MDCT revealed abnormal valve haemodynamics on echocardiography. At 3-year follow-up, abnormal valve haemodynamics on echocardiography were observed in 3% of patients. HALT on MDCT and abnormal valve haemodynamics on echocardiography were not associated with increased risk of ischemic stroke/TIA. Conclusion On MDCT, 12.5% of patients showed HALT or reduced leaflet motion, whereas only one of these patients had abnormal valve haemodynamics on echocardiography. Neither HALT nor increased transvalvular gradient were associated with stroke/TIA.
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Affiliation(s)
- E Mara Vollema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - William K F Kong
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, National University Heart Centre, Singapore
| | - Spyridon Katsanos
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Vasileios Kamperidis
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
| | | | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arend de Weger
- Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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22
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Management of Nonagenarian Patients With Severe Aortic Stenosis: The Role of Comorbidity. Heart Lung Circ 2018; 27:219-226. [DOI: 10.1016/j.hlc.2017.02.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/25/2017] [Accepted: 02/28/2017] [Indexed: 11/23/2022]
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23
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Does diabetes mellitus impact prognosis after transcatheter aortic valve implantation? Insights from a meta-analysis. J Cardiol 2017; 70:484-490. [DOI: 10.1016/j.jjcc.2017.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/15/2017] [Accepted: 01/28/2017] [Indexed: 01/13/2023]
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24
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Tarantini G, Purita PAM, D'Onofrio A, Fraccaro C, Frigo AC, D'Amico G, Fovino LN, Martin M, Cardaioli F, Badawy MRA, Napodano M, Gerosa G, Iliceto S. Long-term outcomes and prosthesis performance after transcatheter aortic valve replacement: results of self-expandable and balloon-expandable transcatheter heart valves. Ann Cardiothorac Surg 2017; 6:473-483. [PMID: 29062742 DOI: 10.21037/acs.2017.08.02] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Data on transcatheter aortic valve replacement (TAVR) long-term clinical outcomes and hemodynamic performance of the self-expandable CoreValve (CV) and the balloon-expandable Edwards SAPIEN XT (ES) (Edwards Lifesciences, Irvine, California, USA) transcatheter heart valves (THV) are limited. Therefore, this study aimed to compare long-term clinical outcome data and hemodynamic performance of TAVR with either CV or ES. METHODS We reviewed prospectively collected data of 171 patients treated with TAVR for severe aortic stenosis (AS) at our center between June 2007 and December 2010, with last follow-up contact in 2016. RESULTS Out of 171 patients treated with TAVR at our Institution, 87 received a CV and 84 an ES THV. Mean age was 81 [78-85] years, and mean Society of Thoracic Surgeons (STS) score was 7.5% (4.5-13.9%). Hemodynamic success by Valve Academic Research Consortium (VARC) definition was 97.1%. Mean trans-prosthetic gradient remained low and stable during follow-up in both groups (at 5-year 9.2±6.4 versus 12.7±5.1 mmHg, P=0.10). Late prosthesis failure occurred in 4 cases (2.4%). Thirty-day mortality was 4.7%, and estimated survival rates by Kaplan-Meyer after 1, 5 and 8 years were 87.6%, 44.9%, and 24.5%, respectively, without difference between THV groups. Rates of cardiovascular death, stroke, myocardial infarction (MI) and congestive heart failure (CHF) were also similar with CV and ES at long-term follow-up. History of CHF, pre-existent severe mitral regurgitation, paravalvular leak grade ≥2+, and chronic obstructive pulmonary disease were independent predictors of late mortality at multivariable analysis. CONCLUSIONS Clinical and hemodynamic outcomes of patients treated by self-expandable CV or balloon-expandable ES THV were favorable and similar throughout long-term follow-up, with a rate of prosthesis failure of less than 3%.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Paola A M Purita
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Augusto D'Onofrio
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Gianpiero D'Amico
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Marta Martin
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | | | - Massimo Napodano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
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25
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Review of Major Registries and Clinical Trials of Late Outcomes After Transcatheter Aortic Valve Replacement. Am J Cardiol 2017; 120:331-336. [PMID: 28532778 DOI: 10.1016/j.amjcard.2017.04.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/12/2017] [Accepted: 04/12/2017] [Indexed: 11/23/2022]
Abstract
The results of the Placement of AoRtic TraNscathetER Valves (PARTNER) 2 trial established the feasibility of transcatheter aortic valve replacement (TAVR) for intermediate surgical risk patients. The expansion of TAVR into the low-risk patient population will largely depend on its durability outcomes due to the high life expectancy in low-risk patients. Long-term follow-up results from low-risk clinical trials will take several years to be reported. Given this, we performed a systematic review of current long-term data to provide further insights into TAVR durability and long-term patient survival. We searched MEDLINE, Embase, Google Scholar, BIOSIS, and major conference abstracts for TAVR studies with follow-up of at least 4 years. Abstracts were retrieved and independently reviewed for eligibility. Final studies were selected irrespective of the type of TAVR valve, route of vascular access, or surgical risk profile. A total of 12 studies met the inclusion criteria. We reviewed data from these studies with emphasis on long-term survival and echocardiographic findings.
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26
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Predictive Value of Age-Adjusted Charlson Co-Morbidity Index for 1-, 3-, and 5-Year Mortality in Patients Requiring Transcatheter Mitral Valve Repair. Am J Cardiol 2017; 120:309-314. [PMID: 28532777 DOI: 10.1016/j.amjcard.2017.04.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/12/2017] [Accepted: 04/12/2017] [Indexed: 11/20/2022]
Abstract
Co-morbidities increase markedly with aging, and they often negatively affect its prognosis. Although mortality with transcatheter mitral valve repair (TMVr) is significantly less than for open mitral valve surgery in patients at high surgical risk, it remains a concern to identify which patients will benefit from this treatment. Some prognostic metrics have been reported to guide better patient selection; however, universal risk stratification measures have not been established. This study aimed to determine if age-adjusted Charlson co-morbidity index (CCI) could predict mortality in patients who underwent TMVr and to assess its discriminatory performance in long-term outcomes. We retrospectively reviewed 222 patients who underwent TMVr, and 7 who died in hospital was excluded. Cox proportional hazard models were applied to select the demographic characteristics that were associated with cumulative mortality. Receiver-operating characteristic analyses were performed for predicting all-cause mortality, and discriminatory performance was assessed. We found that the age-adjusted CCI (hazard ratio 1.33, 95% confidence interval 1.16 to 1.51, p <0.001), New York Heart Association classification, and atrial fibrillation were independently associated with mortality. The age-adjusted CCI demonstrated good discriminative performance for predicting mortality at 3 and 5 years (area under the curve 0.71 and 0.77, respectively) and were greater than those of the Society of Thoracic Surgeons score in receiver-operating characteristic analysis. Kaplan-Meier curve demonstrated that the age-adjusted CCI ≥ 8 had poor prognosis after TMVr. In conclusions, the age-adjusted CCI could predict mortality and had a good discriminative performance for predicting longer term outcomes in patients who underwent TMVr.
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27
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Zahn R, Werner N, Gerckens U, Linke A, Sievert H, Kahlert P, Hambrecht R, Sack S, Abdel-Wahab M, Hoffmann E, Zeymer U, Schneider S. Five-year follow-up after transcatheter aortic valve implantation for symptomatic aortic stenosis. Heart 2017; 103:1970-1976. [PMID: 28684438 DOI: 10.1136/heartjnl-2016-311004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/13/2017] [Accepted: 05/15/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Transcatheter aortic valve implantation (TAVI) has been implemented into the care of elderly patients suffering from severe symptomatic aortic stenosis. However, data on long-term follow-up are sparse and predictors of long-term mortality need to be evaluated to better select patients. Therefore, we aimed to analyse predictors of 5-year mortality after TAVI. METHODS We analysed data from the German Transcatheter Aortic Valve Interventions-Registry. Each of the 27 participating hospitals agreed to include all consecutive TAVI patients at their institution. Out of 1444 patients treated with TAVI, 1378 patients had a follow-up of at least 4.5 years (completeness 95.4%). Endpoint for this analysis was 5-year survival. Cox regression analysis was used to determine risk factors associated with this endpoint. RESULTS Patients who died were compared with survivors. The two groups showed multiple differences in patient characteristics, indications for interventions, preinterventional, as well as interventional characteristics and postinterventional events. Calculated 1-year mortality was 21.8% and 5-year mortality 59.1%. A higher logistic EuroScore was associated with a lower 5-year survival, being 45.5% in patients with a logistic EuroScore of <20%, 34.5% in those with 20% to 40% and 28.4% in patients with a logistic EuroScore >40%. Cox proportional hazard analysis revealed the following independent predictors of 5-year mortality: female gender (HR =0.66, 95% CI 0.56 to 0.77, p<0.0001), renal failure (HR=1.43, 95% CI 1.22 to 1.69, p<0.0001), prior mitral regurgitation ≥II° (HR=1.42, 95% CI 1.21 to 1.65, p<0.0001), residual aortic regurgitation ≥II° (HR=1.52, 95% CI 1.24 to 1.85, p<0.0001), atrial fibrillation (HR=1.38, 95% CI 1.18 to 1.64, p=0.0001), low gradient aortic stenosis (HR=1.48, 95% CI 1.19 to 1.84, p=0.0004), prior decompensation (HR=1.32, 95% CI 1.13 to 1.54, p=0.0006), frailty (HR=1.31, 95% CI 1.09 to 1.58, p=0.004), surgical TAVI (HR=1.42, 95% CI 1.12 to 1.80, p=0.004), age (by year) (HR=1.02, 95% CI 1.01 to 1.03, p=0.006), prior myocardial infarction (HR=1.29, 95% CI 1.07 to 1.57, p=0.009), urgent TAVI (HR=1.25, 95% CI 1.04 to 51, p=0.020) and diabetes mellitus (HR=1.20, 95% CI 1.02 to 1.40, p=0.024). CONCLUSIONS These data from the early TAVI experience show a 5-year mortality of 59.1%. Some of the predictors of 5-year mortality seem to be modifiable, such as residual aortic regurgitation, type of TAVI access route and concomitant mitral regurgitation.
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Affiliation(s)
- Ralf Zahn
- Abteilung für Kardiologie, Herzzentrum Ludwigshafen, Ludwigshafen, Germany
| | - Nicolas Werner
- Abteilung für Kardiologie, Herzzentrum Ludwigshafen, Ludwigshafen, Germany
| | | | - Axel Linke
- Klinik für Kardiologie, Herzzentrum Leipzig, Leipzig, Germany
| | - Horst Sievert
- Klinik für Kardiologie, CardioVasculäres Centrum Frankfurt, Katharinenkrankenhaus, Frankfurt, Germany
| | - Philipp Kahlert
- Klinik für Kardiologie, Westdeutsches Herz- und Gefäßzentrum Essen, Universitätsklinikum Essen, Essen, Germany
| | | | - Stefan Sack
- Abteilung für Kardiologie, Klinikum München Schwabing, Munich, Germany
| | | | - Ellen Hoffmann
- Abteilung für Kardiologie, Städtisches Klinikum München-Bogenhausen, Munich, Germany
| | - Uwe Zeymer
- Abteilung für Kardiologie, Herzzentrum Ludwigshafen, Ludwigshafen, Germany
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28
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Foroutan F, Guyatt GH, Otto CM, Siemieniuk RA, Schandelmaier S, Agoritsas T, Vandvik PO, Bhagra S, Bagur R. Structural valve deterioration after transcatheter aortic valve implantation. Heart 2017; 103:1899-1905. [DOI: 10.1136/heartjnl-2017-311329] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/17/2017] [Accepted: 05/03/2017] [Indexed: 11/03/2022] Open
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29
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Gilard M, Eltchaninoff H, Donzeau-Gouge P, Chevreul K, Fajadet J, Leprince P, Leguerrier A, Lievre M, Prat A, Teiger E, Lefevre T, Tchetche D, Carrié D, Himbert D, Albat B, Cribier A, Sudre A, Blanchard D, Rioufol G, Collet F, Houel R, Dos Santos P, Meneveau N, Ghostine S, Manigold T, Guyon P, Grisoli D, Le Breton H, Delpine S, Didier R, Favereau X, Souteyrand G, Ohlmann P, Doisy V, Grollier G, Gommeaux A, Claudel JP, Bourlon F, Bertrand B, Laskar M, Iung B. Late Outcomes of Transcatheter Aortic Valve Replacement in High-Risk Patients: The FRANCE-2 Registry. J Am Coll Cardiol 2017; 68:1637-1647. [PMID: 27712776 DOI: 10.1016/j.jacc.2016.07.747] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/30/2016] [Accepted: 07/12/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has revolutionized management of high-risk patients with severe aortic stenosis. However, survival and the incidence of severe complications have been assessed in relatively small populations and/or with limited follow-up. OBJECTIVES This report details late clinical outcome and its determinants in the FRANCE-2 (FRench Aortic National CoreValve and Edwards) registry. METHODS The FRANCE-2 registry prospectively included all TAVRs performed in France. Follow-up was scheduled at 30 days, at 6 months, and annually from 1 to 5 years. Standardized VARC (Valve Academic Research Consortium) outcome definitions were used. RESULTS A total of 4,201 patients were enrolled between January 2010 and January 2012 in 34 centers. Approaches were transarterial (transfemoral 73%, transapical 18%, subclavian 6%, and transaortic or transcarotid 3%) or, in 18% of patients, transapical. Median follow-up was 3.8 years. Vital status was available for 97.2% of patients at 3 years. The 3-year all-cause mortality was 42.0% and cardiovascular mortality was 17.5%. In a multivariate model, predictors of 3-year all-cause mortality were male sex (p < 0.001), low body mass index, (p < 0.001), atrial fibrillation (p < 0.001), dialysis (p < 0.001), New York Heart Association functional class III or IV (p < 0.001), higher logistic EuroSCORE (p < 0.001), transapical or subclavian approach (p < 0.001 for both vs. transfemoral approach), need for permanent pacemaker implantation (p = 0.02), and post-implant periprosthetic aortic regurgitation grade ≥2 of 4 (p < 0.001). Severe events according to VARC criteria occurred mainly during the first month and subsequently in <2% of patients/year. Mean gradient, valve area, and residual aortic regurgitation were stable during follow-up. CONCLUSIONS The FRANCE-2 registry represents the largest database available on late results of TAVR. Late mortality is largely related to noncardiac causes. Incidence rates of severe events are low after the first month. Valve performance remains stable over time.
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Affiliation(s)
- Martine Gilard
- Department of Cardiology, Brest University Hospital, Brest, France.
| | | | - Patrick Donzeau-Gouge
- Department of Cardiology and Surgery, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Karine Chevreul
- Department of URC-ECO and Cardiology, Creteil University Hospital, Paris, France
| | - Jean Fajadet
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Pascal Leprince
- Department of Surgery, Pitié Salpetrière University Hospital, Paris, France
| | - Alain Leguerrier
- Department of Cardiology and Surgery, Rennes University Hospital, Rennes, France
| | - Michel Lievre
- UMR and Department of Cardiology, Lyon University Hospital, Lyon, France
| | - Alain Prat
- Department of Cardiology and Surgery, Lille University Hospital, Lille, France
| | - Emmanuel Teiger
- Department of URC-ECO and Cardiology, Creteil University Hospital, Paris, France
| | - Thierry Lefevre
- Department of Cardiology and Surgery, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Didier Tchetche
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | | | - Bernard Albat
- Department of Surgery, Montpellier University Hospital, Montpellier, France
| | - Alain Cribier
- Department of Cardiology, Rouen University Hospital, Rouen, France
| | - Arnaud Sudre
- Department of Cardiology and Surgery, Lille University Hospital, Lille, France
| | | | - Gilles Rioufol
- UMR and Department of Cardiology, Lyon University Hospital, Lyon, France
| | | | - Remi Houel
- Department of Surgery, Hospital Saint Joseph, Marseille, France
| | - Pierre Dos Santos
- Department of Cardiology, Bordeaux University Hospital, Bordeaux, France
| | - Nicolas Meneveau
- Department of Cardiology, Besancon University Hospital, Besancon, France
| | - Said Ghostine
- Department of Cardiology, Centre Cardiologique Marie Lannelongue, Le Plessis Robinson, France
| | - Thibaut Manigold
- Department of Cardiology, Nantes University Hospital, Nantes, France
| | - Philippe Guyon
- Department of Cardiology, Centre Cardiologique du Nord, Saint Denis, France
| | - Dominique Grisoli
- Department of Surgery, Marseille University Hospital, Marseille, France
| | - Herve Le Breton
- Department of Cardiology and Surgery, Rennes University Hospital, Rennes, France
| | - Stephane Delpine
- Department of Cardiology, Angers University Hospital, Angers, France
| | - Romain Didier
- Department of Cardiology, Brest University Hospital, Brest, France
| | - Xavier Favereau
- Department of Cardiology, Parly 2 Hospital, Le Chesnay, France
| | - Geraud Souteyrand
- Department of Cardiology, Clermont Ferrand University Hospital, Clermont Ferrand, France
| | - Patrick Ohlmann
- Department of Cardiology, Strasbourg University Hospital, Strasbourg, France
| | - Vincent Doisy
- Department of Surgery, Clinique du Tonkin, Lyon, France
| | - Gilles Grollier
- Department of Cardiology, Caen University Hospital, Caen, France
| | - Antoine Gommeaux
- Department of Cardiology, Hôpital Bois Bernard, Bois Bernard, France
| | | | | | - Bernard Bertrand
- Department of Cardiology, Grenoble University Hospital, Grenoble, France
| | - Marc Laskar
- Department of Surgery, Limoges University Hospital, Limoges, France
| | - Bernard Iung
- Department of Cardiology, Bichat University Hospital, Paris, France
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Petrini L, Dordoni E, Allegretti D, Pott D, Kütting M, Migliavacca F, Pennati G. Simplified Multistage Computational Approach to Assess the Fatigue Behavior of a Niti Transcatheter Aortic Valve During In Vitro Tests: A Proof-of-Concept Study. J Med Device 2017. [DOI: 10.1115/1.4035791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Nowadays, transcatheter aortic valve (TAV) replacement is an alternative to surgical therapy in selected high risk patients for the treatment of aortic stenosis. However, left ventricular contraction determines a severe cyclic loading for the implanted stent-frame, undermining its long-term durability. Technical standards indicate in vitro tests as a suitable approach for the assessment of TAV fatigue behavior: generally, they do not specify test methods but require to test TAV in the worst loading conditions. The most critical conditions could be different according to the specific valve design, hence the compartment where deploying the valve has to be properly identified. A fast and reliable computational methodology could significantly help to face this issue. In this paper, a numerical approach to analyze Nickel-Titanium TAV stent-frame behavior during in vitro durability tests is proposed. A simplified multistage strategy was adopted where, in each stage, only two of the three involved components are considered. As a proof-of-concept, the method was applied to a TAV prototype. Despite its simplifications, the developed computational framework gave useful insights into the stent-frame failures behavior during a fatigue test. Numerical results agree with experimental findings. In particular, the most dangerous condition was identified among a number of experimental tests, where different compartments and pressure gradients were investigated. The specific failure location was also correctly recognized. In conclusion, the presented methodology provides a tool to support the choice of proper testing conditions for the in vitro assessment of TAV fatigue behavior.
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Affiliation(s)
- Lorenza Petrini
- Department of Civil and Environmental Engineering, Politecnico di Milano, Milano 20133, Italy
| | - Elena Dordoni
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,” Politecnico di Milano, Milano 20133, Italy
| | - Dario Allegretti
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,” Politecnico di Milano, Milano 20133, Italy
| | - Desiree Pott
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen 52062, Germany
| | - Maximilian Kütting
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen 52062, Germany
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,” Politecnico di Milano, Milano 20133, Italy
| | - Giancarlo Pennati
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta,” Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano 20133, Italy e-mail:
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31
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Levi A, Landes U, Assali AR, Orvin K, Sharony R, Vaknin-Assa H, Hamdan A, Shapira Y, Schwartzenberg S, Codner P, Shaul AA, Vaturi M, Gutstein A, Sagie A, Kornowski R. Long-Term Outcomes of 560 Consecutive Patients Treated With Transcatheter Aortic Valve Implantation and Propensity Score-Matched Analysis of Early- Versus New-Generation Valves. Am J Cardiol 2017; 119:1821-1831. [PMID: 28388992 DOI: 10.1016/j.amjcard.2017.02.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/22/2017] [Accepted: 02/22/2017] [Indexed: 12/30/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis in patients at high or prohibitive surgical risk. Nevertheless, long-term clinical and echocardiographic data are still lacking. We carried out an analysis of 560 consecutive patients who underwent TAVI at our institution from 2008 to 2016 to evaluate temporal changes in TAVI characteristics, predictors of 1-year and long-term outcomes, and to compare the performance of the early- and new-generation valve systems. With time, we have adopted lower risk threshold for patient selection and have been using conscious sedation and transfemoral access preferentially (p <0.001 for all). The incidence of greater than mild PVL decreased from 16% to 7.6%, p = 0.029. Within 5 years, 47% of the patients died, the majority (78%) due to noncardiac causes. Independent predictors of 1-year death included periprocedural aspects (i.e., vascular complications, stroke, and PVL), whereas death occurring later than 1 year was solely related to baseline co-morbidities. Transvalvular gradients and residual regurgitation remained nonclinically significant for up to 5 years of follow-up. New-generation valves were associated with less PVL compared with propensity score-matched early-generation valves (p <0.001). In conclusion, TAVI utilization at our institution has progressed to include lower risk patients with transfemoral access becoming applicable in the great majority. Poor long-term survival is attributable to population factors rather than to procedural factors. Intermediate- and long-term hemodynamics are excellent. PVL has diminished significantly with the new-generation valves. Efforts to improve long- and short-term outcomes remain a therapeutic challenge.
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Affiliation(s)
- Amos Levi
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Landes
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abid R Assali
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Katia Orvin
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ram Sharony
- "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiothoracic Surgery, "Rabin Medical Center," Petah Tikva, Israel
| | - Hanna Vaknin-Assa
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ashraf Hamdan
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Shapira
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Schwartzenberg
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pablo Codner
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; Department of Cardiothoracic Surgery, "Rabin Medical Center," Petah Tikva, Israel
| | - Aviv A Shaul
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Vaturi
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Gutstein
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Sagie
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Cardiology Department, "Rabin Medical Center," Petah Tikva, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Frigiola A, Pluchinotta F, Saracino A, Giamberti A, Arcidiacono C, Piazza L, Reali M, Butera G, Varrica A, Carminati M. Surgical mitral valve replacement with the Melody valve in infants and children: the Italian experience. EUROINTERVENTION 2017; 12:2104-2109. [DOI: 10.4244/eij-d-16-00853] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ando T, Briasoulis A, Holmes AA, Taub CC, Takagi H, Afonso L. Sapien 3 versus Sapien XT prosthetic valves in transcatheter aortic valve implantation: A meta-analysis. Int J Cardiol 2016; 220:472-8. [DOI: 10.1016/j.ijcard.2016.06.159] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
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Bouleti C, Chauvet M, Franchineau G, Himbert D, Iung B, Alos B, Brochet E, Urena M, Ghodbane W, Ou P, Provenchere S, Nataf P, Vahanian A. The impact of the development of transcatheter aortic valve implantation on the management of severe aortic stenosis in high-risk patients: treatment strategies and outcome. Eur J Cardiothorac Surg 2016; 51:80-88. [PMID: 27582074 DOI: 10.1093/ejcts/ezw211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/29/2016] [Accepted: 05/10/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Transcatheter aortic valve implantation (TAVI) has reoriented the treatment of aortic stenosis (AS) for high-risk patients. Little is known about late outcome after TAVI, surgical aortic valve replacement (AVR) or medical treatment in a single centre. We report patients' characteristics, early and 6-year survival rates after the three therapeutic strategies, and the evolution over time. We also analysed predictive factors of mortality after TAVI or surgical AVR. METHODS Between October 2006 and December 2010, 478 high-risk consecutive patients were referred for severe symptomatic AS. After Heart Team evaluation, 253 underwent a TAVI, 102 a surgical AVR and 123 medical treatment including 33 compassionate percutaneous balloon aortic valvuloplasties (PBAVs). Follow-up was complete in 98% of patients. RESULTS Medically treated patients had higher risk scores than the other two groups. They presented a significantly worse survival (P < 0.001), with a 1-year rate of only 30%. The 33 patients who underwent compassionate PBAV presented the lowest survival rate, even lower than patients receiving drug therapy alone. In the TAVI group, patients had more comorbidities than those in the surgical group. There was no difference in 30-day survival rates [91 ± 2% for TAVI and 88 ± 3% for surgical AVR, hazard ratio (HR) for TAVI: 1.37; 95% CI: 0.73-2.58, P = 0.32]. Predictive factors of 30-day mortality were mainly postintervention complications illustrated by higher troponin levels and infection. The 6-year survival rates were 32 ± 4 and 40 ± 6% for TAVI and surgical AVR, respectively (HR for TAVI: 0.71; 95% CI: 0.53-0.97, P = 0.03), but the difference was no longer significant after adjustment on the Charlson comorbidity index (HR: 0.94; 95% CI: 0.68-1.29, P = 0.68). Predictive factors of late mortality were patients' comorbidities for both groups and paraprosthetic aortic regurgitation ≥2/4 for the TAVI group. The number of interventions (TAVI or surgery) increases over years, driven by the number of TAVI procedures without any decrease in surgical AVR. CONCLUSIONS In this single-centre study, medically treated patients with severe AS have a higher risk profile than those undergoing surgery or TAVI. Their survival is particularly poor and not improved by compassionate PBAV. When comparing TAVI and surgical AVR, there was no difference in 30-day and 6-year survival rates after adjusting for comorbidities.
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Affiliation(s)
- Claire Bouleti
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France .,DHU Fire, Paris-Diderot University, Paris, France
| | - Marion Chauvet
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Guillaume Franchineau
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Dominique Himbert
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.,DHU Fire, Paris-Diderot University, Paris, France.,INSERM U1148 Bichat Hospital, Paris, France
| | - Bernard Iung
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.,DHU Fire, Paris-Diderot University, Paris, France.,INSERM U1148 Bichat Hospital, Paris, France.,Faculté de Médecine Paris-Diderot University, Paris, France
| | - Benjamin Alos
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Eric Brochet
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.,DHU Fire, Paris-Diderot University, Paris, France
| | - Marina Urena
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.,DHU Fire, Paris-Diderot University, Paris, France
| | - Walid Ghodbane
- Department of Cardiac Surgery, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Phalla Ou
- INSERM U1148 Bichat Hospital, Paris, France.,Faculté de Médecine Paris-Diderot University, Paris, France.,Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Sophie Provenchere
- Department of Anaesthesiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Patrick Nataf
- DHU Fire, Paris-Diderot University, Paris, France.,Faculté de Médecine Paris-Diderot University, Paris, France.,Department of Cardiac Surgery, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Alec Vahanian
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.,DHU Fire, Paris-Diderot University, Paris, France.,INSERM U1148 Bichat Hospital, Paris, France.,Faculté de Médecine Paris-Diderot University, Paris, France
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Abdelghani M, Serruys PW. Transcatheter Aortic Valve Implantation in Lower-Risk Patients With Aortic Stenosis. Circ Cardiovasc Interv 2016; 9:e002944. [DOI: 10.1161/circinterventions.115.002944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/04/2016] [Indexed: 01/01/2023]
Abstract
Transcatheter aortic valve implantation underwent progressive improvements until it became the default therapy for inoperable patients, and a recommended therapy in high-risk operable patients with symptomatic severe aortic stenosis. In the lower-risk patient strata, a currently costly therapy that still has important complications with questionable durability is competing with the established effective and still-improving surgical replacement. This report tries to weigh the clinical evidence, the recent technical improvements, the durability, and the cost-effectiveness claims supporting the adoption of transcatheter aortic valve implantation in intermediate-low risk patients. The importance of appropriate patients’ risk stratification and a more comprehensive approach to estimate that risk are also emphasized in the present report.
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Affiliation(s)
- Mohammad Abdelghani
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (M.A.); and International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Patrick W. Serruys
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (M.A.); and International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.)
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36
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Bouleti C, Amsallem M, Touati A, Himbert D, Iung B, Alos B, Brochet E, Urena M, Ghodbane W, Ou P, Dilly MP, Nataf P, Vahanian A. Early and late outcomes after trans-catheter aortic valve implantation in patients with previous chest radiation. Heart 2016; 102:1044-51. [DOI: 10.1136/heartjnl-2015-309101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/03/2016] [Indexed: 11/04/2022] Open
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Bax JJ, Delgado V, Prendergast B. Does computed tomography detect bioprosthetic aortic valve thrombosis? New findings, new questions? Eur Heart J 2016; 37:2272-5. [DOI: 10.1093/eurheartj/ehv742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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38
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Hiltrop N, Belmans A, Claes M, Hornikx M, Peeters B, Flamaing J, Adriaenssens T, De Praetere H, Herregods MC, Herijgers P, Dubois C. Functional performance and quality of life in high-risk comorbid patients undergoing transcatheter aortic valve implantation for symptomatic aortic valve stenosis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:184-192. [DOI: 10.1093/ehjqcco/qcw001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Indexed: 11/13/2022]
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Praz F, Windecker S, Huber C, Carrel T, Wenaweser P. Expanding Indications of Transcatheter Heart Valve Interventions. JACC Cardiovasc Interv 2015; 8:1777-96. [DOI: 10.1016/j.jcin.2015.08.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 01/10/2023]
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40
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Hamm CW, Arsalan M, Mack MJ. The future of transcatheter aortic valve implantation. Eur Heart J 2015; 37:803-10. [PMID: 26578195 DOI: 10.1093/eurheartj/ehv574] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/05/2015] [Indexed: 11/13/2022] Open
Abstract
Since the introduction of transcatheter aortic valve implantation (TAVI) into clinical practice, the treatment of aortic stenosis has changed dramatically. In the past, medical therapy with or without balloon aortic valvuloplasty was the only option for inoperable patients. More recently, TAVI has become the treatment of choice for these patients and the preferred alternative for high-risk operable patients. Surgical aortic valve replacement (SAVR) currently remains the gold standard for patients at low or intermediate operative risk. As randomized trials have demonstrated comparable results between TAVI and SAVR in the high-risk population, there is now a clear trend towards performing TAVI even in intermediate-risk patients while awaiting the results of randomized trials in that population. Nevertheless, there are still questions regarding TAVI involving paravalvular leak (PVL), stroke, pacemaker requirements, and durability that remain to be more definitively answered before TAVI can routinely be performed in a broader, lower risk population. Improvements in patient selection, imaging, and second and third generation devices have decreased the incidence of PVLs and vascular complications that followed the earliest TAVI procedures, but the rates of perioperative stroke and permanent pacemaker implantation must still be addressed. Furthermore, the long-term durability of TAVI devices and a role for post-procedure antithrombotic management remain unanswered. Until these questions are more clearly answered, it is the Heart Team's task to determine the optimal treatment for each patient based on risk scores, frailty metrics, comorbidities, patient preference, and potential for improvement in quality of life.
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Affiliation(s)
- Christian W Hamm
- Department of Medical Clinic I, University of Giessen, Klinikstr. 33, Gießen 35392, Germany Department Cardiac Surgery, Kerckhoff Heart Center, Benekestrasse 2-8, Bad Nauheim 61231, Germany
| | - Mani Arsalan
- Department Cardiac Surgery, Kerckhoff Heart Center, Benekestrasse 2-8, Bad Nauheim 61231, Germany The Heart Hospital Baylor Plano, 1100 Allied Drive, Plano, TX 75093, USA
| | - Michael J Mack
- Cardiovascular Surgery, Baylor Health Care System, Dallas, TX, USA
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Codner P, Orvin K, Assali A, Sharony R, Vaknin-Assa H, Shapira Y, Schwartzenberg S, Bental T, Sagie A, Kornowski R. Long-Term Outcomes for Patients With Severe Symptomatic Aortic Stenosis Treated With Transcatheter Aortic Valve Implantation. Am J Cardiol 2015; 116:1391-8. [PMID: 26342515 DOI: 10.1016/j.amjcard.2015.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/01/2015] [Accepted: 08/01/2015] [Indexed: 11/16/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an established technique for the treatment of severe symptomatic aortic stenosis. Data on long-term TAVI outcomes, both hemodynamic and clinical, in real-world practice settings are limited. We aim to explore the long-term clinical results in patients with severe symptomatic aortic stenosis using multiple catheter-based options: 360 TAVI-treated patients were followed up for ≤5 years. The Medtronic CoreValve was used in 71% and the Edwards SAPIEN in 26%. The primary end point was all-cause mortality during follow-up. Outcomes were assessed based on the Valve Academic Research Consortium 2 criteria. The mean ± SD patient age was 82.1 ± 6.9 years (56.4% women). The Society of Thoracic Surgeons score was 7.5 ± 4.7. The clinical efficacy end point and time-related valve safety at 3 years was 50% and 81.7%, respectively. The calculated 3- and 5-year survival rates were 71.6% and 56.4%, respectively. Five-year follow-up data were obtained for 54 patients alive; 96.2% of alive patients were in the New York Heart Association class I and II, 4 years after TAVI. No gender differences in all-cause mortality rates were observed (p = 0.58). In multivariate analysis, hospitalization 6 months previous to TAVI (hazard ratio [HR] 1.92, 95% confidence interval [CI] 1.17 to 3.15, p = 0.01), frailty (HR 1.89, 95% CI 1.11 to 3.2, p = 0.02), acute kidney injury (HR 1.93, 95% CI 1.03 to 3.61, p = 0.04), and moderate or more paravalvular aortic regurgitation after TAVI (HR 4.26, 95% CI 2.54 to 7.15, p <0.001) were independent predictors for all-cause mortality. In conclusion, long-term outcomes of TAVI are encouraging. Prevention and early identification of paravalvular leak and acute renal failure after the procedure would improve short- and long-term outcomes.
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Affiliation(s)
- Pablo Codner
- Cardiology Department, Rabin Medical Center, Petah Tikwa, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Katia Orvin
- Cardiology Department, Rabin Medical Center, Petah Tikwa, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abid Assali
- Cardiology Department, Rabin Medical Center, Petah Tikwa, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ram Sharony
- "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel; Cardiothoracic Surgery Department, Rabin Medical Center, Petah Tikwa, Israel
| | - Hanna Vaknin-Assa
- Cardiology Department, Rabin Medical Center, Petah Tikwa, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Shapira
- Cardiology Department, Rabin Medical Center, Petah Tikwa, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Schwartzenberg
- Cardiology Department, Rabin Medical Center, Petah Tikwa, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Bental
- Cardiology Department, Rabin Medical Center, Petah Tikwa, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Sagie
- Cardiology Department, Rabin Medical Center, Petah Tikwa, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikwa, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Thyregod HGH, Steinbrüchel DA, Ihlemann N, Nissen H, Kjeldsen BJ, Petursson P, Chang Y, Franzen OW, Engstrøm T, Clemmensen P, Hansen PB, Andersen LW, Olsen PS, Søndergaard L. Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Valve Stenosis: 1-Year Results From the All-Comers NOTION Randomized Clinical Trial. J Am Coll Cardiol 2015; 65:2184-94. [PMID: 25787196 DOI: 10.1016/j.jacc.2015.03.014] [Citation(s) in RCA: 670] [Impact Index Per Article: 74.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is an option in certain high-risk surgical patients with severe aortic valve stenosis. It is unknown whether TAVR can be safely introduced to lower-risk patients. OBJECTIVES The NOTION (Nordic Aortic Valve Intervention Trial) randomized clinical trial compared TAVR with surgical aortic valve replacement (SAVR) in an all-comers patient cohort. METHODS Patients ≥ 70 years old with severe aortic valve stenosis and no significant coronary artery disease were randomized 1:1 to TAVR using a self-expanding bioprosthesis versus SAVR. The primary outcome was the composite rate of death from any cause, stroke, or myocardial infarction (MI) at 1 year. RESULTS A total of 280 patients were randomized at 3 Nordic centers. Mean age was 79.1 years, and 81.8% were considered low-risk patients. In the intention-to-treat population, no significant difference in the primary endpoint was found (13.1% vs. 16.3%; p = 0.43 for superiority). The result did not change in the as-treated population. No difference in the rate of cardiovascular death or prosthesis reintervention was found. Compared with SAVR-treated patients, TAVR-treated patients had more conduction abnormalities requiring pacemaker implantation, larger improvement in effective orifice area, more total aortic valve regurgitation, and higher New York Heart Association functional class at 1 year. SAVR-treated patients had more major or life-threatening bleeding, cardiogenic shock, acute kidney injury (stage II or III), and new-onset or worsening atrial fibrillation at 30 days than did TAVR-treated patients. CONCLUSIONS In the NOTION trial, no significant difference between TAVR and SAVR was found for the composite rate of death from any cause, stroke, or MI after 1 year. (Nordic Aortic Valve Intervention Trial [NOTION]; NCT01057173).
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Affiliation(s)
- Hans Gustav Hørsted Thyregod
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Daniel Andreas Steinbrüchel
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nikolaj Ihlemann
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Nissen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Bo Juel Kjeldsen
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Petur Petursson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Yanping Chang
- Department of Statistics, Medtronic Inc., Mounds View, Minnesota
| | - Olaf Walter Franzen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Clemmensen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Bo Hansen
- Department of Cardiac Anesthesia, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Willy Andersen
- Department of Cardiac Anesthesia, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Skov Olsen
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Søndergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Huynh K. Interventional cardiology: 6-year follow-up of TAVI patients. Nat Rev Cardiol 2015; 12:195. [PMID: 25707387 DOI: 10.1038/nrcardio.2015.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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