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Raidou V, Mitete K, Kourek C, Antonopoulos M, Soulele T, Kolovou K, Vlahodimitris I, Vasileiadis I, Dimopoulos S. Quality of life and functional capacity in patients after cardiac surgery intensive care unit. World J Cardiol 2024; 16:436-447. [DOI: 10.4330/wjc.v16.i8.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 06/24/2024] [Accepted: 07/22/2024] [Indexed: 08/26/2024] Open
Abstract
Coronary heart disease and aortic stenosis are prevalent cardiovascular diseases worldwide, leading to morbidity and mortality. Coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR) have therapeutic benefits, including improved postoperative quality of life (QoL) and enhanced patient functional capacity which are key indicators of cardiac surgery outcome. In this article, we review the latest studies of QoL outcomes and functional capacity in patients who underwent cardiac surgery. Many standardized instruments are used to evaluate QoL and functional conditions. Preoperative health status, age, length of intensive care unit stay, operative risk, type of procedure, and other pre-, intra-, and postoperative factors affect postoperative QoL. Elderly patients experience impaired physical status soon after cardiac surgery, but it improves in the following period. CABG and SAVR are associated with increases of physical and mental health and functional capacity in the immediate postoperative and the long long-term. Cardiac rehabilitation improves patient functional capacity, QoL, and frailty following cardiac surgery.
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Affiliation(s)
- Vasiliki Raidou
- Clinical Ergospirometry, Exercise, and Rehabilitation Laboratory, Department of First Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Katerina Mitete
- Clinical Ergospirometry, Exercise, and Rehabilitation Laboratory, Department of First Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Christos Kourek
- Clinical Ergospirometry, Exercise, and Rehabilitation Laboratory, Department of First Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Michael Antonopoulos
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Theodora Soulele
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Kyriaki Kolovou
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Ioannis Vlahodimitris
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Ioannis Vasileiadis
- Clinical Ergospirometry, Exercise, and Rehabilitation Laboratory, Department of First Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Stavros Dimopoulos
- Clinical Ergospirometry, Exercise, and Rehabilitation Laboratory, Department of First Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Greece
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
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Metra M, Radulescu CI, Cersosimo A, Massussi M, Laurito A, Chioncel O, Adamo M. Quality of life in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: tools and evidence. J Cardiovasc Med (Hagerstown) 2024; 25:259-270. [PMID: 38488063 DOI: 10.2459/jcm.0000000000001591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Aortic stenosis is the most prevalent valvular heart disease requiring intervention, especially in the elderly population. Surgical aortic valve replacement and transcatheter aortic valve implantation (TAVI) are well established treatment options for symptomatic patients with severe aortic stenosis, as they provide a significant survival benefit. Aortic stenosis may have an important impact on patients' quality of life (QoL). However, advanced age, comorbidities and frailty may limit the beneficial effect of aortic stenosis interventions in terms of QoL. Current guidelines mention the importance of frailty and avoiding the futility of interventions, but lack specific indications about decision-making. Also, there are limited data on how to specifically assess QoL in aortic stenosis patients since the most used questionnaires are validated in different populations (i.e. heart failure). The aim of this review is to summarize all the available tools for QoL assessment in patients with aortic stenosis; to report current evidence on the impact of TAVI on QoL; and to discuss the role of frailty and comorbidities in this setting.
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Affiliation(s)
- Marco Metra
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Crina-Ioana Radulescu
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- University of Medicine and Pharmacy Carol Davila
| | - Angelica Cersosimo
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Mauro Massussi
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Laurito
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Ovidiu Chioncel
- University of Medicine and Pharmacy Carol Davila
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
| | - Marianna Adamo
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Ko TY, Kao HL, Yeh CF, Lin JH, Huang CC, Chen YH, Chao CC, Li HY, Chan CY, Lin LC, Chen YS, Wang MJ, Lin MS. Serial neurocognitive changes following transcatheter aortic valve replacement: comparison between low and intermediate-high risk groups. Aging (Albany NY) 2022; 14:6111-6127. [PMID: 35939340 PMCID: PMC9417238 DOI: 10.18632/aging.204202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/03/2022] [Indexed: 11/25/2022]
Abstract
Background: Data comparing the neurocognitive trajectory between low and intermediate-high risk patients following transcatheter aortic valve replacement (TAVR) is never reported. Aims: To report serial neurocognitive changes up to 1 year post-TAVR in low and intermediate-high risk groups as well as overall cohort. Methods: Prospective neurological assessments (NIHSS and Barthel Index), global cognitive tests (MMSE and Alzheimer Disease Assessment Scale–Cognitive Subtest, ADAS-cog) and executive performances (Color Trail Test A and B and verbal fluency), were applied at baseline, 3 months and 1 year post-TAVR. Results: In overall cohort, persistent improvement to 1 year in MMSE, ADAS-cog, Color Trail Test A and B was found. According to the STS score, the study cohort was divided into low (<4%, N = 81) and intermediate-high (≧4%, N = 75) risk groups. The baseline neurologic and cognitive performance was significantly worse in intermediate-high risk group. Slight improvement on general neurological functions (Barthel index and proportion of NIHSS>0 patients) at 1 year could be observed only in intermediate-high risk group. In global cognitive assessments, improvement in MMSE and ADAS-cog at 1 year was found in both groups, but the proportion of cognitive improvement was more obvious in intermediate-high risk group. In Color Trail Tests and verbal fluency, significant and persistent improvement up to 1 year could be observed only in low risk group. Conclusions: TAVR was associated with persistent improvement in global cognitive function, as well as in attention and psychomotor processing speed, up to 1 year in overall cohort. However, improvement in tests for executive functions can only be seen in low risk group.
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Affiliation(s)
- Tsung-Yu Ko
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, Medical College, National Taiwan University, Taipei, Taiwan
| | - Hsien-Li Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Fan Yeh
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiu-Hsiang Lin
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Ching-Chang Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Hsien Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Chao Chao
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Yuan Li
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Yang Chan
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Lung-Chun Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Jiuh Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Shin Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Humbert M, Büla CJ, Muller O, Krief H, Monney P. Delirium in older patients undergoing aortic valve replacement: incidence, predictors, and cognitive prognosis. BMC Geriatr 2021; 21:153. [PMID: 33653285 PMCID: PMC7927377 DOI: 10.1186/s12877-021-02100-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/22/2021] [Indexed: 12/14/2022] Open
Abstract
Background Transcatheter aortic valve replacement is increasingly performed in frail older patients who were previously ineligible for a standard surgical procedure. The objectives of this study are to determine delirium incidence, predictors, and relationship with cognitive performance at 3-month follow-up in older patients undergoing aortic valve replacement (AVR). Methods Patients (N = 93) aged 70 years and older, undergoing transcatheter (TAVR, N = 66) or surgical (SAVR, N = 27) aortic valve replacement in an academic medical center were enrolled in this prospective cohort study. Delirium was assessed using the Confusion Assessment Method (CAM) on postoperative days 1, 2, 3, and 7. Data on patients’ socio-demographics, functional status (including instrumental activities of daily living (IADL), and surgical risk scores (including Society of Thoracic Surgeons (STS) risk score), were collected at baseline. Cognitive status was assessed with the Mini-Mental Status Exam (MMSE) and the Clock Drawing Test (CDT) at baseline and 3 months after AVR. Results Delirium occurred in 21 (23%) patients, within the first three postoperative days in 95% (20/21) of the cases. Delirium incidence was lower in TAVR (13/66 = 20%) than SAVR (8/27 = 30%) patients, but this difference was not statistically significant (p = .298). Patients with delirium had lower baseline cognitive performance (median MMSE score 27.0 ± 3.0 vs 28.0 ± 3.0, p = .029), lower performance in IADL (7.0 vs 8.0, p = .038), and higher STS risk scores (4.7 ± 2.7 vs 2.9 ± 2.3, p = .020). In multivariate analyses, patients with intermediate (score > 3 to ≤8) and high (score > 8) STS risk scores had 4.3 (95%CI 1.2–15.1, p = .025) and 16.5 (95%CI 2.0–138.2, p = .010), respectively, higher odds of incident delirium compared to patients with low (score ≤ 3) STS risk scores. At 3-month follow-up (N = 77), patients with delirium still had lower MMSE score (27.0 ± 8.0 vs 28.0 ± 2.0, p = .007) but this difference did not remain significant once adjusting for baseline MMSE (β-coefficient 1.11, 95%CI [− 3.03–0.80], p = .248). Conclusions Delirium occurred in about one in five older patients undergoing AVR, almost essentially within the first three postoperative days. Beside cognitive performance, STS risk score could enhance the identification of high-risk older patients to better target preventative interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02100-5.
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Affiliation(s)
- Marc Humbert
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Medical Center (CHUV), Lausanne, Switzerland.
| | - Christophe J Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Medical Center (CHUV), Lausanne, Switzerland
| | - Olivier Muller
- Service of Cardiology, Department of Cardio-Vascular Medicine and Surgery, University of Lausanne Medical Center (CHUV), Lausanne, Switzerland
| | - Hélène Krief
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Medical Center (CHUV), Lausanne, Switzerland
| | - Pierre Monney
- Service of Cardiology, Department of Cardio-Vascular Medicine and Surgery, University of Lausanne Medical Center (CHUV), Lausanne, Switzerland
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Ghezzi ES, Ross TJ, Davis D, Psaltis PJ, Loetscher T, Keage HA. Meta-Analysis of Prevalence and Risk Factors for Cognitive Decline and Improvement After Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 127:105-112. [PMID: 32402486 PMCID: PMC8376655 DOI: 10.1016/j.amjcard.2020.04.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 12/17/2022]
Abstract
Changes to cognition, both decline and improvement, are commonly reported after transcatheter aortic valve implantation (TAVI). However, previous systematic reviews and meta-analyses have missed these subgroups by assessing whole-group-averages for cognitive outcomes. We sought to pool estimates to identify the prevalence of cognitive decline and improvement after TAVI, as well as associated factors for these outcomes. A systematic review identified 15 articles appropriate for meta-analysis. When robust cognitive change definitions were employed, the pooled prevalence of incident cognitive impairment up to 1-, 1 to 6-, and ≥6-months post-TAVI was 7%, 14%, and 12%, respectively. For cognitive improvement, the prevalence from 1 to 6 months and ≥6 months after TAVI was estimated to be 19% and 11%, respectively. Two factors were associated with these cognitive outcomes: (1) using a cerebral embolic protection device was associated with decreased prevalence of cognitive decline up to 1-week post-TAVI; (2) baseline cognitive impairment had a large association with post-TAVI cognitive improvement. In conclusion, cognitive decline and cognitive improvement are experienced by approximately 7% to 19% of patients after TAVI, respectively. Those with the lowest cognitive performance pre-TAVI appear to have the most to gain in terms of cognitive improvement post-TAVI. Identifying further predictive factors for cognitive decline and improvement post-TAVI will facilitate a personalized-medicine approach for cognitive care and prognosis.
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González-Montalvo JI, Ramírez-Martín R, Menéndez Colino R, Alarcón T, Tarazona-Santabalbina FJ, Martínez-Velilla N, Vidán MT, Pi-Figueras Valls M, Formiga F, Rodríguez Couso M, Hormigo Sánchez AI, Vilches-Moraga A, Rodríguez-Pascual C, Gutiérrez Rodríguez J, Gómez-Pavón J, Sáez López P, Bermejo Boixareu C, Serra Rexach JA, Martínez Peromingo J, Sánchez Castellano C, González Guerrero JL, Martín-Sánchez FJ. [Cross-speciality geriatrics: A health-care challenge for the 21st century]. Rev Esp Geriatr Gerontol 2020; 55:84-97. [PMID: 31870507 DOI: 10.1016/j.regg.2019.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
Increasing numbers of older persons are being treated by specialties other than Geriatric Medicine. Specialists turn to Geriatric Teams when they need to accurately stratify their patients' risk and prognosis, predict the potential impact of their, often, invasive interventions, optimise their clinical status, and contribute to discharge planning. Oncology and Haematology, Cardiology, General Surgery, and other surgical departments are examples where such collaborative working is already established, to a varying extent. The use of the term "Cross-speciality Geriatrics" is suggested when geriatric care is provided in clinical areas traditionally outside the reach of Geriatric Teams. The core principles of Geriatric Medicine (comprehensive geriatric assessment, patient-centred multidisciplinary targeted interventions, and input at point-of-care) are adapted to the specifics of each specialty and applied to frail older patients in order to deliver a holistic assessment/treatment, better patient/carer experience, and improved clinical outcomes. Using Comprehensive Geriatric Assessment methodology and Frailty scoring in such patients provides invaluable prognostic information, helps in decision making, and enables personalised treatment strategies. There is evidence that such an approach improves the efficiency of health care systems and patient outcomes. This article includes a review of these concepts, describes existing models of care, presents the most commonly used clinical tools, and offers examples of excellence in this new era of geriatric care. In an ever ageing population it is likely that teams will be asked to provide Cross-specialty Geriatrics across different Health Care systems. The fundamentals for its implementation are in place, but further evidence is required to guide future development and consolidation, making it one of the most important challenges for Geriatrics in the coming years.
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Affiliation(s)
- Juan Ignacio González-Montalvo
- Servicio de Geriatría, Hospital Universitario La Paz, IdiPAZ, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España.
| | | | | | - Teresa Alarcón
- Servicio de Geriatría, Hospital Universitario La Paz, IdiPAZ, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | | | - Nicolás Martínez-Velilla
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IDISNA, Pamplona, España
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, IiSGM, Facultad de Medicina, Universidad Complutense de Madrid, CIBERFES, Madrid, España
| | | | - Francesc Formiga
- Unidad de Geriatría, Servicio de Medicina Interna, IDIBELL, Hospital Universitario de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España
| | | | - Ana Isabel Hormigo Sánchez
- Servicio de Geriatría, Hospital Universitario Fundación Jiménez Díaz, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Arturo Vilches-Moraga
- Servicio de Geriatría, Salford Royal NHS Foundation Trust, Facultad de Medicina, Universidad de Manchester, Manchester, Inglaterra
| | | | - José Gutiérrez Rodríguez
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España
| | - Javier Gómez-Pavón
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, Facultad de Medicina, Universidad Alfonso X el Sabio, Madrid, España
| | - Pilar Sáez López
- Unidad de Geriatría, Hospital Universitario Fundación de Alcorcón, IdiPAZ, Alcorcón, Madrid, España
| | | | - José Antonio Serra Rexach
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, IiSGM, Facultad de Medicina, Universidad Complutense de Madrid, CIBERFES, Madrid, España
| | | | | | - José Luis González Guerrero
- Servicio de Geriatría, Hospital San Pedro de Alcántara, Complejo Hospitalario Universitario de Cáceres, Cáceres, España
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Universitario Clínico San Carlos, IdiSSC, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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Evaluation of Cognitive Function Following Transcatheter Aortic Valve Replacement. Heart Lung Circ 2018; 27:1454-1461. [DOI: 10.1016/j.hlc.2017.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 09/19/2017] [Accepted: 10/06/2017] [Indexed: 12/13/2022]
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Straiton N, Jin K, Bhindi R, Gallagher R. Functional capacity and health-related quality of life outcomes post transcatheter aortic valve replacement: a systematic review and meta-analysis. Age Ageing 2018; 47:478-482. [PMID: 29377982 DOI: 10.1093/ageing/afx203] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/23/2017] [Indexed: 12/11/2022] Open
Abstract
Background transcatheter aortic valve replacement (TAVR) provides prognostic benefit for high surgical-risk patients with severe aortic stenosis (AS), yet the impact to patient outcomes is far less understood. Method we performed a systematic review and meta-analysis to evaluate functional capacity and health-related quality of life (HRQoL) outcomes for patients up to 12 months post TAVR. A total of 20 eligible publications, comprising randomised-controlled trials, observational studies and a registry study were identified from electronic databases, including MEDLINE, EMBASE, Cochrane Library and others (inception to February 2017). Results the total sample was 2,775 with a mean age of 81.8 ± 2.1 years, more than half (52%) were female and high surgical risk 9.6 ± 4.3% mean STS (Society of Thoracic Surgeons risk model). Post TAVR, patients had significant improvement in functional capacity of >40 m in the 6-minute walk test (6MWT) (95% confidence interval (CI) 9.69-73.28) and a clinically meaningful increase in ability to perform daily physical-based tasks (Duke Activity Status Index (DASI), mean difference (MD) increase 5.42 points, 95% CI 3.16-7.68). HRQoL improved consistently following TAVR regardless of measure used. Significant increases occurred in the physical component summary scores (PCS) of the short form (SF) health surveys (MD increase 10.45 (SF36) and 10.14 (SF12) points). Conclusion functional capacity and HRQoL improved substantially following TAVR, despite evolving patient selection criteria, thus TAVR continues to provide a directly beneficial option for severe AS patients.
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Affiliation(s)
- Nicola Straiton
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Kai Jin
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Robyn Gallagher
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
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Abstract
Cognition is essential to all aspects of our everyday life. Although we take our cognitive function for granted, the perioperative period is prone to several aggressions that might impair it. Postoperative cognitive dysfunction, has been the aim of many studies recently, and was shown to be very common with an incidence that can reach 40%, yielding not only impairment in cognition, but also longer hospital stays, higher costs and greater mortality. While several studies have revealed some of the mechanisms contributing to postoperative cognitive dysfunction, the search for the perfect instrument to screen and measure cognitive (dys)function has proven more elusive. The present paper aims to review several cognitive evaluation methods, discussing their advantages and disadvantages as well as their potential clinical applications in evaluating the dynamics of the recovery of cognitive function after anesthesia and surgery. The current availability of easy to use computerized tests might provide the tools necessary to identify patients at risk, and promptly provide them with the adequate course of action.
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Affiliation(s)
- Sérgio Vide
- Hospital CLINIC de Barcelona, Anesthesiology Department, Systems Pharmacology Effect Control & Modeling (SPEC-M) Research Group, Barcelona, Spain; Hospital Pedro Hispano, Department of Anesthesia, Matosinhos, Portugal; Centro Hospitalar Universitário do Porto, Department of Anesthesiology, Center for Clinical Research in Anesthesia, Porto, Portugal
| | - Pedro L Gambús
- Hospital CLINIC de Barcelona, Anesthesiology Department, Systems Pharmacology Effect Control & Modeling (SPEC-M) Research Group, Barcelona, Spain; University of California San Francisco (UCSF), Department of Anesthesia and Perioperative Care, San Francisco, California, USA; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), NeuroImmunology Research Group, Barcelona, Spain.
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10
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Lazar RM, Pavol MA, Bormann T, Dwyer MG, Kraemer C, White R, Zivadinov R, Wertheimer JC, Thöne-Otto A, Ravdin LD, Naugle R, Mechanic-Hamilton D, Garmoe WS, Stringer AY, Bender HA, Kapadia SR, Kodali S, Ghanem A, Linke A, Mehran R, Virmani R, Nazif T, Parhizgar A, Leon MB. Neurocognition and Cerebral Lesion Burden in High-Risk Patients Before Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:384-392. [DOI: 10.1016/j.jcin.2017.10.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 12/11/2022]
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Corrêa B, Cardoso DM. Functional capacity and mental state of patients undergoing cardiac surgery. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.004.ao16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Cardiovascular diseases are a serious public health problem in Brazil. Myocardial revascularization surgery (MRS) as well as cardiac valve replacement and repair are procedures indicated to treat them. Thus, extracorporeal circulation (ECC) is still widely used in these surgeries, in which patients with long ECC times may have greater neurological deficits. Neurological damage resulting from MRS can have devastating consequences such as loss of independence and worsening of quality of life. Objective: To assess the effect of cardiac surgery on a patient’s mental state and functional capacity in both the pre- and postoperative periods. Methods: We conducted a cross-sectional study with convenience sampling of subjects undergoing MRS and valve replacement. Participants were administered the Mini-Mental State Exam (MMSE) and the Duke Activity Status Index (DASI) in the pre- and postoperative periods, as well as before their hospital discharge. Results: This study assessed nine patients (eight males) aged 62.4 ± 6.3 years with a BMI of 29.5 ± 2.3 kg/m2. There was a significant decrease in DASI scores and VO2 from preoperative to postoperative status (p = 0.003 and p = 0.003, respectively). Conclusion: This study revealed a loss of cognitive and exercise capacity after cardiac surgery. A larger sample however is needed to consolidate these findings.
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Khan MM, Herrmann N, Gallagher D, Gandell D, Fremes SE, Wijeysundera HC, Radhakrishnan S, Sun YR, Lanctôt KL. Cognitive Outcomes After Transcatheter Aortic Valve Implantation: A Metaanalysis. J Am Geriatr Soc 2017; 66:254-262. [PMID: 29159840 DOI: 10.1111/jgs.15123] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To quantitatively summarize changes in cognitive performance in individuals with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). DESIGN Metaanalysis. PARTICIPANTS Individuals undergoing TAVI (N = 1,065 (48.5% male) from 18 studies, average age ≥80). MEASUREMENTS The MEDLINE, EMBASE, and Cochrane Central databases were searched for original peer-reviewed reports assessing cognitive performance using standardized cognitive tests before and after TAVI. Data were extracted for cognitive scores before TAVI; perioperatively (within 7 days after TAVI); 1, 3, and 6 months after TAVI, and 12 to 34 months after TAVI (over the long term). Standardized mean differences (SMDs) were generated using random-effects models for changes in cognition at each time point. Metaregression analyses were conducted to assess the association between population and procedural characteristics and cognitive outcomes. Risk of bias was assessed. RESULTS There were no significant changes from baseline in perioperative cognitive performance (SMD = 0.05, 95% confidence interval (CI) = -0.08-0.18; z = 0.75, P = .46), although overall cognitive performance had improved significantly 1 month after TAVI (SMD = -0.33, 95% CI = -0.50 to -0.16; z = 3.83, P < .001). There were no differences in cognitive performance 3 and 6 months after TAVI or over the long term. Cognitive outcomes were not associated with any covariates in regression analyses. CONCLUSION Cognitive performance is preserved after TAVI, suggesting TAVI is not detrimental to cognition.
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Affiliation(s)
- Maisha M Khan
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Herrmann
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada
| | - Damien Gallagher
- Department of Psychiatry, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada
| | - Dov Gandell
- Department of Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Sam Radhakrishnan
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Yue Ran Sun
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Krista L Lanctôt
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada
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13
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Ciuca C, Ferrari S, Placuzzi L, Marrozzini C, Taglieri N, Bordoni B, Dall'Ara G, Moretti C, Montefiori M, Chattat R, Marzocchi A, Saia F. Cognitive functions: evaluation and changes after transcatheter aortic valve implantation in elderly patients. Future Cardiol 2017; 13:229-237. [PMID: 28585899 DOI: 10.2217/fca-2016-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To assess the prevalence and postprocedural evolution of cognitive impairment (CI) in patients undergoing transcatheter aortic valve implantation. METHODS 62 patients were enrolled. Mini Mental state examination (MMSE), verbal memory test (VMT), visual search test (VST) and phonemic verbal fluency (PVF) were used to evaluate the cognitive status. CI was considered when a pathological result of MMSE was confirmed by VMT, VST and PVF. RESULTS A total of 26.2% patients had CI at baseline. MMSE, VMT, VST and PVF were pathologic in 39, 16.1, 8.1 and 22.6% of the patients, respectively. Overall, no significant differences in cognitive function in any dimension were observed from baseline up to 1-year follow-up. CONCLUSION CI is frequent in patients undergoing transcatheter aortic valve implantation, though the procedure does not forge cognitive status.
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Affiliation(s)
- Cristina Ciuca
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Susy Ferrari
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy.,Department of Psychology, University of Bologna, Italy
| | - Lisa Placuzzi
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy.,Department of Psychology, University of Bologna, Italy
| | - Cinzia Marrozzini
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Nevio Taglieri
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Barbara Bordoni
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Gianni Dall'Ara
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Carolina Moretti
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Michela Montefiori
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Italy
| | - Antonio Marzocchi
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Francesco Saia
- Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
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14
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Siciliano M, Santangelo G, D’Iorio A, Basile G, Piscopo F, Grossi D, Trojano L. Rouleau version of the Clock Drawing Test: age- and education-adjusted normative data from a wide Italian sample. Clin Neuropsychol 2016; 30:1501-1516. [DOI: 10.1080/13854046.2016.1241893] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Auffret V, Campelo-Parada F, Regueiro A, Del Trigo M, Chiche O, Chamandi C, Allende R, Cordoba-Soriano JG, Paradis JM, De Larochellière R, Doyle D, Dumont E, Mohammadi S, Côté M, Marrero A, Puri R, Rodés-Cabau J. Serial Changes in Cognitive Function Following Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2016; 68:2129-2141. [PMID: 27692728 DOI: 10.1016/j.jacc.2016.08.046] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/18/2016] [Accepted: 08/09/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Data regarding the mid- to long-term cognitive trajectory of transcatheter aortic valve (TAVR) recipients are scarce. OBJECTIVES Changes in global cognition and specific cognitive domains up to 1 year post-TAVR were evaluated. METHODS Fifty-one patients (median age 80.0 [interquartile range: 72.0 to 85.0] years; 37% women) underwent TAVR and prospective assessment of cognitive function using the Montreal Cognitive Assessment (MoCA) at baseline, short-term (30 days), and 1 year post-TAVR. Processing speed and executive cognitive functions were further evaluated with the digit-symbol substitution test (DSST), Trail Making Tests (TMT), and verbal fluency tests at the same time points. Cognitive decline (CD) was determined by changes in mean scores and as a rate using practice-corrected reliable change index (RCI). RESULTS The baseline mean total MoCA score was 22.71 ± 3.84. Twenty patients (39.2%) were considered cognitively impaired using a cutoff of <23 of 30 points. Mean total MoCA score improved at short-term post-TAVR and remained stable at 1 year (p = 0.022). On the basis of the RCI of total MoCA score, 4 patients (7.8%) presented with short-term CD, which persisted at 1 year in 1 patient (2.0%). Four patients (7.8%) exhibited cognitive improvement at 1 year, increasing to 15% among those with baseline cognitive impairment. No significant changes were observed over time in the mean DSST, TMT, and verbal fluency test scores. On the basis of the RCI, 10 of 40 patients (25%) presented with a reduction in performance of at least 1 test at 30 days that persisted at 1 year in 4 patients (10%). CONCLUSIONS TAVR was associated with global improvement in cognitive status, more pronounced among those with cognitive impairment pre-TAVR. However, early decline in some complex cognitive functions was observed in one-quarter of TAVR recipients, persisting at 1 year in 10% of patients.
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Affiliation(s)
- Vincent Auffret
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Ander Regueiro
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - María Del Trigo
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Olivier Chiche
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Chekrallah Chamandi
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Ricardo Allende
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Jean-Michel Paradis
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Daniel Doyle
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Eric Dumont
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mélanie Côté
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Alier Marrero
- Department of Neurology, University Hospital Georges. L. Dumont, Moncton, New Brunswick, Canada
| | - Rishi Puri
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
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16
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Schoenenberger AW, Zuber C, Moser A, Zwahlen M, Wenaweser P, Windecker S, Carrel T, Stuck AE, Stortecky S. Evolution of Cognitive Function After Transcatheter Aortic Valve Implantation. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.116.003590. [PMID: 27655999 DOI: 10.1161/circinterventions.116.003590] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 08/19/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study aimed to assess the evolution of cognitive function after transcatheter aortic valve implantation (TAVI). Previous smaller studies reported conflicting results on the evolution of cognitive function after TAVI. METHODS AND RESULTS In this prospective cohort, cognitive function was measured in 229 patients ≥70 years using the Mini Mental State Examination before and 6 months after TAVI. Cognitive deterioration or improvement was defined as change of ≥3 points decrease or increase in the Mini Mental State Examination score between baseline and follow-up. Cognitive deterioration was found in 29 patients (12.7%). Predictive analysis using logistic regression did not identify any statistically significant predictor of cognitive deterioration. A review of individual medical records in 8 patients with a major Mini Mental State Examination score decrease of ≥5 points revealed specific causes in 6 cases (postinterventional delirium in 2; postinterventional stroke, progressive renal failure, progressive heart failure, or combination of preexisting cerebrovascular disease and mild cognitive impairment in 1 each). Among 48 patients with impaired baseline cognition (Mini Mental State Examination score <26 points), 18 patients (37.5%) cognitively improved. The preinterventional aortic valve area was lower in patients who cognitively improved (median aortic valve area 0.60 cm2) as compared with patients who did not improve (median aortic valve area 0.70 cm2; P=0.01). CONCLUSIONS This is the first study providing evidence that TAVI results in cognitive improvement among patients who had impaired preprocedural cognitive function, possibly related to hemodynamic improvement in patients with severe aortic stenosis. Our results confirm that some patients experience cognitive deterioration after TAVI.
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Affiliation(s)
- Andreas W Schoenenberger
- From the Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland (A.W.S., C.Z., A.M., A.E.S.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (A.M., M.Z.); Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (P.W., S.W., S.S.); and Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (T.C.).
| | - Chantal Zuber
- From the Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland (A.W.S., C.Z., A.M., A.E.S.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (A.M., M.Z.); Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (P.W., S.W., S.S.); and Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (T.C.)
| | - André Moser
- From the Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland (A.W.S., C.Z., A.M., A.E.S.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (A.M., M.Z.); Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (P.W., S.W., S.S.); and Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (T.C.)
| | - Marcel Zwahlen
- From the Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland (A.W.S., C.Z., A.M., A.E.S.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (A.M., M.Z.); Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (P.W., S.W., S.S.); and Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (T.C.)
| | - Peter Wenaweser
- From the Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland (A.W.S., C.Z., A.M., A.E.S.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (A.M., M.Z.); Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (P.W., S.W., S.S.); and Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (T.C.)
| | - Stephan Windecker
- From the Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland (A.W.S., C.Z., A.M., A.E.S.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (A.M., M.Z.); Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (P.W., S.W., S.S.); and Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (T.C.)
| | - Thierry Carrel
- From the Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland (A.W.S., C.Z., A.M., A.E.S.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (A.M., M.Z.); Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (P.W., S.W., S.S.); and Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (T.C.)
| | - Andreas E Stuck
- From the Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland (A.W.S., C.Z., A.M., A.E.S.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (A.M., M.Z.); Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (P.W., S.W., S.S.); and Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (T.C.)
| | - Stefan Stortecky
- From the Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Switzerland (A.W.S., C.Z., A.M., A.E.S.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (A.M., M.Z.); Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (P.W., S.W., S.S.); and Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (T.C.)
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17
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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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18
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Cognitive Outcomes following Transcatheter Aortic Valve Implantation: A Systematic Review. Cardiovasc Psychiatry Neurol 2015; 2015:209569. [PMID: 25785192 PMCID: PMC4345202 DOI: 10.1155/2015/209569] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 12/11/2022] Open
Abstract
Severe aortic stenosis is the most common valvular heart disease in the elderly in the Western world and contributes to a large proportion of all deaths over the age of 70. Severe aortic stenosis is conventionally treated with surgical aortic valve replacement; however, the less invasive transcatheter aortic valve implantation (TAVI) is suggested for those at high surgical risk. While TAVI has been associated with improved survival and favourable outcomes, there is a higher incidence of cerebral microembolisms in TAVI patients. This finding is of concern given mechanistic links with cognitive decline, a symptom highly prevalent in those with cardiovascular disease. This paper reviews the literature assessing the possible link between TAVI and cognitive changes. Studies to date have shown that global cognition improves or remains unchanged over 3 months following TAVI while individual cognitive domains remain preserved over time. However, the association between TAVI and cognition remains unclear due to methodological limitations. Furthermore, while these studies have largely focused on memory, cognitive impairment in this population may be predominantly of vascular origin. Therefore, cognitive assessment focusing on domains important in vascular cognitive impairment, such as executive dysfunction, may be more helpful in elucidating the association between TAVI and cognition in the long term.
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19
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Akhtar S, Morris B, Roy R, Balogun SA. Case 3-2015: preventing adverse outcomes in the very elderly cardiac surgical patients. J Cardiothorac Vasc Anesth 2014; 29:510-21. [PMID: 25440648 DOI: 10.1053/j.jvca.2014.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Shamsuddin Akhtar
- Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut.
| | - Benjamin Morris
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Raymond Roy
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Seki A Balogun
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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