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Moreines LT, David D, Murali KP, Dickson VV, Brody A. The perspectives of older adults related to transcatheter aortic valve replacement: An integrative review. Heart Lung 2024; 68:23-36. [PMID: 38901178 DOI: 10.1016/j.hrtlng.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/10/2024] [Accepted: 05/31/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Aortic Stenosis (AS) is a common syndrome in older adults wherein the narrowing of the aortic valve impedes blood flow, resulting in advanced heart failure.1 AS is associated with a high mortality rate (50 % at 6 months if left untreated), substantial symptom burden, and reduced quality of life.1-3 Transcatheter aortic valve replacement (TAVR) was approved in 2012 as a less invasive alternative to surgical valve repair, offering a treatment for older frail patients. Although objective outcomes have been widely reported,4 the perspectives of older adults undergoing the TAVR process have never been synthesized. OBJECTIVES To contextualize the perspectives and experiences of older adults undergoing TAVR. METHODS An integrative review was conducted using Whittemore and Knafl's five-stage methodology.5 Four electronic databases were searched in April 2023. Articles were included if a qualitative methodology was used to assess the perceptions of older adults (>65 years old) undergoing or recovering from TAVR. RESULTS Out of 4619 articles screened, 12 articles met the criteria, representing 353 individuals from 10 countries. Relevant themes included the need for an individualized care plan, caregiver and family support, communication and education, persistent psychosocial and physical symptoms, and the unique recovery journey. CONCLUSION Older adults with AS undergoing TAVR generally perceive their procedure positively. Improved interdisciplinary and holistic management, open communication, symptom assessment, support, and education is needed.
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Affiliation(s)
| | - Daniel David
- New York University Rory Meyers College of Nursing
| | | | | | - Abraham Brody
- New York University Rory Meyers College of Nursing; New York University Grossman School of Medicine
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2
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Khan MZ, Alvarez R, Bhuiyan MAN, Faisal ASM, O'Neill P, Siddiqui M, Kaki P, Franklin S, Waqas M, Shah H, Kanawati EI, Murtaza M. Clinical Outcomes of Transcatheter Aortic Valve Replacement (TAVR) vs Surgical Aortic Valve Replacement (SAVR) in Patients With Sarcoidosis. Cureus 2024; 16:e62477. [PMID: 39015863 PMCID: PMC11251442 DOI: 10.7759/cureus.62477] [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: 06/13/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction Data regarding clinical outcomes after transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) in patients with sarcoidosis is lacking. This study aims to clarify the clinical outcomes of TAVR vs SAVR in patients with sarcoidosis. Methods Data was collected from the National Inpatient Sample database from 2016-2019 using validated ICD-10-CM codes for sarcoidosis, TAVR, and SAVR. Patients were divided into two cohorts: those who underwent TAVR and those who underwent SAVR. Statistical analysis was performed using Pearson's chi-squared test to determine clinical outcomes of TAVR vs SAVR in patients with sarcoidosis. Results The prevalence of sarcoidosis was 0.23% among total study patients (n=142,420,378). After exclusions, the prevalence of TAVR was 650 (49%) and SAVR was 675 (51%) in patients with sarcoidosis. Patients who underwent TAVR were on average older (74 vs 65 years old, p=0.001), and more likely to be female (57 vs 40%, p<0.001) compared to patients who underwent SAVR. The TAVR cohort had higher rates of congestive heart failure (CHF) (77.7 vs 42.2%, p=0.001), chronic kidney disease (CKD) (42.3 vs 24.4% p=0.001), anemia (5.4 vs 2.2%, p=0.004), percutaneous coronary intervention (PCI) (1.5 vs 0%, p=0.004), and hypothyroidism (31.5 vs 16.3%, p=0.001) compared to the SAVR cohort. Inpatient mortality post-procedure was higher in the SAVR cohort compared to the TAVR cohort (15 vs 0, p=0.001). Regarding post-procedure complications, respiratory complications were more common in the SAVR cohort (4.4 vs 0%, p=0.001), while TAVR was associated with a higher incidence of permanent pacemaker (PPM) insertion (2.15 vs 0.8%, p=0.001). There was no statistical difference in the development of acute kidney injury (AKI) (0.8 vs 1.5%, p=0.33), AKI requiring hemodialysis (0 vs. 0.7%, p=0.08), or stroke (0.8 vs 0.7, p=1) post-procedure between the two cohorts. Conclusion This study found that in the sarcoidosis population, TAVR was associated with reduced mortality, shorter hospital length of stay, and lower hospitalization costs in comparison to SAVR.
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Affiliation(s)
| | - Rene Alvarez
- Heart Failure, Thomas Jefferson University Hospital, Philadelphia, USA
| | | | | | - Parker O'Neill
- Internal Medicine, Thomas Jefferson University, Philadelphia, USA
| | | | - Praneet Kaki
- Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Sona Franklin
- Internal Medicine, Jefferson Abington Hospital, Abington, USA
| | | | - Hadia Shah
- Medicine and Surgery, Saidu Medical College Swat, Swat, PAK
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3
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Butala AD, Nanayakkara S, Navani RV, Palmer S, Noaman S, Haji K, Htun NM, Walton AS, Stub D. Incidence, Predictors, and Outcomes of Nonhome Discharge Following Transcatheter Aortic Valve Implantation: A Multicenter Australian Experience-The NHD TAVI Study. Am J Cardiol 2024; 220:94-101. [PMID: 38583699 DOI: 10.1016/j.amjcard.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/10/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
Patients who undergo transcatheter aortic valve implantation (TAVI) commonly experience nonhome discharge (NHD), a phenomenon associated with increased health care expenditure and possibly poorer outcomes. Despite its clinical relevance in TAVI, the incidence and predictors of NHD and its impact on the quality of life remain poorly characterized. Also unknown is the proportion of patients who undergo TAVI that require long-term residential care after initial NHD. Therefore, we aimed to address these questions using a large, multicenter Australian cohort. A total of 2,229 patients who underwent TAVI from 2010 to 2023 included in the Alfred-Cabrini-Epworth TAVI Registry were analyzed. The median age was 82 (interquartile range 78 to 86) years and 41% were women. A total of 257 patients (12%) were not discharged home after TAVI, with the incidence falling over time (R2 = 0.636, p <0.001). A multivariable logistic regression model for NHD prediction was developed with excellent calibration and discrimination (C-statistic = 0.835). The independent predictors of NHD were postprocedural stroke (adjusted odds ratio [aOR] 11.05), procedure at a private hospital (aOR 3.01), living alone (aOR 2.35), vascular access site complications (aOR 2.09), frailty (aOR 1.89), age >80 years (aOR 1.82), hypoalbuminemia (aOR 1.76), New York Heart Association III to IV (aOR 1.74), and hospital length of stay (aOR 1.13) (all p <0.05). NHD was not associated with mortality at 30 days and <1% of all patients required longer-term residential care. In conclusion, although common after TAVI, NHD does not predict short-term mortality, most patients successfully return home within 30 days, and when used appropriately, NHD may serve as a brief and effective method of optimizing functional status without compromising long-term independence.
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Affiliation(s)
- Anant D Butala
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Shane Nanayakkara
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Victoria, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Victoria, Australia
| | - Rohan V Navani
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Sonny Palmer
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Samer Noaman
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Kawa Haji
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Nay M Htun
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Victoria, Australia
| | - Antony S Walton
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Victoria, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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4
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Gajjar R, Carlini GB, Teaima T, Aziz I, Vardar U, Jamshed A, Karki S, Dhar G, Jolly N, Vij A. Outcomes of transcatheter aortic valve replacement in patients with history of chest wall irradiation: Propensity matched analysis of five years data from national inpatient sample (2016-2020). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00508-6. [PMID: 38806330 DOI: 10.1016/j.carrev.2024.05.031] [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: 02/02/2024] [Revised: 05/06/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION Chest radiotherapy has been utilized to treat intra-thoracic and mediastinal tumors. Chest wall irradiation (C-XRT) survivors frequently develop valvular disease, including aortic stenosis, which eventually requires valve replacement. Previous trials have shown worse outcomes with surgical aortic valve replacement. However, transcatheter aortic valve replacement (TAVR) outcomes-related data in patients with C-XRT is limited. METHODS The national inpatient sample (NIS) database was queried from 2016 to 2020 to identify adult hospitalizations with TAVR, which were dichotomized based on a history of C-XRT using ICD-10-CM codes. Propensity score matching was performed to derive age, sex, hospital characteristics, and co-morbidities matched controls without a history of C-XRT. The outcomes studied were inpatient mortality and complications, mean length of stay (LOS), and total hospital charge (THC). Multivariate logistic and linear regression were used to analyze the outcomes. RESULTS Of 296,670 patients who underwent TAVR between 2016 and 2020, 515 had a history of C-XRT. Upon propensity score matching in patients undergoing TAVR, Patients with a history of C-XRT showed significantly lower adjusted odds of in-hospital mortality (adjusted odd ratio [aOR] 0.04, 95 % CI [0.003-0.57], p = 0.017), lower mean LOS by 1.6 days (-1.88 to -1.26 days, p < 0.001) and reduced mean THC (-$74,720, [-$88,784 to -$60,655], p < 0.001). Additionally, patients with C-XRT had significantly lower adjusted odds of inpatient complications, mainly acute myocardial infarction, cerebrovascular events, acute respiratory failure, acute kidney injury, need for vasopressors and cardiopulmonary resuscitation, whereas similar odds of complications, including a requirement of intubation, mechanical ventilation, hemodialysis, and cardiogenic shock. CONCLUSION Our analysis showed reduced adjusted odds of in-hospital mortality, length of stay, total hospital charges, and inpatient complications in patients undergoing TAVR with a history of C-XRT. TAVR appears to be a safe and viable alternative in this population subgroup.
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Affiliation(s)
- Rohan Gajjar
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.
| | | | - Taha Teaima
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Imran Aziz
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Ufuk Vardar
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Aneeza Jamshed
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Sadichhya Karki
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Gaurav Dhar
- Rush University Medical Center, Chicago, IL, USA
| | - Neeraj Jolly
- Rush University Medical Center, Chicago, IL, USA
| | - Aviral Vij
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA; Rush University Medical Center, Chicago, IL, USA
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5
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Ooms JF, Cornelis K, Wijeysundera HC, Vandeloo B, Van Der Heyden J, Kovac J, Wood D, Chan A, Wykyrzykowska J, Rosseel L, Cunnington M, van der Kley F, Rensing B, Voskuil M, Hildick-Smith D, Van Mieghem NM. Safety and feasibility of early discharge after transcatheter aortic valve implantation with ACURATE Neo-the POLESTAR trial. Clin Res Cardiol 2024:10.1007/s00392-024-02436-z. [PMID: 38619575 DOI: 10.1007/s00392-024-02436-z] [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: 02/02/2024] [Accepted: 03/11/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) serves a growing range of patients with severe aortic stenosis (AS). TAVI has evolved to a streamlined procedure minimizing length of hospital stay. AIMS To evaluate the safety and efficacy of an early discharge (ED) strategy after TAVI. METHODS We performed an international, multi-center, prospective observational single-arm study in AS patients undergoing TAVI with the ACURATE valve platform. Eligibility for ED was assessed prior to TAVI and based on prespecified selection criteria. Discharge ≤ 48 h was defined as ED. Primary Valve Academic Research Consortium (VARC)-3-defined 30-day safety and efficacy composite endpoints were landmarked at 48 h and compared between ED and non-ED groups. RESULTS A total of 252 patients were included. The median age was 82 [25th-75th percentile, 78-85] years and the median Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score was 2.2% [25th-75th percentile, 1.6-3.3]. ED and non-ED were achieved in 173 (69%) and 79 (31%) patients respectively. Monitoring for conduction disturbances was the principal reason for non-ED (33%). Overall, at 30 days, all-cause mortality was 1%, new permanent pacemaker rate was 4%, and valve- or procedure-related rehospitalization was 4%. There was no difference in the primary safety and efficacy endpoint between the ED and non-ED cohorts (OR 0.84 [25th-75th percentile, 0.31-2.26], p = 0.73, and OR 0.97 [25th-75th percentile, 0.46-2.06], p = 0.94). The need for rehospitalization was similarly low for ED and non-ED groups. CONCLUSION Early discharge after TAVI with the ACURATE valve is safe and feasible in selected patients. Rhythm monitoring and extended clinical observation protracted hospital stay.
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Affiliation(s)
- Joris F Ooms
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | - Jan Kovac
- University Hospitals Leicester NHS Trust, Leicester, UK
| | - David Wood
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Albert Chan
- Royal Columbian Hospital, New Westminster, BC, Canada
| | | | | | | | | | | | | | | | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
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6
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Imburgio S, Hazaveh S, Klei L, Arcidiacono AM, Sen S, Messenger J, Pyo R, Kiss D, Saybolt M, Jamal S, Sealove B, Heaton J. Temporal trends in outcomes following inpatient transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00146-5. [PMID: 38584082 DOI: 10.1016/j.carrev.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Despite the growing adoption of transcatheter aortic valve replacement (TAVR), there remains a lack of clinical data evaluating procedural safety and discharge practices. AIMS This study aims to investigate if there have been improvements in postoperative clinical outcomes following TAVR. METHODS In this large-scale, retrospective cohort study, patients who underwent TAVR as an inpatient were identified from 2016 to 2020 using the National Readmissions Database. The primary outcome was temporal trends in the rates of discharge to home. Secondary endpoints assessed annual discharge survival rates, 30-day readmissions, length of stay, and periprocedural cardiac arrest rates. RESULTS Over the 5-year study period, a total of 31,621 inpatient TAVR procedures were identified. Of these, 79.2 % of patients were successfully discharged home with home disposition increasing year-over-year from 74.5 % in 2016 to 85.9 % in 2020 (Odds ratio: 2.01; 95 % CI 1.62-2.48, p < 0.001). The mean annual discharge survival rate was 97.7 % which did not change significantly over the 5-year study period (p = 0.551). From 2016 to 2020, 30-day readmissions decreased from 14.0 % to 10.3 %, respectively (p = 0.028). Perioperative cardiac arrest occurred in 1.8 % (n = 579) of cases with rates remaining unchanged during the study (p = 0.674). CONCLUSION Most TAVR patients are successfully discharged alive and home, with decreasing 30-day readmissions observed over recent years. This data suggests potential improvements in preoperative planning, procedural safety, and postoperative care. Despite perioperative cardiac arrest being associated with high mortality, it remains a relatively rare complication of TAVR.
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Affiliation(s)
- Steven Imburgio
- Jersey Shore University Medical Center, Department of Medicine, 1945 NJ-33, Neptune City, NJ 07753, United States of America.
| | - Sara Hazaveh
- Jersey Shore University Medical Center, Department of Medicine, 1945 NJ-33, Neptune City, NJ 07753, United States of America
| | - Lauren Klei
- Jersey Shore University Medical Center, Department of Medicine, 1945 NJ-33, Neptune City, NJ 07753, United States of America
| | - Anne Marie Arcidiacono
- Jersey Shore University Medical Center, Department of Medicine, 1945 NJ-33, Neptune City, NJ 07753, United States of America
| | - Shuvendu Sen
- Jersey Shore University Medical Center, Department of Medicine, 1945 NJ-33, Neptune City, NJ 07753, United States of America
| | - John Messenger
- University of Colorado Hospital, Department of Cardiology, 12605 E 16th Ave, Aurora, CO 80045, United States of America
| | - Robert Pyo
- Stony Brook University Hospital, Department of Cardiology, 101 Nicolls Rd, Stony Brook, NY 11794, United States of America
| | - Daniel Kiss
- Jersey Shore University Medical Center, Department of Cardiology, 1945 NJ-33, Neptune City, NJ 07753, United States of America
| | - Matthew Saybolt
- Jersey Shore University Medical Center, Department of Cardiology, 1945 NJ-33, Neptune City, NJ 07753, United States of America
| | - Sameer Jamal
- Hackensack University Medical Center, Department of Cardiology, 30 Prospect Ave, Hackensack, NJ 07601, United States of America
| | - Brett Sealove
- Jersey Shore University Medical Center, Department of Cardiology, 1945 NJ-33, Neptune City, NJ 07753, United States of America
| | - Joseph Heaton
- Jersey Shore University Medical Center, Department of Medicine, 1945 NJ-33, Neptune City, NJ 07753, United States of America
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7
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Menhour S, Abellan Van Kan G, Toulza O, Lhermusier T, Nourhashemi F, Rolland Y. [Percutaneous aortic valve replacement: outcome of patients evaluated by EMG at Toulouse University Hospital preprocedure]. SOINS. GERONTOLOGIE 2024; 29:36-41. [PMID: 38418070 DOI: 10.1016/j.sger.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Transcatheter Aortic Valve Implantation has become the preferred method of aortic valve replacement in the elderly. Preoperative standardized geriatric assessment (SGA) helps guide the decision to proceed, taking into account geriatric parameters not targeted by surgical risk scores. This is a descriptive, retrospective study of patients who underwent EGS at the Toulouse University Hospital, analyzing their length of stay and postoperative care pathway.
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Affiliation(s)
- Soumiya Menhour
- Centre hospitalier intercommunal de Castres-Mazamet,6 avenue de la Montagne-Noire, 81108 Castres, France.
| | | | - Olivier Toulza
- CHU de Toulouse, 2 rue Charles-Viguerie, 31300 Toulouse, France
| | | | | | - Yves Rolland
- CHU de Toulouse, 2 rue Charles-Viguerie, 31300 Toulouse, France
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8
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Kai T, Izumo M, Okuno T, Kobayashi Y, Sato Y, Kuwata S, Koga M, Tanabe Y, Sakamoto M, Akashi YJ. Prevalence and Clinical Outcomes of Noncardiac Surgery After Transcatheter Aortic Valve Replacement. Am J Cardiol 2024; 210:259-265. [PMID: 37875233 DOI: 10.1016/j.amjcard.2023.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 10/26/2023]
Abstract
Aortic stenosis is a prevalent valvular heart disease, especially in the older people. They often coexist with other co-morbidities, and noncardiac surgery carries a higher risk because of the underlying valve condition. Despite the growing concern about the safety and optimal management of noncardiac surgery post-transcatheter aortic valve replacement (TAVR), there is limited evidence on this matter. This study aims to assess the clinical outcomes of noncardiac surgeries after TAVR. This retrospective study included 718 patients who underwent TAVR. Of these, 36 patients underwent noncardiac surgery after TAVR. The primary end point was the incidence of cardiovascular adverse events post-TAVR and the secondary end point was the incidence of structural valve deterioration. Composite end points included disabling stroke, heart failure requiring hospitalization, and cardiac death as defined by Valve Academic Research Consortium 3. Most of these surgeries were orthopedic and classified as intermediate risk. All noncardiac surgeries were performed without perioperative adverse events. There was no observed structural valve deterioration, and the incidence of composite end points did not significantly differ between the surgical and nonsurgical groups during the follow-up period. Noncardiac surgery after TAVR can be performed safely and does not have a negative impact on prognosis. Further studies are warranted to determine the optimal strategy for noncardiac surgery after TAVR.
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Affiliation(s)
- Takahiko Kai
- Department ofCardiology, St. Marianna University School of Medicine, Kawasaki, Japan.
| | - Masaki Izumo
- Department ofCardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Taishi Okuno
- Department ofCardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshikuni Kobayashi
- Department ofCardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yukio Sato
- Department ofCardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shingo Kuwata
- Department ofCardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masashi Koga
- Department ofCardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yasuhiro Tanabe
- Department ofCardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Miki Sakamoto
- Department of Anesthesiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J Akashi
- Department ofCardiology, St. Marianna University School of Medicine, Kawasaki, Japan
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9
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Trimaille A, Matsushita K, Marchandot B, Carmona A, Hess S, Reydel A, Faucher L, Granier A, Mai TA, Diop B, Ohlmann P, Jesel L, Morel O. Outcomes of patients with active cancer undergoing transcatheter aortic valve replacement. Arch Cardiovasc Dis 2023; 116:506-513. [PMID: 37758593 DOI: 10.1016/j.acvd.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Cardiovascular disease and cancer are the two leading causes of mortality worldwide, and their association presents a therapeutic challenge. Current data regarding the prognosis of active cancer in patients undergoing transcatheter aortic valve replacement are conflicting. AIM To determine the impact and prognosis of active cancer in transcatheter aortic valve replacement. METHODS All consecutive patients with severe aortic stenosis treated by transcatheter aortic valve replacement between February 2010 and May 2019 were enrolled in a prospective study. The cohort was divided according to the presence or absence of active cancer at baseline. The primary endpoint was all-cause mortality 1 year after the procedure. RESULTS A total of 1,125 patients were enrolled: 1,037 (92.2%) without and 88 (7.8%) with active cancer. The most frequent cancers were haematological (36.4%), breast (14.8%) and prostate (14.8%), with 79.5% of patients receiving curative treatment and 17.0% receiving palliative treatment. The 1-year mortality rate was higher in patients with active cancer (27.3% vs. 13.9%; P<0.01), mainly driven by non-cardiovascular causes. An increased cardiovascular mortality rate at 2 years was seen in patients with active cancer (27.5% vs. 15.0%; P=0.03) compared with a similar rate at 1-year follow-up. Active cancer was a strong predictor of 1-year all-cause mortality (hazard ratio 2.46, 95% confidence interval 1.19-4.68; P=0.02). Major/life-threatening bleeding events at 1 year were more frequent in patients with active cancer (P=0.02). CONCLUSIONS Among patients who undergo transcatheter aortic valve replacement, 1-year all-cause mortality is higher in those with active cancer. We also observed a trend towards increased long-term bleeding events in case of active cancer.
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Affiliation(s)
- Antonin Trimaille
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France; Inserm (French National Institute of Health and Medical Research), FMTS, Regenerative Nanomedicine, UMR 1260, 67000 Strasbourg, France
| | - Kensuke Matsushita
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France; Inserm (French National Institute of Health and Medical Research), FMTS, Regenerative Nanomedicine, UMR 1260, 67000 Strasbourg, France
| | - Benjamin Marchandot
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Adrien Carmona
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Sebastien Hess
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Antje Reydel
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Loic Faucher
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Amandine Granier
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Trung Anh Mai
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Bamba Diop
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Patrick Ohlmann
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Laurence Jesel
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France; Inserm (French National Institute of Health and Medical Research), FMTS, Regenerative Nanomedicine, UMR 1260, 67000 Strasbourg, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France; Inserm (French National Institute of Health and Medical Research), FMTS, Regenerative Nanomedicine, UMR 1260, 67000 Strasbourg, France.
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Szotek M, Drużbicki Ł, Sabatowski K, Amoroso GR, De Schouwer K, Matusik PT. Transcatheter Aortic Valve Implantation and Cardiac Conduction Abnormalities: Prevalence, Risk Factors and Management. J Clin Med 2023; 12:6056. [PMID: 37762995 PMCID: PMC10531796 DOI: 10.3390/jcm12186056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Over the last decades, transcatheter aortic valve implantation (TAVI) or replacement (TAVR) has become a potential, widely accepted, and effective method of treating aortic stenosis in patients at moderate and high surgical risk and those disqualified from surgery. The method evolved what translates into a noticeable decrease in the incidence of complications and more beneficial clinical outcomes. However, the incidence of conduction abnormalities related to TAVI, including left bundle branch block and complete or second-degree atrioventricular block (AVB), remains high. The occurrence of AVB requiring permanent pacemaker implantation is associated with a worse prognosis in this group of patients. The identification of risk factors for conduction disturbances requiring pacemaker placement and the assessment of their relation to pacing dependence may help to develop methods of optimal care, including preventive measures, for patients undergoing TAVI. This approach is crucial given the emerging evidence of no worse outcomes for intermediate and low-risk patients undergoing TAVI in comparison to surgical aortic valve replacement. This paper comprehensively discusses the mechanisms, risk factors, and consequences of conduction abnormalities and arrhythmias, including AVB, atrial fibrillation, and ventricular arrhythmias associated with aortic stenosis and TAVI, as well as provides insights into optimized patient care, along with the potential of conduction system pacing and cardiac resynchronization therapy, to minimize the risk of unfavorable clinical outcomes.
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Affiliation(s)
- Michał Szotek
- Department of Electrocardiology, The John Paul II Hospital, 80 Prądnicka St., 31-202 Kraków, Poland
| | - Łukasz Drużbicki
- Department of Cardiovascular Surgery and Transplantology, The John Paul II Hospital, 80 Prądnicka St., 31-202 Kraków, Poland
| | - Karol Sabatowski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Kraków, Poland
| | - Gisella R. Amoroso
- Department of Cardiovascular Medicine, “SS Annunziata” Hospital, ASL CN1-Savigliano, Via Ospedali 9, 12038 Savigliano, Italy
| | - Koen De Schouwer
- Department of Cardiology, Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Paweł T. Matusik
- Department of Electrocardiology, The John Paul II Hospital, 80 Prądnicka St., 31-202 Kraków, Poland
- Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 80 Prądnicka St., 31-202 Kraków, Poland
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11
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Blank M, Robitaille MJ, Wachtendorf LJ, Linhardt FC, Ahrens E, Strom JB, Azimaraghi O, Schaefer MS, Chu LM, Moon JY, Tarantino N, Nair SR, Thalappilil R, Tam CW, Leff J, Di Biase L, Eikermann M. Loss of Independent Living in Patients Undergoing Transcatheter or Surgical Aortic Valve Replacement: A Retrospective Cohort Study. Anesth Analg 2023; 137:618-628. [PMID: 36719955 DOI: 10.1213/ane.0000000000006377] [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: 02/02/2023]
Abstract
BACKGROUND The recommendation for transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) in patients 65 to 80 years of age is equivocal, leaving patients with a difficult decision. We evaluated whether TAVR compared to SAVR is associated with reduced odds for loss of independent living in patients ≤65, 66 to 79, and ≥80 years of age. Further, we explored mechanisms of the association of TAVR and adverse discharge. METHODS Adult patients undergoing TAVR or SAVR within a large academic medical system who lived independently before the procedure were included. A multivariable logistic regression model, adjusting for a priori defined confounders including patient demographics, preoperative comorbidities, and a risk score for adverse discharge after cardiac surgery, was used to assess the primary association. We tested the interaction of patient age with the association between aortic valve replacement (AVR) procedure and loss of independent living. We further assessed whether the primary association was mediated (ie, percentage of the association that can be attributed to the mediator) by the procedural duration as prespecified mediator. RESULTS A total of 1751 patients (age median [quartiles; min-max], 76 [67, 84; 23-100]; sex, 56% female) were included. A total of 27% (222/812) of these patients undergoing SAVR and 20% (188/939) undergoing TAVR lost the ability to live independently. In our cohort, TAVR was associated with reduced odds for loss of independent living compared to SAVR (adjusted odds ratio [OR adj ] 0.19 [95% confidence interval {CI}, 0.14-0.26]; P < .001). This association was attenuated in patients ≤65 years of age (OR adj 0.63 [0.26-1.56]; P = .32) and between 66 and 79 years of age (OR adj 0.23 [0.15-0.35]; P < .001), and magnified in patients ≥80 years of age (OR adj 0.16 [0.10-0.25]; P < .001; P -for-interaction = .004). Among those >65 years of age, a shorter procedural duration mediated 50% (95% CI, 28-76; P < .001) of the beneficial association of TAVR and independent living. CONCLUSIONS Patients >65 years of age undergoing TAVR compared to SAVR had reduced odds for loss of independent living. This association was partly mediated by shorter procedural duration. No association between AVR approach and the primary end point was found in patients ≤65 years of age.
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Affiliation(s)
- Michael Blank
- From the Department of Anesthesia, Critical Care & Pain Medicine
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York City, New York
| | | | - Luca J Wachtendorf
- From the Department of Anesthesia, Critical Care & Pain Medicine
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York City, New York
| | - Felix C Linhardt
- From the Department of Anesthesia, Critical Care & Pain Medicine
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York City, New York
| | - Elena Ahrens
- From the Department of Anesthesia, Critical Care & Pain Medicine
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jordan B Strom
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Omid Azimaraghi
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York City, New York
| | - Maximilian S Schaefer
- From the Department of Anesthesia, Critical Care & Pain Medicine
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesiology, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Louis M Chu
- Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Nicola Tarantino
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Singh R Nair
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York City, New York
| | - Richard Thalappilil
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York City, New York
| | - Christopher W Tam
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York City, New York
| | - Jonathan Leff
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York City, New York
| | - Luigi Di Biase
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York City, New York
- Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Essen, Germany
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12
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Aranda-Michel E, Kilner D, Toma C, Serna-Gallegos D, Yousef S, Brown J, Diaz-Castrillon CE, Makani A, Sultan I. A Readmission Risk Score for Transcatheter Aortic Valve Replacement: An Analysis of 200,000 Patients. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53:8-12. [PMID: 36907697 DOI: 10.1016/j.carrev.2023.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE The objective of this study was to leverage a national database of TAVR procedures to create a risk model for 30-day readmissions. METHODS The National Readmissions Database was reviewed for all TAVR procedures from 2011 to 2018. Previous ICD coding paradigms created comorbidity and complication variables from the index admission. Univariate analysis included any variables with a P-value of ≤0.2. A bootstrapped mixed-effects logistic regression was run using the hospital ID as a random effect variable. By bootstrapping, a more robust estimate of the variables' effect can be generated, reducing the risk of model overfitting. The odds ratio of variables with a P-value <0.1 was turned into a risk score following the Johnson scoring method. A mixed-effect logistic regression was run using the total risk score, and a calibration plot of the observed to expected readmission was generated. RESULTS A total of 237,507 TAVRs were identified, with an in-hospital mortality of 2.2 %. A total of 17.4 % % of TAVR patients were readmitted within 30 days. The median age was 82 with 46 % of the population being women. The risk score values ranged from -3 to 37 corresponding to a predicted readmission risk between 4.6 % and 80.4 %, respectively. Discharge to a short-term facility and being a resident of the hospital state were the most significant predictors of readmission. The calibration plot shows good agreement between the observed and expected readmission rates with an underestimation at higher probabilities. CONCLUSION The readmission risk model agrees with the observed readmissions throughout the study period. The most significant risk factors were being a resident of the hospital state and discharge to a short-term facility. This suggests that using this risk score in conjunction with enhanced post-operative care in these patients could reduce readmissions and associated hospital costs, improving outcomes.
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Affiliation(s)
- Edgar Aranda-Michel
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, PA, United States of America
| | - Dustin Kilner
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Catalin Toma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, PA, United States of America; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, PA, United States of America
| | - James Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, PA, United States of America
| | - Carlos E Diaz-Castrillon
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, PA, United States of America
| | - Amber Makani
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, PA, United States of America; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America.
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Catsis S, Champneys AR, Hoyle R, Currie C, Enright J, Cheema K, Woodall M, Angelini G, Nadarajah R, Gale C, Gibbison B. Process modelling of NHS cardiovascular waiting lists in response to the COVID-19 pandemic. BMJ Open 2023; 13:e065622. [PMID: 37474168 PMCID: PMC10357301 DOI: 10.1136/bmjopen-2022-065622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/04/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE To model the referral, diagnostic and treatment pathway for cardiovascular disease (CVD) in the English National Health Service (NHS) to provide commissioners and managers with a methodology to optimise patient flow and reduce waiting lists. STUDY DESIGN A systems dynamics approach modelling the CVD healthcare system in England. The model is designed to capture current and predict future states of waiting lists. SETTING Routinely collected, publicly available data streams of primary and secondary care, sourced from NHS Digital, NHS England, the Office of National Statistics and StatsWales. DATA COLLECTION AND EXTRACTION METHODS The data used to train and validate the model were routinely collected and publicly available data. It was extracted and implemented in the model using the PySD package in python. RESULTS NHS cardiovascular waiting lists in England have increased by over 40% compared with pre- COVID-19 levels. The rise in waiting lists was primarily due to restrictions in referrals from primary care, creating a bottleneck postpandemic. Predictive models show increasing point capacities within the system may paradoxically worsen downstream flow. While there is no simple rate-limiting step, the intervention that would most improve patient flow would be to increase consultant outpatient appointments. CONCLUSIONS The increase in NHS CVD waiting lists in England can be captured using a systems dynamics approach, as can the future state of waiting lists in the presence of further shocks/interventions. It is important for those planning services to use such a systems-oriented approach because the feed-forward and feedback nature of patient flow through referral, diagnostics and treatment leads to counterintuitive effects of interventions designed to reduce waiting lists.
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Affiliation(s)
- Salvador Catsis
- Department of Engineering Mathematics, University of Bristol, Bristol, UK
| | - Alan R Champneys
- Department of Engineering Mathematics, University of Bristol, Bristol, UK
| | - Rebecca Hoyle
- Department of Mathematics, University of Southampton, Southampton, UK
| | - Christine Currie
- Department of Mathematics, University of Southampton, Southampton, UK
| | - Jessica Enright
- Department of Mathematics, University of Glasgow, Glasgow, UK
| | | | - Mike Woodall
- NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | | | - Ramesh Nadarajah
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Chris Gale
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Ben Gibbison
- Cardiac Anaesthesia and Intensive Care, University of Bristol, Bristol, UK
- Department of Cardiac Anaesthesia, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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14
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Yost CC, Rosen JL, Mandel JL, Wong DH, Prochno KW, Komlo CM, Ott N, Goldhammer JE, Guy TS. Feasibility of Postoperative Day One or Day Two Discharge After Robotic Cardiac Surgery. J Surg Res 2023; 289:35-41. [PMID: 37079964 DOI: 10.1016/j.jss.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 03/02/2023] [Accepted: 03/16/2023] [Indexed: 04/22/2023]
Abstract
INTRODUCTION The robotic platform reduces the invasiveness of cardiac surgical procedures, thus facilitating earlier discharge in select patients. We sought to evaluate the characteristics, perioperative management, and early outcomes of patients who underwent postoperative day 1 or 2 (POD1-2) discharge after robotic cardiac surgery at our institution. METHODS Retrospective review of 169 patients who underwent robotic cardiac surgery at our facility between 2019 and 2021 identified 57 patients discharged early on POD1 (n = 19) or POD2 (n = 38) and 112 patients who underwent standard discharge (POD3 or later). Relevant data were extracted and compared. RESULTS In the early discharge group, median patient age was 62 [IQR: 55, 66] (IQR = interquartile range) years, and 70.2% (40/57) were male. Median Society of Thoracic Surgeons predictive risk of mortality score was 0.36 [IQR: 0.25, 0.56] %. The most common procedures performed were mitral valve repair [66.6%, (38/57)], atrial mass resection [10.5% (6/57)], and coronary artery bypass grafting [10.5% (6/57)]. The only significant differences between the POD1 and POD2 groups were shorter operative time, higher rate of in-operating room extubation, and shorter ICU length of stay in the POD1 group. Lower in-hospital morbidity and comparable 30-day mortality and readmission rates were observed between the early and standard discharge groups. CONCLUSIONS POD1-2 discharge after various robotic cardiac operations afforded lower morbidity and similar 30-day readmission and mortality rates compared to discharge on POD3 or later. Our findings support the feasibility of POD1-2 discharge after robotic cardiac surgery for patients with low preoperative risk, an uncomplicated postoperative course, and appropriate postoperative management protocols.
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Affiliation(s)
- Colin C Yost
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jake L Rosen
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jenna L Mandel
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daniella H Wong
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Kyle W Prochno
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Caroline M Komlo
- Section of Cardiothoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Nathan Ott
- Department of Surgery, Northwell Health Staten Island, New York, New York
| | - Jordan E Goldhammer
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - T Sloane Guy
- Northeast Georgia Physicians Group Cardiovascular Surgery and Thoracic Surgery, Gainesville, Georgia
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15
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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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16
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Koren O, Patel V, Kohan S, Naami R, Naami E, Allison Z, Natanzon SS, Shechter A, Nagasaka T, Al Badri A, Devanabanda AR, Nakamura M, Cheng W, Jilaihawi H, Makkar RR. The safety of early discharge following transfemoral transcatheter aortic valve replacement under general anesthesia. Front Cardiovasc Med 2022; 9:1022018. [PMID: 36337882 PMCID: PMC9634245 DOI: 10.3389/fcvm.2022.1022018] [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: 08/18/2022] [Accepted: 10/04/2022] [Indexed: 11/27/2022] Open
Abstract
Background There is growing evidence of the safety of same-day discharge for low-risk conscious sedated TAVR patients. However, the evidence supporting the safety of early discharge following GA-TAVR with routine transesophageal echocardiography (TEE) is limited. Aims To assess the safety of early discharge following transcatheter aortic valve replacement (TAVR) using General Anesthesia (GA-TAVR) and identify predictors for patient selection. Materials and methods We used data from 2,447 TEE-guided GA-TAVR patients performed at Cedars-Sinai between 2016 and 2021. Patients were categorized into three groups based on the discharge time from admission: 24 h, 24–48 h, and >48 h. Predictors for 30-day outcomes (cumulative adverse events and death) were validated on a matched cohort of 24 h vs. >24 h using the bootstrap model. Results The >48 h group had significantly worse baseline cardiovascular profile, higher surgical risk, low functional status, and higher procedural complications than the 24 h and the 24–48 h groups. The rate of 30-day outcomes was significantly lower in the 24 h than the >48 h but did not differ from the 24–48 h (11.3 vs. 15.5 vs. 11.7%, p = 0.003 and p = 0.71, respectively). Independent poor prognostic factors of 30-day outcomes had a high STS risk of ≥8 (OR 1.90, 95% CI 1.30–2.77, E-value = 3.2, P < 0.001), low left ventricle ejection fraction of <30% (OR 6.0, 95% CI 3.96–9.10, E-value = 11.5, P < 0.001), and life-threatening procedural complications (OR 2.65, 95% CI 1.20–5.89, E-value = 4.7, P = 0.04). Our formulated predictors showed a good discrimination ability for patient selection (AUC: 0.78, 95% CI 0.75–0.81). Conclusion Discharge within 24 h following GA-TAVR using TEE is safe for selected patients using our proposed validated predictors.
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Affiliation(s)
- Ofir Koren
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
- Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Vivek Patel
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | - Siamak Kohan
- Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, United States
| | - Robert Naami
- Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Edmund Naami
- School of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Zev Allison
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | | | - Alon Shechter
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Takashi Nagasaka
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
- Department of Cardiology, Gunma University Hospital, Gunma, Japan
| | - Ahmed Al Badri
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | | | - Mamoo Nakamura
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | - Wen Cheng
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | - Hasan Jilaihawi
- Heart Valve Center, NYU Langone Health, New York City, NY, United States
| | - Raj R. Makkar
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
- *Correspondence: Raj R. Makkar,
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17
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Fan J, Chen J, Wang L, Dai H, Guo Y, Jiang J, Hu P, Lin X, Li C, Liu X, Wang J. Feasibility and safety of next-day discharge following transcatheter bicuspid aortic valve replacement. IJC HEART & VASCULATURE 2022; 42:101101. [PMID: 35937949 PMCID: PMC9350863 DOI: 10.1016/j.ijcha.2022.101101] [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: 05/02/2022] [Revised: 07/09/2022] [Accepted: 07/27/2022] [Indexed: 11/22/2022]
Abstract
Background Decreased length of stay in the index hospitalization is a tendency in transcatheter aortic valve replacement (TAVR) era. In this study, we aim to evaluate the feasibility and safety of next-day discharge (NDD) in bicuspid aortic valve (BAV) patients following TAVR. Methods The study analyzed patients who received TAVR in 2019 to 2022. Thirty-day mortality and readmission rate were compared between BAV and tricuspid aortic valve (TAV) patients. Results The proportion of NDD was similar between the BAV and TAV group (45.3 % vs 41.3 %, p = 0.487). In NDD patients, the lower age (72.0 [67.0, 77.0] yrs vs 74.0 [70.0, 80.0] yrs, p = 0.011) and STS score (2.33 [1.56, 3.54] % vs 3.82 [2.38, 5.70] %, p < 0.001) were observed in the BAV group. The NDD BAV patients had higher proportion of post-dilatation (74.3 % vs 50.7 %, p = 0.003) when compared with the TAV patients. The NDD patients was safe with no death both in BAV and TAV patients at 30-day follow-up. Moreover, the readmission rate was comparable between BAV and TAV patients who discharged on the next day after TAVR (8.1 % vs 14.0 %, p = 0.397). Conclusions NDD after TAVR was feasible and safe in both BAV and TAV patients. The younger BAV patients with fast recovery deserve the next-day discharge after TAVR.
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Affiliation(s)
- Jiaqi Fan
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jun Chen
- Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Lihan Wang
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Hanyi Dai
- Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Yuchao Guo
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jubo Jiang
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Po Hu
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Xinping Lin
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Cheng Li
- Department of Nursing, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Xianbao Liu
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Corresponding authors at: Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
| | - Jian'an Wang
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Corresponding authors at: Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
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ÖZBEK M, ACUN B, ARIK B, DEMİR M, OYLUMLU M, TOPRAK N. Prognostic value of nutritional and inflammatory scores in Transcatheter aortic valve replacement patients. DICLE MEDICAL JOURNAL 2022. [DOI: 10.5798/dicletip.1170121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Aortic Stenosis (AS) is a common heart valve disease that especially affects the elderly population and is seen with the aging of the society. In recent years Transcatheter aortic valve replacement patients (TAVR) has been increasingly applied worldwide as a procedure for the treatment of severe AS. Recently, various biomarkers and derived marker approaches have been studied in AS patient groups as in many cardiovascular diseases. Since it has been previously shown that increased inflammatory scores and poor nutritional scores are closely associated with the development process and prognosis of cardiovascular diseases, we hypothesized that these scores may be associated with prognosis after TAVR. Therefore, in this study, we aimed to make a detailed evaluation in terms of mortality determinants after TAVR.
Methods and Results: 118 TAVR patients were included in the analysis. Median follow-up of 118 patients was 40.5 months. In terms of inflammatory status scores, the systemic immune inflammatory (SII) score (p= 0.027), the neutrophil/lymphocyte ratio (NLR) score (p= 0.012), and the platelet/lymphocyte ratio (PLR) score (p= 0.012) in the death group was found to be significantly higher. As nutritional status scores, the prognostic nutritional index (PNI) score (p= 0.003) was lower in the death group and the median Controlling Nutritional Status (CONUT) score (p= 0.002)) found significantly higher.
Conclusion: In severe and high-risk AS patients undergoing TAVR, measurement of malnutrition with the CONUT score and increased inflammatory status with the SII score was associated with an increased risk of all causes mortality in long-term follow-up. It has been determined that the development of complications related to the procedure is an indicator of increased mortality not only in the short term but also in the long-term follow-up.
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Frydman S, Zahler D, Merdler I, Freund O, Shacham Y, Banai S, Finkelstein A, Steinvil A. Temporal Trends of Transcatheter Aortic Valve Implantation over 12 Years: A High-Volume Single-Center Experience. J Clin Med 2022; 11:jcm11174962. [PMID: 36078899 PMCID: PMC9456499 DOI: 10.3390/jcm11174962] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 07/28/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has become the mainstay of treatment for patients with severe AS. Since the TAVR population and patients’ outcomes have dramatically changed over the last decade, updated data regarding contemporary practice and trends are pertinent to clinical use. We performed a retrospective observational analysis of consecutive patient who underwent TAVR for symptomatic severe AS between the years 2009 and 2021 in a single high-volume center. Patients were divided into four equal time groups based on the procedure date (2009−2012, 2013−2015, 2016−2018 and 2019−2021). A total of 1988 patients were included in this study and divided into four groups, with 321, 482, 565 and 620 patients in groups 1−4, respectively. Significant trends were seen in baseline characteristics of a few parameters, including lower age, lower procedural risk and reduced rates of comorbidity (p for trend < 0.0001 for all factors mentioned above). A shift was seen in the procedural technique with lower balloon pre-dilatation and higher device success rates (p for trend < 0.0001). The post-procedural period changed over the years with fewer pacemaker placements (p < 0.0001) and reduced rates of AKI and post-procedural bleed (p value 0.02 and <0.0001, respectively). Furthermore, overall hospital stay was shortened from 7 ± 7.1 days to 2.3 ± 1.7 (p < 0.0001). Finally, patient follow up revealed reduced mortality rates at 30 days (p < 0.0001) and 1 year (p = 0.013). Multivariate regression revealed that a late implantation date was an independent protector from mortality (HR 0.84, p = 0.002). In conclusion, our study demonstrated that TAVR has become a safer practice over the years with reduced rates of morbidity and mortality.
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Affiliation(s)
- Shir Frydman
- Correspondence: ; Tel.: +972-3-6973395; Fax: +972-3-6962334
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20
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Temporal Trends in Internal vs. External Referrals for TAVR in a Large Academic Center: Patients Characteristics and Outcomes. J Interv Cardiol 2022; 2022:6074368. [PMID: 36051379 PMCID: PMC9410986 DOI: 10.1155/2022/6074368] [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: 01/16/2022] [Revised: 05/09/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background Since transcatheter aortic valve replacement (TAVR) first became approved for inoperable patients followed by high, intermediate-, and low-risk patients, referrals to TAVR centers have rapidly increased. The purpose of this study was to investigate referral patterns to a large academic TAVR center in the state of North Carolina and evaluate differences between externally and internally referred patients. Methods Data for all patients who underwent TAVR at our institution between November 2014 and March 2020 were pulled from the Transcatheter Valve Therapy Registry. The electronic medical record was used to determine the referral source. The descriptive statistical analysis was performed using Excel (Microsoft, Redmond, Washington). Results 491 patients underwent TAVR at our institution between November 2014 and March 2020. Half of the patients were referred by a cardiologist within the same health system (N = 250, 50.9%). Other referral sources included a cardiologist external to the health system (N = 210, N = 42.8%) and a surgeon or proceduralist (such as urologist, surgeon, or gastroenterologist) during the workup for another procedure (N = 26, 5.3%). Over time, there was a trend toward an increasing proportion of patients referred by a cardiologist external to our system, but this trend did not reach statistical significance (20.0% in 2014, 29.2% in 2015, 30.7% in 2016, 53.0% in 2017, 36% in 2018, 48.4% in 2019, and 56.8% in 2020, p=0.06 using the Mann–Kendall trend test). Externally referred patients were less likely to have private insurance and were more likely to have a reduced ejection fraction and had a higher mean gradient across the valve. Postprocedure, externally referred patients were more likely to have the procedure under moderate sedation and less likely to be discharged home. Conclusions This study presents the referral pattern to a large TAVR center in North Carolina. Over time, there was an increase in external referrals suggesting that TAVR is increasingly adopted as an important component of the management of aortic valve stenosis. Internally and externally referred patients have differences in baseline demographic and clinical characteristics which may have an impact on clinical outcomes.
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21
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Mohr BA, Wadhwa M, Medic G, Lavelle J, Buchenberger JD, Norlock V. Costs and outcomes of mobile cardiac outpatient telemetry monitoring post-transcatheter aortic valve replacement. J Comp Eff Res 2022; 11:1045-1055. [PMID: 35899700 DOI: 10.2217/cer-2022-0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To estimate the costs and outcomes of transcatheter aortic valve replacement (TAVR) recipients based on the use of mobile cardiac outpatient telemetry (MCOT) monitoring. Materials & methods: A retrospective database study was conducted to estimate costs, contribution margins (CMs), pacemaker insertions, and other outcomes for patients undergoing TAVR procedures with MCOT monitoring post-procedure versus non-MCOT monitoring. Results: A total of 4164 patients were identified (283 MCOT monitoring and 3881 non-MCOT monitoring). The rate of pacemaker insertion following hospital discharge was higher in the MCOT cohort (6.6 MCOT vs 2.1% non-MCOT; p = 0.007). MCOT use was associated with lower costs and improved CMs of the index TAVR admission (costs: US$40,569 MCOT vs $43,289 non-MCOT; p = 0.003; CMs: US$7087 MCOT vs $5177 non-MCOT; p = 0.047) with no difference through the subsequent 60-day period following discharge. Conclusion: MCOT for ambulatory cardiac monitoring post-TAVR discharge is associated with higher rates of pacemaker insertion, at no overall greater costs.
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Affiliation(s)
| | - Manish Wadhwa
- BioTelemetry, Inc., a Philips company, Malvern, PA 19355, USA
| | - Goran Medic
- Chief Medical Office, Philips Healthcare, Eindhoven, The Netherlands.,Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | | | | | - Vincent Norlock
- BioTelemetry, Inc., a Philips company, Malvern, PA 19355, USA
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22
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Okuno T, Demirel C, Tomii D, Erdoes G, Heg D, Lanz J, Praz F, Zbinden R, Reineke D, Räber L, Stortecky S, Windecker S, Pilgrim T. Risk and Timing of Noncardiac Surgery After Transcatheter Aortic Valve Implantation. JAMA Netw Open 2022; 5:e2220689. [PMID: 35797045 PMCID: PMC9264039 DOI: 10.1001/jamanetworkopen.2022.20689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Noncardiac surgery after transcatheter aortic valve implantation (TAVI) is a clinical challenge with concerns about safety and optimal management. OBJECTIVES To evaluate perioperative risk of adverse events associated with noncardiac surgery after TAVI by timing of surgery, type of surgery, and TAVI valve performance. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted using data from a prospective TAVI registry of patients at the tertiary care University Hospital in Bern, Switzerland. All patients undergoing noncardiac surgery after TAVI were identified. Data were analyzed from November through December 2021. EXPOSURES Timing, clinical urgency, and risk category of noncardiac surgery were assessed among patients who had undergone TAVI and subsequent noncardiac surgery. MAIN OUTCOMES AND MEASURES A composite of death, stroke, myocardial infarction, and major or life-threatening bleeding within 30 days after noncardiac surgery. RESULTS Among 2238 patients undergoing TAVI between 2013 and 2020, 300 patients (mean [SD] age, 81.8 [6.6] years; 144 [48.0%] women) underwent elective (160 patients) or urgent (140 patients) noncardiac surgery after TAVI and were included in the analysis. Of these individuals, 63 patients (21.0%) had noncardiac surgery within 30 days of TAVI. Procedures were categorized into low-risk (21 patients), intermediate-risk (190 patients), and high-risk (89 patients) surgery. Composite end points occurred within 30 days of surgery among 58 patients (Kaplan-Meier estimate, 19.7%; 95% CI, 15.6%-24.7%). There were no significant differences in baseline demographics between patients with the 30-day composite end point and 242 patients without this end point, including mean (SD) age (81.3 [7.1] years vs 81.9 [6.5] years; P = .28) and sex (25 [43.1%] women vs 119 [49.2%] women; P = .37). Timing (ie, ≤30 days from TAVI to noncardiac surgery), urgency, and risk category of surgery were not associated with increased risk of the end point. Moderate or severe prosthesis-patient mismatch (adjusted hazard ratio [aHR], 2.33; 95% CI, 1.37-3.95; P = .002) and moderate or severe paravalvular regurgitation (aHR, 3.61; 95% CI 1.25-10.41; P = .02) were independently associated with increased risk of the end point. CONCLUSIONS AND RELEVANCE These findings suggest that noncardiac surgery may be performed early after successful TAVI. Suboptimal device performance, such as prosthesis-patient mismatch and paravalvular regurgitation, was associated with increased risk of adverse outcomes after noncardiac surgery.
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Affiliation(s)
- Taishi Okuno
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Caglayan Demirel
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Daijiro Tomii
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Gabor Erdoes
- Department of Anesthesiology and Pain Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Dik Heg
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Rainer Zbinden
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiovascular Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
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23
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Baigent C, Windecker S, Andreini D, Arbelo E, Barbato E, Bartorelli AL, Baumbach A, Behr ER, Berti S, Bueno H, Capodanno D, Cappato R, Chieffo A, Collet JP, Cuisset T, de Simone G, Delgado V, Dendale P, Dudek D, Edvardsen T, Elvan A, González-Juanatey JR, Gori M, Grobbee D, Guzik TJ, Halvorsen S, Haude M, Heidbuchel H, Hindricks G, Ibanez B, Karam N, Katus H, Klok FA, Konstantinides SV, Landmesser U, Leclercq C, Leonardi S, Lettino M, Marenzi G, Mauri J, Metra M, Morici N, Mueller C, Petronio AS, Polovina MM, Potpara T, Praz F, Prendergast B, Prescott E, Price S, Pruszczyk P, Rodríguez-Leor O, Roffi M, Romaguera R, Rosenkranz S, Sarkozy A, Scherrenberg M, Seferovic P, Senni M, Spera FR, Stefanini G, Thiele H, Tomasoni D, Torracca L, Touyz RM, Wilde AA, Williams B. ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2-care pathways, treatment, and follow-up. Cardiovasc Res 2022; 118:1618-1666. [PMID: 34864876 PMCID: PMC8690236 DOI: 10.1093/cvr/cvab343] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular (CV) disease in association with COVID-19. METHODS AND RESULTS A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, which was reported previously, focused on the epidemiology, pathophysiology, and diagnosis of CV conditions that may be manifest in patients with COVID-19. This second part addresses the topics of: care pathways and triage systems and management and treatment pathways, both of the most commonly encountered CV conditions and of COVID-19; and information that may be considered useful to help patients with CV disease (CVD) to avoid exposure to COVID-19. CONCLUSION This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
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24
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Zahid S, Rai D, Tanveer Ud Din M, Khan MZ, Ullah W, Usman Khan M, Thakkar S, Hussein A, Baibhav B, Rao M, Abtahian F, Bhatt DL, Depta JP. Same-Day Discharge After Transcatheter Aortic Valve Implantation: Insights from the Nationwide Readmission Database 2015 to 2019. J Am Heart Assoc 2022; 11:e024746. [PMID: 35621233 PMCID: PMC9238699 DOI: 10.1161/jaha.121.024746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background There is a paucity of data on the feasibility of same-day discharge (SDD) following transcatheter aortic valve implantation (TAVI) at a national level. Methods and Results This study used data from the Nationwide Readmission Database from the fourth quarter of 2015 through 2019 and identified patients undergoing TAVI using the claim code 02RF3. A total of 158 591 weighted hospitalizations for TAVI were included in the analysis. Of the patients undergoing TAVI, 961 (0.6%) experienced SDD. Non-SDDs included 65 814 (41.5%) patients who underwent TAVI who were discharged the next day, and 91 816 (57.9%) discharged on the second or third day. The 30-day readmission rate for SDD after TAVI was similar to non-SDD TAVI (9.8% versus 8.9%, P=0.31). The cumulative incidence of 30-day readmissions for SDD was higher compared with next-day discharge (log-rank P=0.01) but comparable to second- or third-day discharge (log-rank P=0.66). At 30 days, no differences were observed in major or minor vascular complications, heart failure, or ischemic stroke for SDD compared with non-SDD. Acute kidney injury, pacemaker implantation, and bleeding complications were lower with SDD. Predictors associated with SDD included age <85 years, male sex, and prior pacemaker placement, whereas left bundle-branch block, right bundle-branch block, second-degree heart block, heart failure, prior percutaneous coronary intervention, and atrial fibrillation were negatively associated with SDD. Conclusions SDD following TAVI is associated with similar 30-day readmission and complication rates compared with non-SDD. Further prospective studies are needed to assess the safety and feasibility of SDD after TAVI.
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Affiliation(s)
- Salman Zahid
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Devesh Rai
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | | | - Muhammad Zia Khan
- Division of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WV
| | - Waqas Ullah
- Department of Cardiovascular Medicine Jefferson University Hospitals Philadelphia PA
| | - Muhammad Usman Khan
- Division of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WV
| | | | - Ahmed Hussein
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Bipul Baibhav
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Mohan Rao
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Farhad Abtahian
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center Harvard Medical School Boston MA
| | - Jeremiah P Depta
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
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25
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Khan MZ, Brailovsky Y, Vishnevsky O(A, Baqi A, Patel K, Alvarez RJ. Clinical outcome of TAVR vs SAVR in patients with cardiac amyloidosis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 43:20-25. [DOI: 10.1016/j.carrev.2022.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022]
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Liu X, Fan J, Guo Y, Dai H, Xu J, Wang L, Hu P, Lin X, Li C, Zhou D, Li H, Wang J. Wearable Smartwatch Facilitated Remote Health Management for Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2022; 11:e023219. [PMID: 35347997 PMCID: PMC9075450 DOI: 10.1161/jaha.121.023219] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
In the recent decades, the development of novel digital health technologies enables doctors to monitor ECG and vital signs remotely. But the data on applying the noninvasive wearable smartwatch on patients with transcatheter aortic valve replacement (TAVR) are unknown.
Methods and Results
We performed a prospective, observational cohort study to evaluate the feasibility of a novel, virtual, and remote health care strategy for patients with TAVR discharged to home with smart wearable devices. A total of 100 consecutive patients with severe aortic stenosis who underwent elective transfemoral TAVR were enrolled and received the Huawei smartwatch at least 1 day before TAVR. Vital signs, including heart rate, rhythm, oxygen saturation, and activity, were continuously recorded. Single‐lead ECG was recorded twice per day in the week following TAVR discharge and at least 2 days a week for the subsequent month after TAVR discharge. A designated heart team member provided remote health care with the data from the smartwatch when the patient had a need. Thirty‐eight cardiac events were reported in 34 patients after discharge, with most of the events (76.0%) detected and confirmed by the smartwatch. Six patients were advised and readmitted to the hospital for arrhythmia events detected by the smartwatch, of whom 4 patients received pacemaker implantation. The remaining 28 (82.4%) patients received telemedicine monitoring instead of face‐to‐face clinical visits, and 3 of them received new medication treatment under the online guidance of doctors. New‐onset left branch bundle block was found in 48 patients, with transient characteristics, and recovered spontaneously in 30 patients, and new‐onset atrial fibrillation was detected in 4 patients. There were no significant differences in the average weekly heart rates or the ratio of abnormal or low oxygen saturation when compared with the baseline. The average daily steps increased over time significantly (baseline, 870±1353 steps; first week, 1986±2406 steps; second week, 2707±2716 steps; third week, 3059±3036 steps; fourth week, 3678±3485 steps,
P
<0.001).
Conclusions
Smartwatches can facilitate remote health care for patients discharged to home after undergoing TAVR and enable a novel remote follow‐up strategy. The majority of cardiac clinical events that occurred within 30‐day follow‐up were detected by the smartwatch, mainly because of the record of conduction abnormality.
Registration
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT04454177.
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Affiliation(s)
- Xianbao Liu
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
- Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Jiaqi Fan
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Yuchao Guo
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Hanyi Dai
- Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Jianguo Xu
- Department of Electrocardiogram Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Lihan Wang
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Po Hu
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Xinping Lin
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Cheng Li
- Department of Nursing Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Dao Zhou
- Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Huajun Li
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
| | - Jian’an Wang
- Department of Cardiology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou People’s Republic of China
- Zhejiang University School of Medicine Hangzhou People’s Republic of China
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27
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Mhanna M, Minhas AMK, Ariss RW, Ahuja KR, Mostafa A, Nazir S, Sheikh M. Transcatheter Versus Surgical Aortic Valve Replacement in Hypertrophic Cardiomyopathy Patients with Aortic Stenosis. Curr Probl Cardiol 2022:101180. [PMID: 35341800 DOI: 10.1016/j.cpcardiol.2022.101180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/22/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) are well established treatment options for severe aortic stenosis (AS). However, patients with hypertrophic cardiomyopathy (HCM) were excluded from pivotal randomized controlled trials of TAVR versus SAVR. METHOD We queried the 2016 to 2019 National Inpatient Sample to identify adult hospitalizations with HCM who underwent SAVR or TAVR for severe AS. The primary outcome was in-hospital mortality. Secondary outcomes included cardiac arrest, new permanent pacemaker (PPM), cardiac tamponade, bleeding requiring transfusion, stroke/transient ischemic attack (TIA), acute kidney injury (AKI), and resource utilization (length of stay [LOS], hospital costs, and discharge to facility). RESULTS Of 1,245 HCM hospitalizations with severe AS, 595(47.8%) underwent TAVR and 650 (52.2%) underwent SAVR. In-hospital mortality rate was lower in the TAVR group. Cardiac arrest, cardiogenic shock, pressor use, new PPM, and cardiac tamponade were not significantly different between the two groups. When compared to SAVR, TAVR was associated with lower rates of bleeding requiring transfusion, vascular complications, AKI, and invasive mechanical ventilation. Furthermore, TAVR was associated with a shorter hospital stay, fewer facility discharges, but comparable hospital costs. CONCLUSION Our findings indicate that TAVR is associated with lower risk of in-hospital mortality, certain peri-procedural complications, shorter hospital stay, and fewer facility discharges in HCM patients with isolated AS compared to SAVR. Further studies are needed to assess the mid- and long-term outcomes of TAVR versus SAVR in HCM patients with AS.
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Affiliation(s)
- Mohammed Mhanna
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA.
| | | | - Robert W Ariss
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
| | - Keerat Rai Ahuja
- Division of Cardiology, Reading Hospital-Tower Health System, West Reading, Pennsylvania, USA
| | - Abdelmonem Mostafa
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
| | - Salik Nazir
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
| | - Mujeeb Sheikh
- Division of Cardiovascular Medicine, ProMedica Toledo Hospital, Toledo, OH, USA.
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Baigent C, Windecker S, Andreini D, Arbelo E, Barbato E, Bartorelli AL, Baumbach A, Behr ER, Berti S, Bueno H, Capodanno D, Cappato R, Chieffo A, Collet JP, Cuisset T, de Simone G, Delgado V, Dendale P, Dudek D, Edvardsen T, Elvan A, González-Juanatey JR, Gori M, Grobbee D, Guzik TJ, Halvorsen S, Haude M, Heidbuchel H, Hindricks G, Ibanez B, Karam N, Katus H, Klok FA, Konstantinides SV, Landmesser U, Leclercq C, Leonardi S, Lettino M, Marenzi G, Mauri J, Metra M, Morici N, Mueller C, Petronio AS, Polovina MM, Potpara T, Praz F, Prendergast B, Prescott E, Price S, Pruszczyk P, Rodríguez-Leor O, Roffi M, Romaguera R, Rosenkranz S, Sarkozy A, Scherrenberg M, Seferovic P, Senni M, Spera FR, Stefanini G, Thiele H, Tomasoni D, Torracca L, Touyz RM, Wilde AA, Williams B. ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2-care pathways, treatment, and follow-up. Eur Heart J 2022; 43:1059-1103. [PMID: 34791154 PMCID: PMC8690006 DOI: 10.1093/eurheartj/ehab697] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/08/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023] Open
Abstract
AIMS Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular (CV) disease in association with COVID-19. METHODS AND RESULTS A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, which was reported previously, focused on the epidemiology, pathophysiology, and diagnosis of CV conditions that may be manifest in patients with COVID-19. This second part addresses the topics of: care pathways and triage systems and management and treatment pathways, both of the most commonly encountered CV conditions and of COVID-19; and information that may be considered useful to help patients with CV disease (CVD) to avoid exposure to COVID-19. CONCLUSION This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
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Campany ME, Bhandarkar AR, Bydon M, Donato BB, Sell-Dottin KA. Transcatheter aortic valve replacement outcomes in solid organ transplant recipients. J Card Surg 2022; 37:602-607. [PMID: 34985156 DOI: 10.1111/jocs.16202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Transcatheter aortic valve replacement (TAVR) has become the primary treatment for severe symptomatic aortic stenosis in patients >65 years with volumes exceeding surgical aortic valve replacements (SAVR) since 2019. As a less invasive procedure with lower complication rates, TAVR is preferable in most patient populations, particularly those with increased surgical risk. One such population is patients who have undergone solid organ transplant (SOT). We aimed to evaluate periprocedural outcomes and complication rates following TAVR in SOT recipients as compared to the general TAVR population. METHODS The 2016-2018 National Inpatient Sample (NIS) was queried by ICD-10 PCS codes to identify TAVR cases; hospitalizations were subsequently stratified by SOT history. Multivariate analyses were completed to evaluate complication rates, length of stay (LOS), and cost of stay (COS). RESULTS No significant difference was observed in mortality rates or post-procedural complications between SOT recipients (n = 223) and those without transplant history undergoing TAVR (n = 29,448) except for increased thromboembolic events captured in transplant patients (p < .001). There was no significant variation in LOS or COS between the two populations; female sex and Black or Hispanic race were predictors of increased inpatient time. CONCLUSIONS SOT recipients have no increased risk of mortality or periprocedural complications when undergoing TAVR. Though the rate of thromboembolic events was higher in SOT recipients, observation size was small (n = 27 TAVR, n = 4 TAVR + SOT) thus external validity is limited. Based on these data, transplant recipients experience no difference in outcomes following TAVR as compared to patients without a history of organ transplant.
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Affiliation(s)
- Megan E Campany
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | | | - Mohamad Bydon
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Britton B Donato
- Division of Cardiothoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
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Zisiopoulou M, Berkowitsch A, Seppelt P, Zeiher AM, Vasa-Nicotera M. A Novel Method to Predict Mortality and Length of Stay after Transfemoral Transcatheter Aortic Valve Implantation. Medicina (B Aires) 2021; 57:medicina57121332. [PMID: 34946277 PMCID: PMC8707781 DOI: 10.3390/medicina57121332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/25/2021] [Accepted: 12/04/2021] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives: We tested if a novel combination of predictors could improve the accuracy of outcome prediction after transfemoral transcatheter aortic valve implantation (TAVI). Materials and Methods: This prospective study recruited 169 participants (49% female; median age 81 years). The primary endpoint was midterm mortality; secondary endpoints were acute Valve Academic Research Consortium (VARC)-3 complication rate and post-TAVI in-hospital length of stay (LoS). EuroSCORE II (ESII), comorbidities (e.g., coronary artery disease), eGFR (estimated glomerular filtration rate; based on cystatin C), hemoglobin, creatinine, N-Terminal pro-Brain Natriuretic Peptide (NTproBNP) levels and patient-reported outcome measures (PROMs, namely EuroQol-5-Dimension-5-Levels, EQ5D5L; Kansas City Cardiomyopathy Questionnaire, KCCQ; clinical frailty scale, CFS) at baseline were tested as predictors. Regression (uni- and multi-variate Cox; linear; binary logistic) and receiver operating characteristic (ROC)-curve analysis were applied. Results: Within a median follow-up of 439 (318–585) days, 12 participants died (7.1%). Independent predictors of mortality using multivariate Cox regression were baseline eGFR (p = 0.001) and KCCQ (p = 0.037). Based on these predictors, a Linear Prediction Score (LPS1) was calculated. The LPS1-area under the curve (AUC)-value (0.761) was significantly higher than the ESII-AUC value (0.597; p = 0.035). Independent predictors for LoS > 6 days (the median LoS) were eGFR (p = 0.028), NTproBNP (p = 0.034), and EQ5D5L values (p = 0.002); a respective calculated LPS2 provided an AUC value of 0.677 (p < 0.001). Eighty participants (47.3%) experienced complications. Male sex predicted complications only in the univariate analysis. Conclusions: The combination of KCCQ and eGFR can better predict midterm mortality than ES II alone. Combining eGFR, NTproBNP, and EQ5D5L can reliably predict LoS after TAVI. This novel method improves personalized TAVI risk stratification and hence may help reduce post-TAVI risk.
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Mori M, Gupta A, Wang Y, Vahl T, Nazif T, Kirtane AJ, George I, Yong CM, Onuma O, Kodali S, Geirsson A, Leon MB, Krumholz HM. Trends in Transcatheter and Surgical Aortic Valve Replacement Among Older Adults in the United States. J Am Coll Cardiol 2021; 78:2161-2172. [PMID: 34823659 DOI: 10.1016/j.jacc.2021.09.855] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/25/2021] [Accepted: 09/07/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recent trends, including survival beyond 30 days, in aortic valve replacement (AVR) following the expansion of indications for transcatheter aortic valve replacement (TAVR) are not well-understood. OBJECTIVES The authors sought to characterize the trends in characteristics and outcomes of patients undergoing AVR. METHODS The authors analyzed Medicare beneficiaries who underwent TAVR and SAVR in 2012 to 2019. They evaluated case volume, demographics, comorbidities, 1-year mortality, and discharge disposition. Cox proportional hazard models were used to assess the annual change in outcomes. RESULTS Per 100,000 beneficiary-years, AVR increased from 107 to 156, TAVR increased from 19 to 101, whereas SAVR declined from 88 to 54. The median [interquartile range] age remained similar from 77 [71-83] years to 78 [72-84] years for overall AVR, decreased from 84 [79-88] years to 81 [75-86] years for TAVR, and decreased from 76 [71-81] years to 72 [68-77] years for SAVR. For all AVR patients, the prevalence of comorbidities remained relatively stable. The 1-year mortality for all AVR decreased from 11.9% to 9.4%. Annual change in the adjusted odds of 1-year mortality was 0.93 (95% CI: 0.92-0.94) for TAVR and 0.98 (95% CI: 0.97-0.99) for SAVR, and 0.94 (95% CI: 0.93-0.95) for all AVR. Patients discharged to home after AVR increased from 24.2% to 54.7%, primarily driven by increasing home discharge after TAVR. CONCLUSIONS The advent of TAVR has led to about a 60% increase in overall AVR in older adults. Improving outcomes in AVR as a whole following the advent of TAVR with increased access is a reassuring trend.
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Affiliation(s)
- Makoto Mori
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Aakriti Gupta
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA; Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Yun Wang
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA; Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Torsten Vahl
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Tamim Nazif
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Ajay J Kirtane
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Isaac George
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Celina M Yong
- Department of Medicine (Cardiovascular Medicine), Stanford University School of Medicine, Stanford, California, USA; Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Oyere Onuma
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Susheel Kodali
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Martin B Leon
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA; Section of Cardiology, Yale School of Medicine, New Haven, Connecticut, USA; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA.
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Ando T, Ashraf S, Briasoulis A, Takagi H, Grines CL, Malik AH. Risk of Ischemic Stroke in Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients With Prior Stroke. Am J Cardiol 2021; 157:79-84. [PMID: 34366113 DOI: 10.1016/j.amjcard.2021.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
It has not been well studied whether transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) have lower risk of ischemic stroke (IS) in those with prior history of IS. From the Nationwide Readmission Database from October 2015 to November 2017, TAVI and SAVR above age 50 were identified with the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System codes. Transapical TAVI and SAVR with concomitant bypass, mitral, or tricuspid surgery were excluded. The primary outcome was in-hospital IS. A total of 92,435 TAVI (13,292 with prior stroke) and 68,651 SAVR (5,365 with prior stroke) were identified. In-hospital IS was significantly lower in TAVI compared with SAVR (3.7% vs 8.0%, adjusted odds ratio 0.65, 95% confidence interval 0.47 to 0.89, p <0.01) with prior stroke whereas it was similar between TAVI and SAVR (1.7% vs 2.1%, adjusted odds ratio 0.97, 95% confidence interval 0.78 to 1.19, p = 0.75) in those without prior stroke (P interaction < 0.001). In-hospital mortality, acute kidney injury, and bleeding were lower in TAVI compared with SAVR in patients with and without prior stroke (P interaction > 0.05 for all). This analysis of a national claims database showed that TAVI was associated with a lower risk of in-hospital IS compared with SAVR among patients with prior stroke.
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Next-Day Discharge vs Early Discharge After Transcatheter Aortic Valve Replacement: Systematic Review and Meta-Analysis. Curr Probl Cardiol 2021; 47:100998. [PMID: 34571105 DOI: 10.1016/j.cpcardiol.2021.100998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022]
Abstract
With the growing utilization of transcatheter aortic valve replacement (TAVR) as an alternative option to surgical valve replacement (SAVR) in patients considered to be suboptimal for surgery, there is a need to explore the possibility of next day discharge (NDD) and its potential outcomes. The aim of our study is to compare outcomes and complications following NDD vs the standard early discharge (ED) (less than 3 days). A comprehensive literature search was performed in PubMed, Embase, and Cochrane to identify relevant trials. Summary effects were calculated using a DerSimonian and Laird random effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. Studies comparing same-day or next-day discharge vs discharge within the next three days were included in our analysis. 6 studies with 2,672 patients were identified. The risk of bleeding and vascular complications was significantly lower in patients with NDD compared to ED (OR 0.10, P < 0.00001 and OR 0.22, P = 0.002 respectively). The incidence of permanent pacemaker (PPM) implants was significantly lower in patients who had NDD compared to ED (OR 0.21, P = 0.0005). The incidence of 30 day mortality, stroke, AKI and readmission rates was not different between the two groups. NDD after TAVR allows for reduction in hospital stay and can mitigate hospital costs without an increased risk of complications. Our analysis shows that complication rate is comparable to ED, NDD is a reasonable option for certain patients with severe aortic stenosis who undergo TAVR. Further studies are needed to elucidate whether higher risk patients who would benefit from an extended inpatient monitoring post TAVR.
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Mazzella AJ, Arora S, Hendrickson MJ, Sanders M, Vavalle JP, Gehi AK. Evaluation and Management of Heart Block After Transcatheter Aortic Valve Replacement. Card Fail Rev 2021; 7:e12. [PMID: 34386266 PMCID: PMC8353545 DOI: 10.15420/cfr.2021.05] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/28/2021] [Indexed: 11/25/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has developed substantially since its inception. Improvements in valve design, valve deployment technologies, preprocedural imaging and increased operator experience have led to a gradual decline in length of hospitalisation after TAVR. Despite these advances, the need for permanent pacemaker implantation for post-TAVR high-degree atrioventricular block (HAVB) has persisted and has well-established risk factors which can be used to identify patients who are at high risk and advise them accordingly. While most HAVB occurs within 48 hours of the procedure, there is a growing number of patients developing HAVB after initial hospitalisation for TAVR due to the trend for early discharge from hospital. Several observation and management strategies have been proposed. This article reviews major known risk factors for HAVB after TAVR, discusses trends in the timing of HAVB after TAVR and reviews some management strategies for observing transient HAVB after TAVR.
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Affiliation(s)
- Anthony J Mazzella
- Division of Cardiology, Department of Medicine, University of North Carolina Hospitals Chapel Hill, NC, US
| | - Sameer Arora
- Division of Cardiology, Department of Medicine, University of North Carolina Hospitals Chapel Hill, NC, US
| | | | - Mason Sanders
- Department of Medicine, University of North Carolina Hospitals Chapel Hill, NC, US
| | - John P Vavalle
- Division of Cardiology, Department of Medicine, University of North Carolina Hospitals Chapel Hill, NC, US
| | - Anil K Gehi
- Division of Cardiology, Department of Medicine, University of North Carolina Hospitals Chapel Hill, NC, US
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Shah K, Krinock M, Thyagaturu H, Munshi R, Pandya A, Falta S, Hippen J, Durkin M. Temporal Trend, Prevalence, Predictors, and Outcomes of Pericardial Diseases in Patients Undergoing Transcatheter Aortic Valve Repair. Cureus 2021; 13:e16083. [PMID: 34249583 PMCID: PMC8248747 DOI: 10.7759/cureus.16083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/05/2022] Open
Abstract
Background Pericardial disease (PD) - acute pericarditis (AP) and pericardial effusion (PE) - is a rare complication of transcatheter aortic valve repair (TAVR) although its prevalence, predictors, and outcomes are not well studied. Methods We used the National Inpatient Sample (NIS) database to find patients who received TAVR between 2011 and 2018. TAVR patients were divided into two groups: with and without PD (AP and/or PE). The baseline characteristics between the two groups were compared using the Chi-square test and student t-test. Variables with a p-value of 0.20 or less from the univariate logistic regression were included in the multivariate logistic regression to find independent predictors of PD in TAVR patients. Results Out of 218,340 TAVR hospitalizations, 4323 (1.2%) had a concurrent diagnosis of PD. TAVR patients with PD were older (81 ± 7 vs 80 ± 6 years, p < 0.05), more likely to be females (62 vs 46%, p < 0.001), white (84.2 vs 82.9%, p = 0.83), and had a higher burden of comorbidities (Table 3). TAVR patients with PD had higher in-hospital mortality rate (12.3 vs 1.9%, p < 0.001), mean length of stay (8.4 vs 5.3 days, p < 0.001), and mean total hospital cost ($283,389 vs $224,544, p < 0.001). Age > 75, female sex, atrial fibrillation (Afib), atrial flutter (Aflutter), peripheral vascular disease (PVD), coagulopathy, cirrhosis, malnutrition, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and pacemaker (PM) implantation were the independent predictors of PD in TAVR patients. Conclusion Older, white females with a higher burden of comorbidities and cardiovascular procedures are at higher risk of pericardial complications of TAVR procedure. Sex-based disparities in the prevalence of PD after TAVR is an area of further research. Careful selection of patients for TAVR is essential to reduce the burden of these complications.
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Affiliation(s)
- Kashyap Shah
- Internal Medicine, St. Luke's University Health Network, Bethlehem, USA
| | - Matthew Krinock
- Internal Medicine, St. Luke's University Health Network, Bethlehem, USA
| | | | - Rezwan Munshi
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Ayushi Pandya
- Public Health and Policy, Edward J. Bloustein School of Planning and Public Policy at Rutgers University, New Brunswick, USA
| | - Sarah Falta
- Medicine, Lewis Katz School of Medicine, Philadelphia, USA
| | - John Hippen
- Internal Medicine, St. Luke's University Health Network, Bethlehem, USA
| | - Michael Durkin
- Cardiology, St. Luke's University Health Network, Bethlehem, USA
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Amabile A, Komlo CM, Sloane Guy T. Showcasing the lateral approach for robotic aortic and mitral valve surgery: Does one approach fit it all? J Card Surg 2021; 36:3860-3861. [PMID: 34189761 DOI: 10.1111/jocs.15782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Amabile
- Department of Surgery, Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Caroline M Komlo
- Department of Surgery, Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Thomas Sloane Guy
- Department of Surgery, Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Nazir S, Ahuja KR, Ariss RW, Changal K, Khuder SA, Moukarbel GV. Home health care utilization trend, predictors, and association with early rehospitalization following endovascular transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:1-6. [PMID: 34045166 DOI: 10.1016/j.carrev.2021.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE Home healthcare (HHC) utilization is associated with higher rates of rehospitalization in patients with heart failure and transcatheter mitral valve repair. This study sought to assess the utilization, predictors, and the association of HHC with 30-day readmission in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS/MATERIALS We queried the Nationwide Readmission Database from January 2012 to December 2017 for TAVR discharges with and without HHC referral. Using multivariate analysis, we identified predictors of HHC utilization, and its association with outcomes. RESULTS Of 60,950 TAVR discharges, 21,724 (35.7%) had HHC referral. On multivariable analysis, female sex (OR, 1.34; 95% CI, 1.29-1.40), non-elective admission (OR, 1.49; 95% CI, 1.42-1.56), diabetes mellitus (OR, 1.09; 95% CI, 1.05-1.13), prior stroke (OR, 1.06; 95% CI, 1.01-1.12), anemia (OR, 1.16; 95% CI, 1.11-1.21), and in-hospital complications including cardiogenic shock (OR, 1.37; 95% CI, 1.16-1.50), cardiac arrest (OR, 1.22; 95% CI, 1.00-1.50), stroke (OR, 2.62; 95% CI, 2.20-3.18), and new Permanent pacemaker (OR, 1.49; 95% CI, 1.41-1.58) were identified as independent predictors of HHC referral. HHC utilization was associated with longer median length of stay (4 days vs. 2 days, P < 0.001), higher rate of 30-day all-cause (15.5% vs. 10.6%, P < 0.001) and heart failure (2.1%vs. 1.1%, P < 0.001) readmission rates compared to those without HHC. CONCLUSIONS Our study identified a vulnerable group of TAVR patients that are at higher risk of 30-day readmission. Evidence-based interventions proven effective in reducing the burden of readmissions should be pursed in these patients to improve outcomes and quality of life.
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Affiliation(s)
- Salik Nazir
- Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Keerat Rai Ahuja
- Department of Cardiology, Reading Hospital-Tower Health System, West Reading, PA, USA
| | - Robert W Ariss
- Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Khalid Changal
- Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Sadik A Khuder
- Department of Medicine and Public Health, University of Toledo, Toledo, OH, USA
| | - George V Moukarbel
- Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA.
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Perek B, Olasinska-Wisniewska A, Misterski M, Puslecki M, Grygier M, Buczkowski P, Lesiak M, Stankowski T, Szarpak L, Ruetzler K, Turan O, Jemielity M. How the COVID-19 pandemic changed treatment of severe aortic stenosis: a single cardiac center experience. J Thorac Dis 2021; 13:906-917. [PMID: 33717563 PMCID: PMC7947507 DOI: 10.21037/jtd-20-3025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Currently, two effective therapeutic options for severe aortic stenosis (AS) are available, one catheter-based [transcatheter aortic valve implantation (TAVI)], the other open surgical approach [surgical aortic valve replacement (SAVR)]. The COVID-19 pandemic has limited the availability of medical procedures. The purpose of this cross-sectional study was to assess if this pandemic had any impact on the treatment strategy of severe AS in a single cardiac center. Methods This study involved AS patients treated in 3-month periods (February through April) over 3 consecutive years 2018, 2019 [defined as COV(-) group] and 2020 [COV(+)]. We assessed if there were any differences regarding patients' clinical profile, applied therapeutic method, procedure complexity and early clinical outcomes. Results In the years 2018 through 2019, approximately 50% of AS patients were treated classically (SAVR) while in 2020 this rate dropped to 34%. The preoperative clinical characteristic of TAVI subjects was comparable irrespective of the year. Regarding SAVR, more patients in COV(+) underwent urgent and more complex procedures. More of them were found in NYHA class III or IV, and had lower left ventricular ejection fraction (LVEF) (51.9%±14.4% vs. 58.3%±8.1%; P=0.021) than in COV(-) individuals. During the pandemic, a change in applied therapeutic methods and differences in patients' clinical profile did not have an unfavorable impact on in-hospital mortality (2.0% before vs. 3.6% during pandemic) and morbidity. Of note, intubation time and in-hospital stay were significantly shorter (P<0.05) in 2020 (4.2 hours and 7.5 days) than in the previous years (7.5 hours and 9.0 days, respectively). Conclusions The coronavirus pandemic has changed substantially the management of severe AS. The shift into less invasive treatment method of AS patients resulted in shortening of in-hospital stay without compromise of short-term outcomes.
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Affiliation(s)
- Bartlomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Olasinska-Wisniewska
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin Misterski
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Mateusz Puslecki
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.,Department of Medical Rescue, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Piotr Buczkowski
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Stankowski
- Department of Cardiac Surgery, Sana-Herzzentrum Cottbus, Cottbus, Germany
| | - Lukasz Szarpak
- Bialystok Oncology Center, Bialystok, Poland.,Maria Sklodowska-Curie Medical Academy in Warsaw, Warsaw, Poland
| | - Kurt Ruetzler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, OH, USA
| | - Oguz Turan
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, OH, USA
| | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
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39
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Schumer EM, Eleid MF, Greason KL. A report of transcatheter aortic valve insertion in a patient with chronic type B aortic dissection. J Card Surg 2021; 36:772-774. [PMID: 33410208 DOI: 10.1111/jocs.15297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 11/12/2020] [Indexed: 11/29/2022]
Abstract
A 72-year-old man presented with symptomatic, severe aortic valve stenosis and a chronic descending thoracic aorta dissection with descending thoracic aortic aneurysm. After careful consideration, a transcatheter aortic valve was inserted through a transfemoral approach. This case demonstrates feasibility, and consideration should be given to this approach in patients requiring intervention for aortic stenosis.
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Affiliation(s)
- Erin M Schumer
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
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40
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Koschutnik M, Dannenberg V, Nitsche C, Donà C, Siller-Matula JM, Winter MP, Andreas M, Zafar A, Bartko PE, Beitzke D, Loewe C, Aschauer S, Anvari-Pirsch A, Goliasch G, Hengstenberg C, Kammerlander AA, Mascherbauer J. Right ventricular function and outcome in patients undergoing transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging 2020; 22:1295-1303. [PMID: 33377480 DOI: 10.1093/ehjci/jeaa342] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/24/2020] [Indexed: 01/25/2023] Open
Abstract
AIMS Right ventricular dysfunction (RVD) on echocardiography has been shown to predict outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). However, a comparison with the gold standard, RV ejection fraction (EF) on cardiovascular magnetic resonance (CMR), has never been performed. METHODS AND RESULTS Consecutive patients scheduled for TAVR underwent echocardiography and CMR. RV fractional area change (FAC), tricuspid annular plane systolic excursion, RV free-lateral-wall tissue Doppler (S'), and strain were assessed on echocardiography, and RVEF on CMR. Patients were prospectively followed. Adjusted regression analyses were used to report the strength of association per 1-SD decline for each RV function parameter with (i) N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels, (ii) prolonged in-hospital stay (>14 days), and (iii) a composite of heart failure hospitalization and death. Two hundred and four patients (80.9 ± 6.6 y/o; 51% female; EuroSCORE-II: 6.3 ± 5.1%) were included. At a cross-sectional level, all RV function parameters were associated with NT-proBNP levels, but only FAC and RVEF were significantly associated with a prolonged in-hospital stay [adjusted odds ratio 1.86, 95% confidence interval (CI) 1.07-3.21; P = 0.027 and 2.29, 95% CI 1.43-3.67; P = 0.001, respectively]. A total of 56 events occurred during follow-up (mean 13.7 ± 9.5 months). After adjustment for the EuroSCORE-II, only RVEF was significantly associated with the composite endpoint (adjusted hazard ratio 1.70, 95% CI 1.32-2.20; P < 0.001). CONCLUSION RVD as defined by echocardiography is associated with an advanced disease state but fails to predict outcomes after adjustment for pre-existing clinical risk factors in TAVR patients. In contrast, RVEF on CMR is independently associated with heart failure hospitalization and death.
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Affiliation(s)
- Matthias Koschutnik
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Varius Dannenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Christian Nitsche
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Carolina Donà
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Jolanta M Siller-Matula
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.,Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland
| | - Max-Paul Winter
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Martin Andreas
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Amna Zafar
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Philipp E Bartko
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Dietrich Beitzke
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Aschauer
- Department of Internal Medicine, Franziskus Hospital Margareten, Vienna, Austria
| | - Anahit Anvari-Pirsch
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Andreas A Kammerlander
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.,Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Julia Mascherbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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41
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Wu J, Li C, Zheng Y, Tong Q, Liu Q, Cong X, Lou Z, Zhang M. Temporal Trends and Outcomes of Percutaneous and Surgical Aortic Valve Replacement in Patients With Atrial Fibrillation. Front Cardiovasc Med 2020; 7:603834. [PMID: 33365330 PMCID: PMC7750195 DOI: 10.3389/fcvm.2020.603834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/06/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives: The aim of this study was to evaluate the temporal trends of transcatheter aortic valve replacement (TAVR) in severe aortic stenosis (AS) patients with atrial fibrillation (AF) and to compare the in-hospital outcomes between TAVR and surgical aortic valve replacement (SAVR) in patients with AF. Background: Data comparing TAVR to SAVR in severe AS patients with AF are lacking. Methods: National inpatient sample database in the United States from 2012 to 2016 were queried to identify hospitalizations for severe aortic stenosis patients with AF who underwent isolated aortic valve replacement. A propensity score-matched analysis was used to compare in-hospital outcomes for TAVR vs. SAVR for AS patients with AF. Results: The analysis included 278,455 hospitalizations, of which 124,910 (44.9%) were comorbid with AF. Before matching, TAVR had higher in-hospital mortality than SAVR (3.1 vs. 2.2%, p < 0.001); however, there was a declining trend during the study period (Ptrend < 0.001). After matching, TAVR and SAVR had similar in-hospital mortality (2.9 vs. 2.9%, p < 0.001) and stroke. TAVR was associated with lower rates of acute kidney injury, new dialysis, cardiac complications, acquired pneumonia, sepsis, mechanical ventilation, tracheostomy, non-routine discharge, and shorter length of stay; however, TAVR was associated with more pacemaker implantation and higher cost. Of the patients receiving TAVR, the presence of AF was associated with an increased rate of complications and increased medical resource usage compared to those without AF. Conclusions: In-hospital mortality and stroke for TAVR and SAVR in AF, AS are similar; however, the in-hospital mortality in TAVR AF is declining and associated with more favorable in-hospital outcomes.
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Affiliation(s)
- Jing Wu
- Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
| | - Chenguang Li
- Department of Cardiovascular Medicine, Zhongshan Hospital, Shanghai, China
| | - Yang Zheng
- Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
| | - Qian Tong
- Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
| | - Quan Liu
- Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
| | - Xiaoqiang Cong
- Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
| | - Zhiyang Lou
- Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
| | - Mingyou Zhang
- Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
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42
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Arora S, Hendrickson MJ, Strassle PD, Qamar A, Pandey A, Kolte D, Sitammagari K, Cavender MA, Fonarow GC, Bhatt DL, Vavalle JP. Trends in Costs and Risk Factors of 30-Day Readmissions for Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 137:89-96. [PMID: 32991853 DOI: 10.1016/j.amjcard.2020.09.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/29/2022]
Abstract
As transcatheter aortic valve implantation (TAVI) continues its rapid growth as a treatment approach for aortic stenosis, costs associated with TAVI, and its burden to healthcare systems will assume greater importance. Patients undergoing TAVI between January 2012 and November 2017 in the Nationwide Readmission Database were identified. Trends in cause-specific readmissions were assessed using Poisson regression. Thirty-day TAVI cost burden (cost of index TAVI hospitalization plus total 30-day readmissions cost) was adjusted to 2017 U.S. dollars and trended over year from 2012 to 2017. Overall, 47,255 TAVI were included and 30-day readmissions declined from 20% to 12% (p <0.0001). Most common causes of readmission (heart failure, infection/sepsis, gastrointestinal causes, and respiratory) declined as well, except arrhythmia/heart block which increased (1.0% to 1.4%, p <0.0001). Cost of TAVI hospitalization ($52,024 to $44,110, p <0.0001) and 30-day cost burden ($54,122 to $45,252, p <0.0001) declined. Whereas costs of an average readmission did not change ($9,734 to $10,068, p = 0.06), cost burden of readmissions (per every TAVI performed) declined ($4,061 to $1,883, p <0.0001), including reductions in each of the top 5 causes except arrhythmia/heart block ($171 to $263, p = 0.04). Index TAVI hospitalizations complicated by acute kidney injury, length of stay ≥5 days, low hospital procedural volume, and skilled nursing facility discharge were associated with increased odds of 30-day readmissions. In conclusion, the costs of index hospitalizations and 30-day cost burden for TAVI in the U.S. significantly declined from 2012 to 2017. However, readmissions due to arrhythmia/heart block and their associated costs increased. Continued strategies to prevent readmissions, especially those for conduction disturbances, are crucial in the efforts to optimize outcomes and costs with the ongoing expansion of TAVI.
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43
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Mori M, Khera R. Pumping the Breaks on Health Care Costs of Cardiac Surgery by Focusing on Postacute Care Spending. Circ Cardiovasc Qual Outcomes 2020; 13:e007253. [PMID: 33176464 DOI: 10.1161/circoutcomes.120.007253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Makoto Mori
- Division of Cardiac Surgery, Department of Surgery (M.M., R.K.), Yale School of Medicine, New Haven, CT.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (M.M., R.K.)
| | - Rohan Khera
- Division of Cardiac Surgery, Department of Surgery (M.M., R.K.), Yale School of Medicine, New Haven, CT.,Section of Cardiovascular Medicine, Department of Internal Medicine (R.K.), Yale School of Medicine, New Haven, CT.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (M.M., R.K.)
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44
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Mazzella AJ, Hendrickson MJ, Arora S, Sanders M, Li Q, Vavalle JP, Gehi AK. Shifting Trends in Timing of Pacemaker Implantation After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2020; 14:232-234. [PMID: 33183993 DOI: 10.1016/j.jcin.2020.09.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
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45
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Mazzella AJ, Sanders M, Yang H, Li Q, Vavalle JP, Gehi A. Predicting need for pacemaker implantation early and late after transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2020; 97:E588-E596. [PMID: 32857905 DOI: 10.1002/ccd.29239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/15/2020] [Accepted: 08/02/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To identify associations with either early or late permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR) in order to develop an easily interpretable management algorithm. BACKGROUND Injury to the conduction system after TAVR occasionally requires PPM. There is limited data on how to identify which patients will require PPM, particularly after discharge from index hospitalization after TAVR. METHODS All patients having undergone TAVR at the University of North Carolina through August 2019 were identified and records were manually reviewed. Multivariable analyses were performed to identify associations with post-TAVR PPM due to high-degree atrioventricular block (HAVB). Comparisons were made between patients with no PPM (n = 304) and PPM required, stratified into early (during index hospitalization, n = 32) and late (during subsequent hospitalization, n = 11) PPM cohorts. RESULTS Of the 347 patents included for analysis, 43 (12.4%) underwent post-TAVR PPM. In multivariable regression models, early PPM was associated with baseline bifascicular block (OR: 42.16; p < .001), requiring any pacing on first post-TAVR electrocardiogram (ECG) (OR: 31.55; p < .001), and valve oversizing >15% (OR: 3.61; p < .05). Late PPM was associated with baseline right bundle branch block (RBBB) (OR 12.62; p < .001) and history of atrial fibrillation/flutter (OR 4.83; p < .05). CONCLUSIONS Bifascicular block, any pacing on first post-TAVR ECG, and >15% valve oversizing are associated with early PPM, while RBBB and history of atrial fibrillation/flutter are associated with late PPM. We suggest a management strategy for post-TAVR surveillance and management of HAVB.
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Affiliation(s)
- Anthony J Mazzella
- Division of Cardiology, Department of Medicine, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Mason Sanders
- Department of Medicine, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Hannan Yang
- Department of Biostatistics, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Quefeng Li
- Department of Biostatistics, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - John P Vavalle
- Division of Cardiology, Department of Medicine, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Anil Gehi
- Division of Cardiology, Department of Medicine, University of North Carolina Hospitals, Chapel Hill, North Carolina
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46
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Gill C, Lee M, Balanescu DV, Donisan T, Serauto Canache AJ, Palaskas N, Lopez-Mattei J, Kim PY, Song J, Yang EH, Cilingiroglu M, Kar B, Gregoric I, Marmagkiolis K, Iakobishvili Z, Iliescu C. Transcatheter and surgical aortic valve replacement impact on outcomes and cancer treatment schedule. Int J Cardiol 2020; 326:62-70. [PMID: 32858137 DOI: 10.1016/j.ijcard.2020.08.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/01/2020] [Accepted: 08/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent data suggest that transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic stenosis (AS) is viable in cancer patients. TAVR may be preferred in cancer patients due to its minimally invasive nature and smaller impact on oncologic therapies compared to SAVR. Objectives We sought to determine if TAVR is an acceptable alternative to SAVR in cancer patients and whether TAVR allows for earlier initiation or resumption of anti-cancer therapies. METHODS Cancer patients in a tertiary cancer center diagnosed with severe AS were retrospectively included. Patients accepted by the heart team underwent either TAVR or SAVR, while remaining patients received medical therapy alone. Time intervals to initiation of cancer treatment and the impact of cancer treatment on the replaced valves were recorded. Logistic regression was performed to determine the impact of treatment strategy on overall survival (OS) in all 3 subgroups. RESULTS One hundred and eighty-seven cancer patients diagnosed with severe AS were identified. AVR was associated with better OS compared to medical therapy alone (p < 0.0001). TAVR was associated with better OS at 72 months (HR = 0.468, p < 0.001) compared to medical therapy alone, with no difference in OS observed between SAVR and TAVR. Time intervals to initiation of cancer treatments were shorter in the TAVR group, with no valve deterioration or infection observed in all groups. CONCLUSION Cancer patients with severe AS benefit from AVR. TAVR is a viable alternative to SAVR in high-risk cancer patients to prolong survival and allow for earlier administration or resumption of anti-neoplastic therapies.
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Affiliation(s)
- Clarence Gill
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA; Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle Lee
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dinu Valentin Balanescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Teodora Donisan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Astrid Josefina Serauto Canache
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Y Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juhee Song
- Division of Biostatistics, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eric H Yang
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Biswajit Kar
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Igor Gregoric
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Zaza Iakobishvili
- Department of Cardiology, Tel Aviv Jaffa District, Clalit Health Fund, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Cezar Iliescu
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA.
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47
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Acute Care Physical and Occupational Therapy Early Intervention Pathway After Transcatheter Aortic Valve Replacement: A Retrospective Study. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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48
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Jawitz OK, Gulack BC, Grau-Sepulveda MV, Matsouaka RA, Mack MJ, Holmes DR, Carroll JD, Thourani VH, Brennan JM. Reoperation After Transcatheter Aortic Valve Replacement: An Analysis of the Society of Thoracic Surgeons Database. JACC Cardiovasc Interv 2020; 13:1515-1525. [PMID: 32535005 DOI: 10.1016/j.jcin.2020.04.029] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study sought to report the largest series of patients receiving a surgical reoperation after transcatheter aortic valve replacement (TAVR) using the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database. BACKGROUND TAVR has become an effective means of treating aortic stenosis. As TAVR is used in progressively lower-risk cohorts, management of device failure will become increasingly important. METHODS The STS Adult Cardiac Surgery Database was queried for patients with a history of prior TAVR undergoing surgical aortic valve replacement from 2011 to 2015. Observed-to-expected (O/E) mortality ratios were determined to facilitate comparison across reoperative indications and timing from index TAVR procedure. RESULTS A total of 123 patients met inclusion criteria (median age 77 years) with an STS Predicted Risk of Mortality of 4%, 4% to 8%, and >8% in 17%, 24%, and 59%, respectively. Median time to reoperation was 2.5 (interquartile range: 0.7 to 13.0) months, and the operative mortality rate was 17.1%. Common indications for reoperation included early TAVR device failures such as paravalvular leak (15%), structural prosthetic deterioration (11%), failed repair (11%), sizing or position issues (11%), and prosthetic valve endocarditis (10%). All pre-operative risk categories were associated with an increased O/E mortality ratio (Predicted Risk of Mortality <4%: O/E 5.5; 4% to 8%: O/E 1.7; >8%: O/E 1.2). CONCLUSIONS SAVR following early failure of TAVR, while rare, is associated with worse-than-expected outcomes as compared with similar patients initially undergoing SAVR. Continued experience with this developing technology is needed to reduce the incidence of early TAVR failure and further define optimal treatment of failed TAVR prostheses.
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Affiliation(s)
- Oliver K Jawitz
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
| | - Brian C Gulack
- Department of Surgery, SickKids, Toronto, Ontario, Canada
| | | | | | - Michael J Mack
- Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, Texas
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic Health System, Minneapolis, Minnesota
| | - John D Carroll
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart and Vascular Institute, Atlanta, Georgia
| | - J Matthew Brennan
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
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49
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Tanguturi VK, Lindman BR, Pibarot P, Passeri JJ, Kapadia S, Mack MJ, Inglessis I, Langer NB, Sundt TM, Hung J, Elmariah S. Managing Severe Aortic Stenosis in the COVID-19 Era. JACC Cardiovasc Interv 2020; 13:1937-1944. [PMID: 32484159 PMCID: PMC7263810 DOI: 10.1016/j.jcin.2020.05.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 12/29/2022]
Abstract
The novel coronavirus disease-2019 (COVID-19) pandemic has created uncertainty in the management of patients with severe aortic stenosis. This population experiences high mortality from delays in treatment of valve disease but is largely overlapping with the population of highest mortality from COVID-19. The authors present strategies for managing patients with severe aortic stenosis in the COVID-19 era. The authors suggest transitions to virtual assessments and consultation, careful pruning and planning of necessary testing, and fewer and shorter hospital admissions. These strategies center on minimizing patient exposure to COVID-19 and expenditure of human and health care resources without significant sacrifice to patient outcomes during this public health emergency. Areas of innovation to improve care during this time include increased use of wearable and remote devices to assess patient performance and vital signs, devices for facile cardiac assessment, and widespread use of clinical protocols for expedient discharge with virtual physical therapy and cardiac rehabilitation options.
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Affiliation(s)
- Varsha K Tanguturi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Brian R Lindman
- Structural Heart and Valve Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Québec City, Québec, Canada
| | - Jonathan J Passeri
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samir Kapadia
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Ignacio Inglessis
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nathan B Langer
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Judy Hung
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sammy Elmariah
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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50
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Malik AH, Yandrapalli S, Zaid S, Shetty SS, Aronow WS, Ahmad H, Tang GHL. Valve-in-Valve Transcatheter Implantation Versus Redo Surgical Aortic Valve Replacement. Am J Cardiol 2020; 125:1378-1384. [PMID: 32139158 DOI: 10.1016/j.amjcard.2020.02.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/01/2020] [Accepted: 02/04/2020] [Indexed: 11/17/2022]
Abstract
Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) for a failing prosthesis is an appealing alternative to redo surgical AVR. We utilized data from the US National Inpatient Sample for the period 2012 to 2016 to identify hospitalizations for either ViV-TAVI or redo-SAVR. The primary outcomes of interest were in-hospital adverse events composite outcome (comprising of mortality, myocardial infarction, stroke, or acute kidney injury) and all-cause mortality. We used propensity score matching to adjust for the baseline differences between ViV-TAVI and redo-SAVR cohorts. Survey techniques were employed to compare the 2 groups. Over 5 years, there has been a considerable increase in both interventions for prosthetic aortic valve failure, with significantly higher utilization of ViV-TAVI compared to redo-SAVR (p <0.01). Out of the 3,305 hospitalizations for prosthetic aortic valve failure, 1,420 in matched pairs underwent either ViV-TAVI (n = 710) or redo-SAVR (n = 710). ViV-TAVI was associated with lower in-hospital composite adverse outcomes (14.1% vs 25.4%, p = 0.018), and numerically lower but statistically insignificant mortality (<1.0% vs 5.2%; p = 0.06). ViV-TAVI was associated with a decreased length of hospitalization (mean 6.6 vs 9.7 days; p <0.01). In the matched cohort, postoperative bleeding and transfusions were significantly lower for ViV-TAVI compared with redo-SAVR (17.6% vs 31.0% and 12% vs 31% respectively, p <0.01 for both). Acute kidney injury, sepsis, permanent pacemaker implantation, and vascular complications, although numerically better, did not differ between 2 strategies. In conclusion, ViV-TAVI is associated with lower in-hospital MACE rates and reduced length of hospitalization compared with redo-SAVR.
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Affiliation(s)
- Aaqib H Malik
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York.
| | - Srikanth Yandrapalli
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Syed Zaid
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Suchith S Shetty
- Division of Cardiology, Department of Internal Medicine, University of Iowa Health Care, Carver College of Medicine, Iowa City, Iowa
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Hasan Ahmad
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York
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