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Kalisz K, Moore A, Chaturvedi A, Rajiah PS. Multimodality Imaging in Planning of Complex TAVR Procedures. Semin Roentgenol 2024; 59:57-66. [PMID: 38388097 DOI: 10.1053/j.ro.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 02/24/2024]
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2
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Liu W, Wang X. Recent Advances of Nanogenerator Technology for Cardiovascular Sensing and Monitoring. NANO ENERGY 2023; 117:108910. [PMID: 39183759 PMCID: PMC11343574 DOI: 10.1016/j.nanoen.2023.108910] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Cardiovascular sensing and monitoring is a widely used function in cardiovascular devices. Nowadays, achieving desired flexibility, wearability and implantability becomes a major design goal for the advancement of this family of devices. As an emerging technology, nanogenerator (NG) offers an intriguing promise for replacing the battery, an essential obstacle toward tissue-like soft electronics. This article reviews most recent advancements in NG technology for advanced cardiovascular sensing and monitoring. Based on the application targets, the discuss covers implantable NGs on hearts, implantable NGs for blood vessel grafts and patches, and wearable NGs with various sensing functions. The applications of NGs as a power source and as an electromechanical sensing element are both discussed. At the end, current challenges in this direction and future research perspectives are elaborated. This emerging and impactful application direction reviewed in this article is expected to inspire many new research and commercialization opportunities in the field of NG technology.
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Affiliation(s)
- Wenjian Liu
- Department of Materials Science and Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Xudong Wang
- Department of Materials Science and Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
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3
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Isogai T, Agrawal A, Shekhar S, Spilias N, Puri R, Krishnaswamy A, Unai S, Yun JJ, Kapadia SR, Reed GW. Comparison of Outcomes Following Transcatheter Aortic Valve Replacement Requiring Peripheral Vascular Intervention or Alternative Access. J Am Heart Assoc 2023:e028878. [PMID: 37301759 DOI: 10.1161/jaha.122.028878] [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: 11/17/2022] [Accepted: 05/01/2023] [Indexed: 06/12/2023]
Abstract
Background Peripheral vascular intervention (PVI) is occasionally required to facilitate delivery system insertion or to treat vascular complications during transfemoral transcatheter aortic valve replacement (TF-TAVR). However, the impact of PVI on outcomes is not well understood. Therefore, we aimed to compare outcomes between TF-TAVR with versus without PVI and between TF-TAVR with PVI versus non-TF-TAVR. Methods and Results We retrospectively reviewed 2386 patients who underwent TAVR with a balloon-expandable valve at a single institution from 2016 to 2020. The primary outcomes were death and major adverse cardiac/cerebrovascular event (MACCE), defined as death, myocardial infarction, or stroke. Of 2246 TF-TAVR recipients, 136 (6.1%) required PVI (89% bailout treatment). During follow-up (median 23.0 months), there were no significant differences between TF-TAVR with and without PVI in death (15.4% versus 20.7%; adjusted HR [aHR], 0.96 [95% CI, 0.58-1.58]) or MACCE (16.9% versus 23.0%; aHR, 0.84 [95% CI, 0.52-1.36]). However, compared with non-TF-TAVR (n=140), TF-TAVR with PVI carried significantly lower rates of death (15.4% versus 40.7%; aHR, 0.42 [95% CI, 0.24-0.75]) and MACCE (16.9% versus 45.0%; aHR, 0.40 [95% CI, 0.23-0.68]). Landmark analyses demonstrated lower outcome rates following TF-TAVR with PVI than non-TF-TAVR both within 60 days (death 0.7% versus 5.7%, P=0.019; MACCE 0.7% versus 9.3%; P=0.001) and thereafter (death 15.0% versus 38.9%, P=0.014; MACCE 16.5% versus 41.3%, P=0.013). Conclusions The need for PVI during TF-TAVR is not uncommon, mainly due to the bailout treatment for vascular complications. PVI is not associated with worse outcomes in TF-TAVR recipients. Even when PVI is required, TF-TAVR is associated with better short- and intermediate-term outcomes than non-TF-TAVR.
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Affiliation(s)
- Toshiaki Isogai
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Ankit Agrawal
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Shashank Shekhar
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Nikolaos Spilias
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Rishi Puri
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - James J Yun
- Department of Thoracic and Cardiovascular Surgery Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
| | - Grant W Reed
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Cleveland OH USA
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4
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Sedhom R, Dang AT, Elwagdy A, Megaly M, Elgendy IY, Zahr F, Gafoor S, Mamas M, Elbadawi A. Outcomes with plug-based versus suture-based vascular closure device after transfemoral transcatheter aortic valve replacement: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2023; 101:817-827. [PMID: 36802100 DOI: 10.1002/ccd.30597] [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: 05/11/2022] [Revised: 10/25/2022] [Accepted: 02/04/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Studies comparing plug-based (i.e., MANTA) with suture-based (i.e., ProStar XL and ProGlide) vascular closure devices (VCDs) for large-bore access closure after transcatheter aortic valve replacement (TAVR) have yielded mixed results. AIMS To examine the comparative safety and efficacy of both types of VCDs among TAVR recipients. METHODS An electronic database search was performed through March 2022 for studies comparing access-site related vascular complications with plug-based versus suture-based VCDs for large-bore access site closure after transfemoral (TF) TAVR. RESULTS Ten studies (2 randomized controlled trials [RCTs] and 8 observational studies) with 3113 patients (MANTA = 1358, ProGlide/ProStar XL = 1755) were included. There was no difference between plug-based and suture-based VCD in the incidence of access-site major vascular complications (3.1% vs. 3.3%, odds ratio [OR]: 0.89; 95% confidence interval [CI]: 0.52-1.53). The incidence of VCD failure was lower in plug-based VCD (5.2% vs. 7.1%, OR: 0.64; 95% CI: 0.44-0.91). There was a trend toward a higher incidence of unplanned vascular intervention in plug-based VCD (8.2% vs. 5.9%, OR: 1.35; 95% CI: 0.97-1.89). Length of stay was shorter with MANTA. Subgroup analyses suggested significant interaction based on study designs such that there was higher incidence of access-site vascular complications and bleeding events with plug-based versus suture-based VCD among RCTs. CONCLUSION In patients undergoing TF-TAVR, large-bore access site closure with plug-based VCD was associated with a similar safety profile as suture-based VCD. However, subgroup analysis showed that plug-based VCD was associated with higher incidence of vascular and bleeding complications in RCTs.
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Affiliation(s)
- Ramy Sedhom
- Division of Cardiology, Loma Linda University Health, Loma Linda, California, USA
| | - Alexander T Dang
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Amr Elwagdy
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Michael Megaly
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Firas Zahr
- Division of Cardiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Samir Gafoor
- Swedish Heart and Vascular Institute, Seattle, Washington, USA
| | - Mamas Mamas
- Centre for Prognosis Research, Keele Cardiovascular Research Group, Keele University, Keele, UK.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Ayman Elbadawi
- Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
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5
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Tokuda T, Yamamoto M. Vascular management during transcatheter aortic valve replacement. Cardiovasc Interv Ther 2023; 38:18-27. [PMID: 36447120 DOI: 10.1007/s12928-022-00900-z] [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: 03/16/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022]
Abstract
Transcatheter aortic valve replacement (TAVR), as an alternative to open heart surgery, has been established as the standard therapy for patients with severe aortic valve stenosis. Vascular access management, the first step in a TAVR procedure, should be managed properly. Moreover, the transfemoral and alternatives such as the transaxillary/subclavian, transcarotid, transapical, and transcaval approaches are considered access routes during TAVR. More than 90% of cases can be treated via the transfemoral approach in the current TAVR era, whereas other approaches should be considered in patients in whom the transfemoral approach is not suitable. Vascular complications regardless of access route differences are a specific issue of TAVR caused by the use of large sheaths. With the increased number of TAVR cases, we must manage vascular complications and decrease the morbidity and mortality rates associated with TAVR procedures. Thus, this study aimed to review the vascular complications during TAVR and summarize their prognosis, prevention, and adequate management.
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Affiliation(s)
- Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan.
| | - Masanori Yamamoto
- Department of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan. .,Department of Cardiology, Toyohashi Heart Center, Toyohashi, Aichi, Japan. .,Department of Cardiology, Gifu Heart Center, Gifu, Japan.
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Comparison of Suture-Based and Collagen-Based Vascular Closure Devices for Large Bore Arteriotomies-A Meta-Analysis of Bleeding and Vascular Outcomes. J Cardiovasc Dev Dis 2022; 9:jcdd9100331. [PMID: 36286283 PMCID: PMC9604251 DOI: 10.3390/jcdd9100331] [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: 07/16/2022] [Revised: 09/15/2022] [Accepted: 09/27/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Large bore access procedures rely on vascular closure devices to minimize access site complications. Suture-based vascular closure devices (S-VCD) such as ProGlide and ProStar XL have been readily used, but recently, newer generation collagen-based vascular closure devices (C-VCD) such as MANTA have been introduced. Data on comparisons of these devices are limited. METHODS PubMed, Scopus and Cochrane were searched for articles on vascular closure devices using keywords, ("Vascular closure devices" OR "MANTA" OR "ProStar XL" OR "ProGlide") AND ("outcomes") that resulted in a total of 875 studies. Studies were included if bleeding or vascular complications as defined by Valve Academic Research Consortium-2 were compared between the two types of VCDs. The event level data were pooled across trials to calculate the Odds Ratio (OR) with 95% CI, and analysis was done with Review Manager 5.4 using random effects model. RESULTS Pooled analyses from these nine studies resulted in a total of 3410 patients, out of which 2855 were available for analysis. A total of 1229 received C-VCD and 1626 received S- VCD. Among the patients who received C-VCD, the bleeding complications (major and minor) were similar to patients who received S-VCD ((OR: 0.70 (0.35-1.39), p = 0.31, I2 = 55%), OR: 0.92 (0.53-1.61), p = 0.77, I2 = 65%)). The vascular complications (major and minor) in patients who received C-VCD were also similar to patients who received S-VCD ((OR: 1.01 (0.48-2.12), p = 0.98, I2 = 52%), (OR: 0.90 (0.62-1.30), p = 0.56, I2 = 35%)). CONCLUSIONS Bleeding and vascular complications after large bore arteriotomy closure with collagen-based vascular closure devices are similar to suture-based vascular closure devices.
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7
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Peripheral Artery Disease. J Am Coll Cardiol 2022; 79:1236-1238. [DOI: 10.1016/j.jacc.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/19/2022]
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Marcusohn E, Qasum M, Epstein D, Solomonica A, Orbach A, Musallam A, Kerner A, Feld Y. Vascular Complications Among Patients Undergoing Trans-femoral Transcatheter Aortic Valve Implantation: Prostar vs ProGlide Parallel Technique. Angiology 2022; 73:635-642. [PMID: 35147041 DOI: 10.1177/00033197211058498] [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] [Indexed: 12/17/2022]
Abstract
Reliable femoral artery closure devices are essential for the success of trans-femoral Transcatheter Aortic Valve Implantation (TAVI) procedures. Accordingly, device choice might affect vascular complications and bleeding rates. This was a retrospective analysis, comparing vascular complication rates among patients who underwent trans-femoral TAVI with vascular access closure using either the ProGlide parallel suture or Prostar closure devices. We included 191 patients: 106 were treated with Prostar and 85 with ProGlide. The ProGlide group had higher rate of diabetes, chronic kidney disease, peripheral arterial disease, and significantly smaller femoral arteries that were treated via larger sheaths. Valve Academic Research Consortium (VARC)-2 major complications were similar between the groups. (4.7% for ProGlide vs 3.8% for Prostar, P=1), with similar incidence of closure device failure (2 vs 3, P=1). No differences were found after univariant analysis and propensity-score matching in the incidence of major and minor bleeding nor in the rate of in-hospital mortality between ProGlide and Prostar (4.7 vs 2.8%, P=.7, 1.2 vs 2.8%, P=.63, and 1.2 vs .0%, P=.45, respectively). Parallel suture technique using two ProGlide sutures showed comparable rates of vascular complications to the Prostar closure device in higher risk population of TAVI patients.
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Affiliation(s)
- Erez Marcusohn
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Majd Qasum
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Danny Epstein
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - Amir Solomonica
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.,Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ady Orbach
- Schulich Heart Center - Sunnybrook Health Science Center, Toronto, ON, Canada
| | - Anees Musallam
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Arthur Kerner
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.,Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yair Feld
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.,Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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9
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Das TM, Shin J, Czarny MJ, Nanavati J, Resar JR, Hasan RK. Radial versus femoral secondary access for transcatheter aortic valve replacement: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2021; 99:1225-1233. [PMID: 34792259 DOI: 10.1002/ccd.30009] [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: 04/20/2021] [Revised: 09/28/2021] [Accepted: 10/20/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We aimed to evaluate the risk of procedural complications after TAVR using secondary radial access (RA) versus femoral access (FA) through a systematic review and meta-analysis of the published literature. BACKGROUND Transcatheter aortic valve replacement (TAVR) entails both large-bore arterial access for device delivery and secondary arterial access for hemodynamic and imaging assessments. It is unknown whether RA versus FA for this secondary access reduces the risk of procedural complications. METHODS We searched PubMed, Embase, the Cochrane Library, and Web of Science for observational studies comparing TAVR procedural complications in RA versus FA. Event rates were compared via weighted summary odds ratios using the Mantel-Haenszel method. RESULTS Six manuscripts encompassing 6132 patients were included. Meta-analysis showed that RA reduced the risk of major vascular complications (OR 0.58, 95% CI 0.43-0.77, p < 0.001, I2 0%) and major/life-threatening bleeding (OR 0.46, 95% CI 0.36-0.59, p < 0.001, I2 0%) as compared to FA for secondary TAVR access. We also observed a reduction 30-day mortality (OR 0.55, 95% CI 0.38-0.79, p = 0.001, I2 0%), acute kidney injury (OR 0.45, 95% CI 0.34-0.60, p < 0.001, I2 0%), and stroke and transient ischemic attack (OR 0.43, 95% CI 0.27-0.67, p < 0.001, I2 0%). CONCLUSIONS RA reduced the risk of major vascular and bleeding complications when compared to FA for secondary access in TAVR. RA is associated with reduced risk of other adverse outcomes including mortality, but these associations may be related to selection bias and confounding given the observational study designs.
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Affiliation(s)
- Thomas M Das
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joseph Shin
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew J Czarny
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Julie Nanavati
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jon R Resar
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rani K Hasan
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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10
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Prevalence of Posttranscatheter Aortic Valve Implantation Vascular Complications in Real Life. J Interv Cardiol 2021; 2021:5563486. [PMID: 34729054 PMCID: PMC8526196 DOI: 10.1155/2021/5563486] [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: 01/17/2021] [Revised: 09/13/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Vascular complications (VCs) are commonly observed after transfemoral transcatheter aortic valve implantation (TAVI) procedures. Closure devices for the access site were developed to reduce their incidence. We aim to evaluate the prevalence, predictors, and outcomes of the occurrence of post-TAVI VCs. Materials and Methods A retrospective study was conducted on 1336 consecutive patients who underwent TAVI at the University Hospital of Toulouse, France, between January 2016 and March 2020. All included procedures were performed through the common femoral artery, and ProGlide® was the used closure device. The studied population was divided into two groups depending on the occurrence of VCs defined according to Valve Academic Research Consortium-2 criteria. Results The mean age of the studied population was 84.4 ± 6.9, and 48% were male. 90% of TAVI interventions were performed through the right femoral artery. The prevalence of VCs was 18.8%, and 3.7% were major. Prolonged procedure duration was an independent predictor of VCs. Using the right access site and smaller introducer size (14 Fr) were preventive factors. No significant difference in mortality rate was detected between the two groups. Conclusion This study showed a low prevalence for post-TAVI VCs, especially for the major type. An increase in bleeding events and prolonged cardiac care unit stay were the common adverse outcomes.
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11
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Mach M, Okutucu S, Kerbel T, Arjomand A, Fatihoglu SG, Werner P, Simon P, Andreas M. Vascular Complications in TAVR: Incidence, Clinical Impact, and Management. J Clin Med 2021; 10:jcm10215046. [PMID: 34768565 PMCID: PMC8584339 DOI: 10.3390/jcm10215046] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/23/2021] [Accepted: 10/24/2021] [Indexed: 12/12/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has replaced surgical aortic valve replacement as the new gold standard in elderly patients with severe aortic valve stenosis. However, alongside this novel approach, new complications emerged that require swift diagnosis and adequate management. Vascular access marks the first step in a TAVR procedure. There are several possible access sites available for TAVR, including the transfemoral approach as well as transaxillary/subclavian, transcarotid, transapical, and transcaval. Most cases are primarily performed through a transfemoral approach, while other access routes are mainly conducted in patients not suitable for transfemoral TAVR. As vascular access is achieved primarily by large bore sheaths, vascular complications are one of the major concerns during TAVR. With rising numbers of TAVR being performed, the focus on prevention and successful management of vascular complications will be of paramount importance to lower morbidity and mortality of the procedures. Herein, we aimed to review the most common vascular complications associated with TAVR and summarize their diagnosis, management, and prevention of vascular complications in TAVR.
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Affiliation(s)
- Markus Mach
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
- Correspondence: ; Tel.: +43-1-40400-52620
| | - Sercan Okutucu
- Department of Cardiology, Memorial Ankara Hospital, 06520 Ankara, Turkey;
| | - Tillmann Kerbel
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
| | - Aref Arjomand
- Department of Cardiology, St. John of God Hospital, Geelong, VIC 3220, Australia;
| | | | - Paul Werner
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
| | - Paul Simon
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (T.K.); (P.W.); (P.S.); (M.A.)
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12
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Abbas S, Qayum I, Wahid R, Salman F, Khan H, Hassan F, Babar A, Inayat A. Acute Kidney Injury in Transcatheter Aortic Valve Replacement. Cureus 2021; 13:e15154. [PMID: 34168922 PMCID: PMC8214866 DOI: 10.7759/cureus.15154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction Transcatheter aortic valve replacement (TAVR) has been established as a standard of care for patients with severe aortic stenosis. We aim to study the predictors of acute kidney injury (AKI) after TAVR from a contemporary analysis using the National Inpatient Sample (NIS) database. Methods We performed a national analysis using the NIS database to evaluate predictors of acute kidney injury (AKI) after TAVR. Our study period was from 2015 to 2018, and we identified TAVR patients in all procedure fields. Patients aged less than 18 years were excluded from the study. Results We report data of 173,760 TAVR patients, of which 20,045 (11.5%) had AKI and 153,715 (88.4%) did not. There were three principal findings of our study. First, mortality was higher in patients with AKI compared to patients who did not have AKI (8% vs. 0.8%; p<0.01). Second, patients with chronic kidney disease, weight loss, liver disease, congestive heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, metastatic cancer, and peripheral vascular disease had higher adjusted odds of AKI. Third, length of stay and cost of stay were significantly higher in patients who had AKI during the index admission. Conclusion Patients with AKI had higher in-hospital mortality. We also report that at baseline, chronic kidney disease, weight loss, liver disease, congestive heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, metastatic cancer, and peripheral vascular disease were important predictors of AKI in patients after TAVR. Length of stay and cost of stay were higher with AKI, which result in higher burden on the health care system due to increased resource utilization.
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Affiliation(s)
- Sakina Abbas
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Ihtisham Qayum
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
| | - Rabiya Wahid
- Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Fnu Salman
- Medicine, St. Vincent Medical Center, Toledo, USA
| | - Henna Khan
- Internal Medicine, Khyber Girls Medical College, Peshawar, PAK
| | - Fatima Hassan
- Medicine, Fatima Jinnah Medical University, Lahore, PAK
| | - Anum Babar
- Medicine, Khyber Girls Medical College, Peshawar, PAK
| | - Arslan Inayat
- Internal Medicine, University at Buffalo, Catholic Health System, Buffalo, USA
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13
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Weisman SV, Cheng EP, Girvin F, Toy D, Hossain R, Steinberger S, Escalon J, Legasto AC. Acute Thoracic Complications of Minimally Invasive Cardiac Procedures. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00919-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Saad M, Seoudy H, Frank D. Challenging Anatomies for TAVR-Bicuspid and Beyond. Front Cardiovasc Med 2021; 8:654554. [PMID: 33928138 PMCID: PMC8076502 DOI: 10.3389/fcvm.2021.654554] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/15/2021] [Indexed: 12/23/2022] Open
Abstract
Transcatheter aortic valve replacement has emerged as the standard treatment for the majority of patients with symptomatic aortic stenosis. As transcatheter aortic valve replacement expands to patients across all risk groups, optimal patient selection strategies and device implantation techniques become increasingly important. A significant number of patients referred for transcatheter aortic valve replacement present with challenging anatomies and clinical indications that had been historically considered a contraindication for transcatheter aortic valve replacement. This article aims to highlight and discuss some of the potential obstacles that are encountered in clinical practice with a particular emphasis on bicuspid aortic valve disease.
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Affiliation(s)
- Mohammed Saad
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Hatim Seoudy
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
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15
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Buono A, Medda M, Cesna S, Davidavicius G, Casilli F, Bande M, Pellicano M, Tespili M, Ielasi A. Snaring the Transcatheter Heart Valve Delivery System During Aortic Valve Replacement: When and Why. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 28S:81-84. [PMID: 33674218 DOI: 10.1016/j.carrev.2021.02.018] [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: 12/17/2020] [Revised: 01/16/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
None of the commercially available self-expanding (SE)-trans-catheter heart valve (THVs) used for trans-catheter aortic valve replacement (TAVR) has a deflectable delivery system. This aspect can represent a shortcoming, especially in some anatomical scenario where THV advancement is challenging. The use of a snare catheter (SC), applying an external traction force, can increase THV trackability. We describe three different TAVR cases, in which a SE-THV was the only available option and where the THV delivery system advancement in the aortic arch was not feasible, if not with the combined use of a SC.
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Affiliation(s)
- Andrea Buono
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Massimo Medda
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Sigitas Cesna
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Centre of Cardiology and Angiology, Department of Cardiovascular Diseases, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Giedrius Davidavicius
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Centre of Cardiology and Angiology, Department of Cardiovascular Diseases, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Francesco Casilli
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Marta Bande
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Mariano Pellicano
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy.
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16
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Sinclair N, Mordhorst A, Yang GK, MacDonald PS, Sidhu R, Reid JDS. Vascular Access Complications and Clinical Outcomes of Vascular Surgical Repairs Following Transcatheter Aortic Valve Implantation (TAVI). Ann Vasc Surg 2021; 74:258-263. [PMID: 33549772 DOI: 10.1016/j.avsg.2020.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) procedures have revolutionized the treatment of aortic stenosis. However, due to large sheaths, improperly deployed closure devices, and the comorbidities and challenges innate to this population, vascular access complications can be devastating. The objective of this study is to evaluate vascular access complications in one of the largest TAVI sites in North America. METHODS This was a retrospective single center review between January 2014 and December 2018 of vascular access complications necessitating operative intervention by vascular surgery. Patient demographics and preoperative comorbidities were collected. Type of vascular access complication, types of repair, closure device used, and postoperative outcomes were analyzed. RESULTS A total of 37 cases out of a total of 985 TAVI procedures were identified. TAVI was carried out in the operating suite (70%) or the catheterization lab (30%). Consults to vascular surgery were requested intraoperatively (60%), immediately postoperative (14%), later in the day of the TAVI (20%), and on postoperative day 1 (6%). The location of injury included common femoral artery (49%), superficial femoral artery (11%) and external iliac artery (41%), with some cases injuring multiple vessels. Closure devices were found in the subcutaneous tissue (26%), anterior wall (37%), posterior wall (11%), intra-arterial (11%), closing the anterior to the posterior wall (16%), and in the inguinal ligament (5%). Injuries included tears (11%), dissections (38%), and vessel rupture (19%). The majority of repairs were done primarily (64%), with patch (28%) and bypass (8%) less frequently. Four patients died perioperatively (11%), 2 from hemorrhage, 1 from cardiac arrest, and 1 from progressive respiratory disease. CONCLUSIONS Access complications during TAVI procedures predispose complex patients to increased risk of morbidity and mortality. Careful patient selection, proper access techniques, and performing high risk patients in the operating suite with vascular surgery are fundamental in minimizing complications.
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Affiliation(s)
- Nicholas Sinclair
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alexa Mordhorst
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada.
| | - Gary K Yang
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada
| | - P Shaun MacDonald
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Ravi Sidhu
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada
| | - John D S Reid
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada
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17
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Abugroun A, Osman M, Awadalla S, Klein LW. Outcomes of Transcatheter Aortic Valve Replacement With Percutaneous Coronary Intervention versus Surgical Aortic Valve Replacement With Coronary Artery Bypass Grafting. Am J Cardiol 2020; 137:83-88. [PMID: 32991856 DOI: 10.1016/j.amjcard.2020.09.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
We aimed to compare the outcomes of combined surgical aortic valve replacement (SAVR) with coronary artery bypass grafting (CABG) to concurrent transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) in a large U.S. population sample. The National Inpatient Sample was queried for all patients diagnosed with aortic valve stenosis who underwent SAVR with CABG or TAVR with PCI during the years 2016 to 2017. Study outcomes included all-cause in-hospital mortality, acute stroke, pacemaker insertion, vascular complications, major bleeding, acute kidney injury, sepsis, non-home discharge, length of stay and cost. Outcomes of hospitalization were modeled using logistic regression for binary outcomes and generalized linear models for continuous outcomes. Overall, 31,205 patients were included (TAVR + PCI = 2,185, SAVR + CABG = 29,020). In reference to SAVR + CABG, recipients of TAVR + PCI were older with mean age 82 versus 73 years, effect size (d) = 0.9, had higher proportions of females 47.6% versus 26.6%, d = 0.4 and higher prevalence of congestive heart failure and chronic renal failure. On multivariable analysis, TAVR + PCI was associated with lowers odds for mortality adjusted OR: 0.32 (95% CI: 0.17 to 0.62) p = 0.001, lower odds for acute kidney injury, sepsis, non-home discharge, shorter length of stay and higher odds for vascular complications, need for pacemaker insertion and higher cost. The occurrence of stroke was similar between both groups. In conclusion, results from real-world observational data shows less rates of mortality and periprocedural complications in TAVR + PCI compared to SAVR + CABG.
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18
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Berti S, Bedogni F, Giordano A, Petronio AS, Iadanza A, Bartorelli AL, Reimers B, Spaccarotella C, Trani C, Attisano T, Marella Cenname A, Sardella G, Bonmassari R, Medda M, Tomai F, Tarantini G, Navarese EP. Efficacy and Safety of ProGlide Versus Prostar XL Vascular Closure Devices in Transcatheter Aortic Valve Replacement: The RISPEVA Registry. J Am Heart Assoc 2020; 9:e018042. [PMID: 33103545 PMCID: PMC7763424 DOI: 10.1161/jaha.120.018042] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Transcatheter aortic valve replacement (TAVR) requires large‐bore access, which is associated with bleeding and vascular complications. ProGlide and Prostar XL are vascular closure devices widely used in clinical practice, but their comparative efficacy and safety in TAVR is a subject of debate, owing to conflicting results among published studies. We aimed to compare outcomes with Proglide versus Prostar XL vascular closure devices after TAVR. Methods and Results This large‐scale analysis was conducted using RISPEVA, a multicenter national prospective database of patients undergoing transfemoral TAVR treated with ProGlide versus Prostar XL vascular closure devices. Both multivariate and propensity score adjustments were performed. A total of 2583 patients were selected. Among them, 1361 received ProGlide and 1222 Prostar XL. The predefined primary end point was a composite of cardiovascular mortality, bleeding, and vascular complications assessed at 30 days and 1‐year follow‐up. At 30 days, there was a significantly greater reduction of the primary end point with ProGlide versus Prostar XL (13.8% versus 20.5%, respectively; multivariate adjusted odds ratio, 0.80 [95% CI, 0.65–0.99]; P=0.043), driven by a reduction of bleeding complications (9.1% versus 11.7%, respectively; multivariate adjusted odds ratio, 0.76 [95% CI, 0.58–0.98]; P=0.046). Propensity score analysis confirmed the significant reduction of major adverse cardiovascular events and bleeding risk with ProGlide. No significant differences in the primary end point were found between the 2 vascular closure devices at 1 year of follow‐up (multivariate adjusted hazard ratio, 0.88 [95% CI, 0.72–1.10]; P=0.902). Comparable results were obtained by propensity score analysis. During the procedure, compared with Prostar XL, ProGlide yielded significant higher device success (99.2% versus 97.5%, respectively; P=0.001). Conclusions ProGlide has superior efficacy as compared with Prostar XL in TAVR procedures and is associated with a greater reduction of composite adverse events at short‐term, driven by lower bleeding complications. Registration Information URL: clinicaltrials.gov; Unique identifier: NCT02713932.
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Affiliation(s)
- Sergio Berti
- Department of Diagnostic and Interventional Cardiology Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart Hospital Massa Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology IRCCS Policlinico San Donato Milan Italy
| | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare Pineta Grande Hospital Castel Volturno Italy
| | - Anna S Petronio
- Department of Cardiology Azienda Ospedaliero-Universitaria Pisana Pisa Italy
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte Siena Italy
| | - Antonio L Bartorelli
- Centro Monzino IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco" University of Milan Italy
| | - Bernard Reimers
- Cardio Center Humanitas Research Hospital IRCCS Rozzano-Milan Italy
| | - Carmen Spaccarotella
- Division of Cardiology CCU and Interventional Cardiology Cardiovascular Research Center University Magna Graecia Catanzaro Italy
| | - Carlo Trani
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Tiziana Attisano
- Cardiologia Interventistica Dipartimento Cardio Toraco Vascolare AOU S. Giovanni di Dio e Ruggi D'Aragona Salerno Italt
| | - Angela Marella Cenname
- Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Gennaro Sardella
- Department of Cardiology Policlinico "Umberto I" Sapienza University of Rome Italy
| | | | - Massimo Medda
- Istituto Clinico Sant'Ambrogio, Gruppo San Donato Milano Italy
| | | | | | - Eliano P Navarese
- Department of Cardiology and Internal Medicine Interventional Cardiology and Cardiovascular Medicine Research Nicolaus Copernicus University Bydgoszcz Poland.,Faculty of Medicine University of Alberta Edmonton Canada.,SIRIO MEDICINE Research Network Bydgoszcz Poland
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Salas de Armas IA, Basra SS, Patel MK, Akay MH, Kumar S, Carrazo W, Marcano J, Akkanti B, Patel J, Mittal K, de Filippis A, Zaki J, Gregoric ID, Kar B. Axillary Access TAVR: Entrapment of a Transcatheter Aortic Valve in the Innominate Artery With Aortic Dissection. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:43-46. [PMID: 32593599 DOI: 10.1016/j.carrev.2020.06.020] [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: 03/27/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
Abstract
Non-femoral transcatheter aortic valve replacement (TAVR) is indicated when peripheral vascular disease is diagnosed. We describe the "double-stick" technique via the axillary artery. During the procedure, the pigtail coiled around the TAVR system. While retracting the TAVR sheath, the seam along system split dislodging the valve from the balloon. The valve was entrapped in the innominate artery, and an aortic dissection required surgery. With the double-stick technique, friction and resistance between the pigtail and delivery system must be avoided. Pre-procedural planning and early identification is paramount. Smaller and more seamless delivery systems may reduce risk for dissection and entrapment.
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Affiliation(s)
- Ismael A Salas de Armas
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - Sukhdeep S Basra
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - Manish K Patel
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - M Hakan Akay
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - Sachin Kumar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - Wendy Carrazo
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - Juan Marcano
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States of America
| | - Bindu Akkanti
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - Jayeshkumar Patel
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - Kriti Mittal
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - Alejandro de Filippis
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - John Zaki
- Department of Anesthesia, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, Houston, TX 77030, United States of America
| | - Igor D Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center-Houston and Memorial Hermann Hospital-Texas Medical Center, 6400 Fannin, Suite 2350, Houston, TX 77030, United States of America.
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20
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Fugar S, Behnamfar O, Okoh AK, Alabre AF, Salia S, Kosinski M, Mahmood A, Jolly N, Doukky R, Kavinsky CJ. Impact of chronic thrombocytopenia on in-hospital outcomes and healthcare resource utilization after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2019; 96:413-421. [PMID: 31714681 DOI: 10.1002/ccd.28519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 09/18/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND There is little data on the impact of chronic thrombocytopenia (CTP) on outcomes after transcatheter aortic valve repair (TAVR). Most studies are from single centers and mostly focused on postprocedure thrombocytopenia. OBJECTIVES This study sought to report on the impact of CTP (>1 year) on in-hospital outcomes and healthcare resource utilization after TAVR. METHODS From the National Inpatient Sample (NIS) between 2012 and 2015, we identified patients with CTP who underwent TAVR. A 1:1 propensity-matched cohort was created to examine in-hospital outcomes in patients with and without CTP. The primary outcome was in-hospital mortality. Secondary outcomes included postprocedure complications, length of stay, total cost, and discharge disposition. RESULTS A matched pair of 4,300 patients with and without CTP were identified. Patients with CTP had higher in-hospital mortality as compared to no CTP patients (6.0 vs. 3.3%, p-value .007), increased postprocedure hemorrhage, platelet and blood transfusion, vascular complications, postop sepsis, and acute kidney injury. With regards to resource utilization, CTP patients had a longer length of stay, higher total cost and were more likely to be discharged to a facility (34.1 vs. 27.6%) other than home (All, p-value <.001). Subanalysis, however, revealed this difference in resource utilization was seen when patients developed postprocedure complications. CONCLUSION This study demonstrated higher risk of in-hospital mortality, perioperative complications, and healthcare resource utilization in patients with baseline CTP undergoing TAVR. Further studies are required to investigate ways to improve the management of these patients.
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Affiliation(s)
- Setri Fugar
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Omid Behnamfar
- Department of Medicine, Cook County Health, Chicago, Illinois
| | - Alexis K Okoh
- Cardiovascular Research Unit, RWJ Barnabas Heart Health Center, Newark Beth Israel Medical Center, Newark, New Jersey
| | - Alisha F Alabre
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Soziema Salia
- Department of Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Mark Kosinski
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Ali Mahmood
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Neeraj Jolly
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Rami Doukky
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois.,Division of Cardiology, Cook County Health, Chicago, Illinois
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21
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Mohananey D, Villablanca P, Gupta T, Ranka S, Bhatia N, Adegbala O, Ando T, Wang DD, Wiley JM, Eng M, Kalra A, Ramakrishna H, Shah B, O'Neill W, Saucedo J, Bhatt DL. Association of peripheral artery disease with in-hospital outcomes after endovascular transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2019; 94:249-255. [PMID: 31025488 DOI: 10.1002/ccd.28310] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/10/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of this study was to determine the prevalence of peripheral artery disease (PAD) and its association with in-hospital outcomes after endovascular transcatheter aortic valve replacement (EV-TAVR). BACKGROUND TAVR is an established treatment for patients at prohibitive, high, or intermediate surgical risk. PAD is a significant comorbidity in the determination of surgical risk. However, data on association of PAD with outcomes after EV-TAVR are limited. METHODS Patients in the National Inpatient Sample who underwent EV-TAVR between January 1, 2012 and September 30, 2015 were evaluated. The primary outcome was in-hospital mortality. RESULTS A total of 51,685 patients underwent EV-TAVR during the study period. Of these, 12,740 (24.6%) had a coexisting diagnosis of PAD. The adjusted odds for in-hospital mortality [OR 1.08 (95% CI 0.83-1.41)], permanent pacemaker implantation [OR 0.98 (0.85-1.14)], conversion to open aortic valve replacement [OR 1.05 (0.49-2.26)], or acute myocardial infarction [OR 1.31(0.99-1.71)] were not different in patients with versus without PAD. However, patients with PAD had greater adjusted odds of vascular complications [OR 1.80 (1.50-2.16)], major bleeding [OR 1.20 (1.09-1.34)], acute kidney injury (AKI) [OR 1.19 (1.05-1.36)], cardiac complications [aOR 1.21 (1.01-1.44)], and stroke [OR 1.39(1.10-1.75)] compared with patients without PAD. Length of stay (LOS) was significantly longer for patients with PAD [7.23 (0.14) days vs. 7.11 (0.1) days, p < 0.001]. CONCLUSION Of patients undergoing EV-TAVR, ~25% have coexisting PAD. PAD was not associated with increased risk of in-hospital mortality but was associated with higher risk of vascular complications, major bleeding, AKI, stroke, cardiac complications, and longer LOS.
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Affiliation(s)
- Divyanshu Mohananey
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pedro Villablanca
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan
| | - Tanush Gupta
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Sagar Ranka
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
| | - Nirmanmoh Bhatia
- Division of Cardiovascular Medicine, Vanderbilt, University Medical Center, Nashville, Tennessee
| | - Oluwole Adegbala
- Department of Internal Medicine, Englewood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, South Orange, New Jersey
| | - Tomo Ando
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan
| | - Jose M Wiley
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Marvin Eng
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Binita Shah
- Leon H. Charney Division of Cardiology, New York University, New York, New York
| | - William O'Neill
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan
| | - Jorge Saucedo
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
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22
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Williams JV, Flynn Makic MB. Postoperative Care for Transcatheter Aortic Valve Replacement. J Perianesth Nurs 2019; 34:431-434. [PMID: 30819598 DOI: 10.1016/j.jopan.2018.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/31/2018] [Indexed: 11/28/2022]
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23
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van Wiechen MP, Ligthart JM, Van Mieghem NM. Large-bore Vascular Closure: New Devices and Techniques. ACTA ACUST UNITED AC 2019; 14:17-21. [PMID: 30858887 PMCID: PMC6406132 DOI: 10.15420/icr.2018.36.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Endovascular aneurysm repair, transcatheter aortic valve implantation and percutaneous mechanical circulatory support systems have become valuable alternatives to conventional surgery and even preferred strategies for a wide array of clinical entities. Their adoption in everyday practice is growing. These procedures require large-bore access into the femoral artery. Their use is thus associated with clinically significant vascular bleeding complications. Meticulous access site management is crucial for safe implementation of large-bore technologies and includes accurate puncture technique and reliable percutaneous closure devices. This article reviews different strategies for obtaining femoral access and contemporary percutaneous closure technologies.
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Affiliation(s)
- Maarten P van Wiechen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Jurgen M Ligthart
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
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24
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Lazkani M, Singh N, Howe C, Patel N, Colón MJ, Tasset M, Amabile O, Morris M, Fang HK, Pershad A. An updated meta-analysis of TAVR in patients at intermediate risk for SAVR. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:57-69. [DOI: 10.1016/j.carrev.2018.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 11/25/2022]
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26
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Foley TR, Stinis CT. Imaging Evaluation and Interpretation for Vascular Access for Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2018; 7:285-291. [PMID: 29983141 DOI: 10.1016/j.iccl.2018.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as an effective therapy for aortic stenosis in patients who are at intermediate and high surgical risk. Vascular access remains critical to the success of the TAVR procedure. This article reviews the use of imaging in planning and executing TAVR access.
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Affiliation(s)
- T Raymond Foley
- Division of Interventional Cardiology, Scripps Clinic, 9898 Genessee Avenue, La Jolla, CA 92037, USA
| | - Curtiss T Stinis
- Division of Interventional Cardiology, Scripps Clinic, 9898 Genessee Avenue, La Jolla, CA 92037, USA.
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Toppen W, Suh W, Aksoy O, Benharash P, Bowles C, Shemin RJ, Kwon M. Vascular Complications in the Sapien 3 Era: Continued Role of Transapical Approach to Transcatheter Aortic Valve Replacement. Semin Thorac Cardiovasc Surg 2018. [DOI: 10.1053/j.semtcvs.2018.02.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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CME Opportunities and Save the Date. Vasc Med 2017; 22:554-555. [PMID: 29202679 DOI: 10.1177/1358863x17737423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Chaudhry MA, Sardar MR. Vascular complications of transcatheter aortic valve replacement: A concise literature review. World J Cardiol 2017; 9:574-582. [PMID: 28824787 PMCID: PMC5545141 DOI: 10.4330/wjc.v9.i7.574] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/25/2017] [Accepted: 05/15/2017] [Indexed: 02/06/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a relatively newer therapeutic modality which offers a promising alternative to surgical aortic valve replacement for patients with prohibitive, high and intermediate surgical risk. The increasing trend to pursue TAVR in these patients has also led to growing awareness of the associated potential vascular complications. The significant impact of these complications on eventual clinical outcome and mortality makes prompt recognition and timely management a critical factor in TAVR patients. We hereby present a concise review with emphasis on diverse vascular complications associated with TAVR and their effective management to improve overall clinical outcomes.
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