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Caetano L, Gibicoski TB, Rodriguez F, Scabello I, da Silva Neto EP, Iplinski B. Impact of carotid artery stenosis on outcomes of transcatheter aortic valve replacement: A systematic review and meta-analysis. Int J Cardiol 2024; 399:131670. [PMID: 38141726 DOI: 10.1016/j.ijcard.2023.131670] [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: 06/26/2023] [Revised: 12/03/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Carotid Artery Stenosis (CAS) is common in elderly patients undergoing Transcatheter Aortic Valve Replacement (TAVR). However, the impact of CAS on the outcomes of TAVR is unclear. PURPOSE This systematic review and meta-analysis aimed to compare the clinical and periprocedural outcomes in patients with and without CAS undergoing TAVR. METHODS PubMed, Embase, and Cochrane databases were searched until February 2023. We included studies that performed a direct comparison of outcomes of TAVR in CAS versus non-CAS patients. Data was extracted from published reports and the ROBINS-I tool was utilized for quality assessment. The R studio software (version 4.2.2) was adopted for statistical analysis. RESULTS Five observational studies and 111.915 patients were included. The mean age was 80.7 ± 8.2 years and 46.3% were female. The risk of stroke or transient ischemic attack was elevated in the group of patients with CAS (OR 1.44; 95% CI 1.07-1.95; p = 0.016). In contrast, myocardial infarction (OR 1.24; 95% CI 1.05-1.47; p = 0.074) and all-cause mortality (OR 0.99; 95% CI 0.73-1.35; p = 0.95) were not significantly different between CAS and non-CAS groups. Acute kidney injury and new pacemaker implantation did not differ between patients with and without CAS. CONCLUSIONS Our findings suggest that CAS is significantly associated with cerebrovascular events in patients undergoing TAVR, without significantly impacting all-cause mortality. Further prospective studies are needed for a more granular assessment of additional determinants of this association, such as unilateral vs. bilateral involvement and whether there is a threshold of CAS severity for increased risk.
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Affiliation(s)
- Lucas Caetano
- Department of Medicine, Federal University of Paraiba, Joao Pessoa, Brazil.
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Lundahl C, Kragholm K, Tayal B, Karasoy D, Andersen NH, Strange JE, Olesen JB, Østergaard L, Fosbøl E, Torp-Pedersen C, Søgaard P, Terkelsen CJ, Nissen H, De Backer O, Freeman PM. Temporal Trends in Patient Characteristics and Outcomes of Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement: A Nationwide Study. Am J Cardiol 2024; 211:299-306. [PMID: 37984636 DOI: 10.1016/j.amjcard.2023.11.024] [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: 06/08/2023] [Revised: 11/05/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
With increased use of transcatheter aortic valve implantation (TAVI) in treatment of aortic stenosis, it is important to evaluate real life data trends in outcomes. This nationwide register-based study aimed to present an outlook on temporal trends in characteristics and outcomes, including mortality. First-time consecutive Danish patients who underwent TAVI from 2010 to 2019 were included in this study. The chi-square and Kruskal-Wallis tests were performed to assess the differences in the characteristics over time and Cochrane-Armitage trend tests were used to examine changes in complications and mortality. Between 2010 and 2019, 4,847 patients (54.6% men, median age 82 [quartile 1 to quartile 3: 77 to 85] years) underwent first-time TAVI. A statistically significant decrease over time was observed for preprocedural hypertension, ischemic heart disease, and heart failure, whereas preexisting chronic obstructive lung disease and preprocedural pacemaker remained stable. We observed a significant decrease in 30- and 90-day postoperative preprocedural pacemaker implantation from 2011 to 2017, with 15.1% and 15.9% in 2011 and 8.6% and 8.9% in 2017, respectively. The incidence of for 30- and 90-day heart failure significantly decreased from 19.3% and 20.3% to 8.5% and 9.1%, respectively. We observed significant changes for 30-day atrial fibrillation, whereas the changes over time for 90-day atrial fibrillation and 30- and 90-day stroke/transient ischemic attack remained insignificant. The all-cause mortality within 30- and 90 days significantly decreased over time from 6.7% and 9.2% in 2011 to 1.5% and 2.7% in 2019 and 2016, respectively. In conclusion, this national study provides general insight on the trends of complications and mortality of TAVI, demonstrating significant reductions over time.
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Affiliation(s)
- Camilla Lundahl
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jarl E Strange
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark; Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jonas B Olesen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Lauge Østergaard
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Emil Fosbøl
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology and Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christian J Terkelsen
- Department of Cardiology, Aarhus University Hospital, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - Henrik Nissen
- Department of Cardiology, Odense University Hospital, Denmark
| | - Ole De Backer
- Department of Cardiology, the Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Phillip M Freeman
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Sun J, Meng QT, Wang YW, Zhao WL, Sun FZ, Liu JH, Liu JY. Comparison of the levels of depression and anxiety in elderly aortic stenosis patients treated with surgical or transcatheter aortic valve replacement. J Cardiothorac Surg 2022; 17:141. [PMID: 35659343 PMCID: PMC9164896 DOI: 10.1186/s13019-022-01888-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Currently, only a few studies have been conducted on the mental status recovery in elderly aortic stenosis (AS) patients after treatment. How transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) differentially impinge on the mental status of elderly AS patients is completely unknown. The present prospective study aims to investigate this question by comparing the post-treatment levels of depression and anxiety, quality of life and frailty. Methods A total of 120 elderly patients (age above 70) with symptomatic AS were included, where 78 of them were treated with TAVR and 42 of them were treated with SAVR. Levels of depression and anxiety, quality of life and frailty were assessed by the Chinese version of Hospital Anxiety and Depression Scale (HADS), World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD) and clinical frailty scale, respectively. Scores were recorded and compared at admission, 1 month, 4 months and 8 months after treatment.
Results Before treatment, both patient groups had similar baseline characteristics and all mental parameters. During the follow-up period, patients in the TAVR group demonstrated significant improvement in all assessed mental parameters to certain extent compared to the SAVR group. Specifically, frailty was significantly improved in the TAVR-treated patients at all three follow-up time points. Levels of depression and anxiety were significantly improved 8 months after treatment, although the remaining patient number is limited. Quality of life was only significantly improved 1 month after treatment. Conclusion TAVR may provide a better mental recovery outcome in elderly AS patients.
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Affiliation(s)
- Jiao Sun
- Department of Neurology, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, Liaoning, China
| | - Qing-Tao Meng
- Department of Cardiac Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, Liaoning, China
| | - Yu-Wei Wang
- Department of Cardiac Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, Liaoning, China
| | - Wei-Long Zhao
- Heart Centre, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, Liaoning, China
| | - Feng-Zhi Sun
- Heart Centre, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, Liaoning, China
| | - Ji-Hong Liu
- Department of Cardiac Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, Liaoning, China.
| | - Ji-Yi Liu
- Heart Centre, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, Liaoning, China.
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Boxhammer E, Berezin AE, Paar V, Bacher N, Topf A, Pavlov S, Hoppe UC, Lichtenauer M. Severe Aortic Valve Stenosis and Pulmonary Hypertension: A Systematic Review of Non-Invasive Ways of Risk Stratification, Especially in Patients Undergoing Transcatheter Aortic Valve Replacement. J Pers Med 2022; 12:jpm12040603. [PMID: 35455719 PMCID: PMC9026430 DOI: 10.3390/jpm12040603] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 02/01/2023] Open
Abstract
Patients with severe aortic valve stenosis and concomitant pulmonary hypertension show a significantly reduced survival prognosis. Right heart catheterization as a preoperative diagnostic tool to determine pulmonary hypertension has been largely abandoned in recent years in favor of echocardiographic criteria. Clinically, determination of echocardiographically estimated systolic pulmonary artery pressure falls far short of invasive right heart catheterization data in terms of accuracy. The aim of the present systematic review was to highlight noninvasive possibilities for the detection of pulmonary hypertension in patients with severe aortic valve stenosis, with a special focus on cardiovascular biomarkers. A total of 525 publications regarding echocardiography, cardiovascular imaging and biomarkers related to severe aortic valve stenosis and pulmonary hypertension were analyzed in a systematic database analysis using PubMed Central®. Finally, 39 publications were included in the following review. It was shown that the current scientific data situation, especially regarding cardiovascular biomarkers as non-invasive diagnostic tools for the determination of pulmonary hypertension in severe aortic valve stenosis patients, is poor. Thus, there is a great scientific potential to combine different biomarkers (biomarker scores) in a non-invasive way to determine the presence or absence of PH.
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Affiliation(s)
- Elke Boxhammer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (V.P.); (N.B.); (A.T.); (U.C.H.)
| | - Alexander E. Berezin
- Internal Medicine Department, State Medical University of Zaporozhye, 69035 Zaporozhye, Ukraine;
| | - Vera Paar
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (V.P.); (N.B.); (A.T.); (U.C.H.)
| | - Nina Bacher
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (V.P.); (N.B.); (A.T.); (U.C.H.)
| | - Albert Topf
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (V.P.); (N.B.); (A.T.); (U.C.H.)
| | - Sergii Pavlov
- Department of Clinical Laboratory Diagnostics, State Medical University of Zaporozhye, 69035 Zaporozhye, Ukraine;
| | - Uta C. Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (V.P.); (N.B.); (A.T.); (U.C.H.)
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (V.P.); (N.B.); (A.T.); (U.C.H.)
- Correspondence:
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Sabatino J, De Rosa S, Leo I, Strangio A, La Bella S, Sorrentino S, Mongiardo A, Spaccarotella C, Polimeni A, Indolfi C. Early reduction of left atrial function predicts adverse clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Open Heart 2021; 8:openhrt-2021-001685. [PMID: 34233914 PMCID: PMC8264907 DOI: 10.1136/openhrt-2021-001685] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/18/2021] [Indexed: 12/23/2022] Open
Abstract
Aims To investigate the changes in left atrial strain (LAS) after correction of severe aortic stenosis (AS) with transcatheter aortic valve replacement (TAVR) and assess its prognostic impact. Methods and results One hundred consecutive patients with severe symptomatic AS who underwent TAVR at the Magna Graecia University of Catanzaro underwent echocardiographic examination including assessment of LAS before and after TAVR. Independent investigators collected outcome data and information. The primary study outcome was the difference in ΔLAS (postTAVR–preTAVR) between patients those met the main clinical endpoint (a composite of cardiovascular mortality and heart failure hospitalisation) and those not meeting the endpoint. During a median follow-up of 31 months, 35 patients (35%) met the combined clinical endpoint. The difference between LAS post-TAVR and LAS pre-TAVR (ΔLAS) was significantly larger in patients who met the combined endpoint (HR=0.76 (0.67–0.86); p<0.001). Multivariate logistic regression analysis including ΔLAS, EuroSCORE II and left ventricular ejection fraction showed that ΔLAS (HR=0.80, p<0.001) was the only independent predictor of the combined clinical endpoint. Finally, a Kaplan-Maier analysis showed that patients with a ΔLAS above its median value had a significantly better event-free survival compared with those below the median (p<0.001). Conclusions A lower reduction in ΔLAS after TAVR was an independent predictor of the primary composite outcome of cardiovascular death and hospitalisation for heart failure.
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Affiliation(s)
- Jolanda Sabatino
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Isabella Leo
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Antonio Strangio
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Sabrina La Bella
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Sabato Sorrentino
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Annalisa Mongiardo
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Carmen Spaccarotella
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Alberto Polimeni
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy .,Mediterranea Cardiocentro, Napoli, Italy
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Bäz L, Puscholt M, Lasch C, Diab M, Möbius-Winkler S, Schulze PC, Dannberg G, Franz M. Delayed Improvement of Depression and Anxiety after Transcatheter Aortic Valve Implantation (TAVI) in Stages of Extended Extra-Valvular Cardiac Damage. J Clin Med 2021; 10:jcm10081579. [PMID: 33918058 PMCID: PMC8070529 DOI: 10.3390/jcm10081579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Depression and anxiety are frequently occurring and likely to be linked to the severity of cardiac diseases like aortic stenosis (AS). This seems to be of interest since a staging classification of extra-valvular cardiac damage in AS has been introduced and shown to be of prognostic relevance. Objective: The current study aimed to investigate the frequency of depression and anxiety in association to staging and their dynamics after transcatheter aortic valve implantation (TAVI). Methods: A total number of 224 AS patients undergoing TAVI were classified according to the 2017 staging classification into stage 0 to 4 and further dichotomized into group A (stage 0 to 2) and B (stage 3 and 4). Using the Hospital Anxiety and Depression Scale (HADS-D), patients were assigned to depressive versus non-depressive or anxious versus non-anxious per staging group respectively, and analyzed at baseline, 6 weeks, 6 months and 12 months after TAVI. Results: After dichotomization, 158 patients (70.5%) were assigned to group A and 66 patients (29.5%) to group B. The part showing pathologic values for depression was 25.4% (57/224 patients) in the entire collective, 26.6% (42/158 patients) in group A and 22.7% (15/66 patients) in group B (p = n.s.). The proportion showing pathologic values for anxiety was 26.8% (60/224 patients) in the entire collective and did not differ between group A (24.7%, 39/158 patients) and B (31.8%, 21/66 patients) (p = n.s.). In patients revealing pathologic values for depression or anxiety prior to TAVI, there were significant and stable improvements over time observable already in short-term (6 weeks) follow-up in group A, and likewise, but later, in long-term (6/12 months) follow-up in group B. Conclusions: Although of proven prognostic relevance, higher stages of extra-valvular cardiac damage are not associated with higher rates of pre-existing depression or anxiety. The TAVI procedure resulted in a persisting reduction of depression and anxiety in patients showing pathologic values at baseline. Notably, these improvements are timely delayed in higher stages.
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Affiliation(s)
- Laura Bäz
- Department of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.B.); (M.P.); (C.L.); (S.M.-W.); (P.C.S.); (G.D.)
| | - Marisa Puscholt
- Department of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.B.); (M.P.); (C.L.); (S.M.-W.); (P.C.S.); (G.D.)
| | - Claudia Lasch
- Department of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.B.); (M.P.); (C.L.); (S.M.-W.); (P.C.S.); (G.D.)
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany;
| | - Sven Möbius-Winkler
- Department of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.B.); (M.P.); (C.L.); (S.M.-W.); (P.C.S.); (G.D.)
| | - P. Christian Schulze
- Department of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.B.); (M.P.); (C.L.); (S.M.-W.); (P.C.S.); (G.D.)
| | - Gudrun Dannberg
- Department of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.B.); (M.P.); (C.L.); (S.M.-W.); (P.C.S.); (G.D.)
| | - Marcus Franz
- Department of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany; (L.B.); (M.P.); (C.L.); (S.M.-W.); (P.C.S.); (G.D.)
- Correspondence: ; Tel.: +49-(3641)-9324127; Fax: +49-(3641)-0324102
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Abstract
Structural heart disease (SHD) emergencies include acute deterioration of a stable lesion or development of a new critical lesion. Structural heart disease emergencies can produce heart failure and cardiogenic shock despite preserved systolic function that may not respond to standard medical therapy and typically necessitate surgical or percutaneous intervention. Comprehensive Doppler echocardiography is the initial diagnostic modality of choice to determine the cause and severity of the underlying SHD lesion. Patients with chronic SHD lesions which deteriorate due to intercurrent illness (eg, infection or arrhythmia) may not require urgent intervention, whereas patients with an acute SHD lesion often require definitive therapy. Medical stabilization prior to definitive intervention differs substantially between stenotic lesions (aortic stenosis, mitral stenosis, left ventricular outflow tract obstruction) and regurgitant lesions (aortic regurgitation, mitral regurgitation, ventricular septal defect). Patients with regurgitant lesions typically require aggressive afterload reduction and inotropic support, whereas patients with stenotic lesions may paradoxically require β-blockade and vasoconstrictors. Emergent cardiac surgery for patients with decompensated heart failure or cardiogenic shock carries a substantial mortality risk but may be necessary for patients who are not eligible for catheter-based percutaneous SHD intervention. This review explores initial medical stabilization and subsequent definitive therapy for patients with SHD emergencies.
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Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, 4352Mayo Clinic Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, 4352Mayo Clinic Rochester, MN, USA
| | - Bradley Ternus
- Division of Cardiovascular Medicine, 5228University of Wisconsin, Madison, WI, USA
| | - Mackram Eleid
- Department of Cardiovascular Medicine, 4352Mayo Clinic Rochester, MN, USA
| | - Charanjit Rihal
- Department of Cardiovascular Medicine, 4352Mayo Clinic Rochester, MN, USA
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Theologou T, Harky A, Shaw M, Harrington D, Kuduvalli M, Oo A, Field M. Mitroflow and Perimount Magna 10 years outcomes a direct propensity match analysis to assess reintervention rates and long follow‐up mortality. J Card Surg 2019; 34:1279-1287. [DOI: 10.1111/jocs.14250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Thomas Theologou
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Amer Harky
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Matthew Shaw
- Department of Clinical Audit and Clinical QualityThe Liverpool Heart and Chest HospitalLiverpool UK
| | - Deborah Harrington
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Manoj Kuduvalli
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Aung Oo
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Mark Field
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
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Indolfi C, Bartorelli AL, Berti S, Golino P, Esposito G, Musumeci G, Petronio S, Tamburino C, Tarantini G, Ussia G, Vassanelli C, Spaccarotella C, Violini R, Mercuro G, Romeo F. Updated clinical indications for transcatheter aortic valve implantation in patients with severe aortic stenosis: expert opinion of the Italian Society of Cardiology and GISE. J Cardiovasc Med (Hagerstown) 2018; 19:197-210. [PMID: 29578921 DOI: 10.2459/jcm.0000000000000636] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: The introduction of percutaneous treatment of severe aortic stenosis with transcatheter aortic valve implantation (TAVI) remains one of the greatest achievements of interventional cardiology. In fact, TAVI emerged as a better option than either medical therapy or balloon aortic valvuloplasty for patients who cannot undergo surgical aortic valve replacement (SAVR) or are at high surgical risk. Recently, increased operator experience and improved device systems have led to a worldwide trend toward the extension of TAVI to low-risk or intermediate-risk patients. In this expert opinion paper, we first discuss the basic pathophysiology of aortic stenosis in different settings then the key results of recent clinical investigations on TAVI in intermediate-risk aortic stenosis patients are summarized. Particular emphasis is placed on the results of the nordic aortic valve intervention, placement of aortic transcatheter valves (PARTNER) 2 and Surgical Replacement and Transcatheter Aortic Valve Implantation Randomized trials. The PARTNER 2 was the first large randomized trial that evaluated the outcome of TAVI in patients at intermediate risk. The PARTNER 2 data demonstrated that TAVI is a feasible and reasonable alternative to surgery in intermediate-risk patients (Society of Thoracic Surgeons 4-8%), especially if they are elderly or frail. There was a significant interaction between TAVI approach and mortality, with transfemoral TAVI showing superiority over SAVR. Moreover, we examine the complementary results of the recently concluded Surgical Replacement and Transcatheter Aortic Valve Implantation trial. This prospective randomized trial demonstrated that TAVI is comparable with surgery (primary end point 12.6% in the TAVI group vs. 14.0% in the SAVR group) in severe aortic stenosis patients deemed to be at intermediate risk. We review the most relevant clinical evidence deriving from nonrandomized studies and meta-analyses. Altogether, clinical outcome available data suggest that TAVI with a newer generation device might be the preferred treatment option in this patient subgroup. Finally, the differences between the latest European and American Guidelines on TAVI were reported and discussed. The conclusion of this expert opinion article is that TAVI, if feasible, is the treatment of choice in patients with prohibitive or high surgical risk and may lead to similar or lower early and midterm mortality rates compared with SAVR in intermediate-risk patients with severe aortic stenosis.
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Affiliation(s)
- Ciro Indolfi
- Cattedra di Cardiologia, Università degli Studi Magna Graecia, Catanzaro, Italy
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Wheeler RAE. Aortic Pathology. Echocardiography 2018. [DOI: 10.1007/978-3-319-71617-6_9] [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] Open
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Description and Validation of TAVIApp: A Novel Mobile Application for Support of Physicians in the Management of Aortic Stenosis-Management of Aortic Stenosis with TAVIApp. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9027597. [PMID: 29270437 PMCID: PMC5705902 DOI: 10.1155/2017/9027597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 10/11/2017] [Indexed: 11/17/2022]
Abstract
Background Aortic stenosis (AS) is the most common heart valve disease in developed countries. The advent of transcatheter aortic valve implantation (TAVI) significantly improved patients' outcome but made clinical management more complex. The aim of the present study was to describe TAVIApp, a mobile app we developed to guide the management of AS, and test its efficacy. Methods and Results Clinical cases comprising 42 patients with AS were blindly evaluated by (A) an interventional cardiologist, assisted by the Heart Team (EXPERT), (B) young residents in cardiology, and (C) a young resident supported by TAVIApp. There was poor concordance between Group A and Group B with low performance by young residents (k = 0.52; p < 0.001). However, concordance increased to an optimal value when young residents were supported by TAVIApp (k = 1.0; p < 0.001) for the diagnosis of severe AS and eligibility assessment. Furthermore, regarding the selection of the most appropriate prosthesis size, concordance to Group A was poor without TAVIApp support (Group B) (k = 0.78; p = 0.430), but excellent with TAVIApp (k = 1.0; p < 0.001). Conclusions This study is the first describing and validating a new mobile application to support the management of AS. TAVIApp supports cardiologists in the evaluation of stenosis severity, eligibility for TAVI or AVR, and selection of the most appropriate prosthesis size in individual patients.
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Bajrangee A, Coughlan JJ, Teehan S, O'Connor C, Murphy RT, Foley B, Daly C, Burke D, Maree AO, Crean PA. Early and mid-term outcomes after transcatheter aortic valve implantation (TAVI) in Ireland. IJC HEART & VASCULATURE 2017; 16:1-3. [PMID: 28785604 PMCID: PMC5502795 DOI: 10.1016/j.ijcha.2017.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 06/16/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND TAVI is a percutaneous approach to aortic valve replacement in high surgical risk patients deemed inoperable. AIM To evaluate the early and mid-term outcomes for an Irish TAVI cohort over a six-year period at St James's Hospital and Blackrock Clinic, Dublin, Ireland. RESULTS In total 147 patients, 56% male with an average age of 82 underwent TAVI between December 2008 and December 2014. Thirty day, one year and two year survival was 90.5%, 83% and 71% respectively. Major vascular complications and renal failure were the biggest predictors of mortality at 30 days (p = 0.02). We observed a pacing rate of 13.5%, the majority in patients who had Medtronic Corevalve implants (p < 0.05). With increasing procedural experience there was a reduction in length of stay from 10 days to 7.5 days. CONCLUSION This review, the first of its kind in Ireland showed favorable rates of 30 day and one year and two year survival post TAVI with procedural success and complication rates similar to international registry data.
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Affiliation(s)
- A Bajrangee
- Department of Cardiology CREST, Dept. St. James's Hospital James Street Dublin, Ireland
| | - J J Coughlan
- Department of Cardiology CREST, Dept. St. James's Hospital James Street Dublin, Ireland
| | - S Teehan
- Department of Cardiology CREST, Dept. St. James's Hospital James Street Dublin, Ireland
| | - C O'Connor
- Department of Cardiology CREST, Dept. St. James's Hospital James Street Dublin, Ireland
| | - R T Murphy
- Department of Cardiology CREST, Dept. St. James's Hospital James Street Dublin, Ireland
| | - B Foley
- Department of Cardiology CREST, Dept. St. James's Hospital James Street Dublin, Ireland
| | - C Daly
- Department of Cardiology CREST, Dept. St. James's Hospital James Street Dublin, Ireland
| | - D Burke
- Department of Cardiology CREST, Dept. St. James's Hospital James Street Dublin, Ireland
| | - A O Maree
- Department of Cardiology CREST, Dept. St. James's Hospital James Street Dublin, Ireland
| | - P A Crean
- Department of Cardiology CREST, Dept. St. James's Hospital James Street Dublin, Ireland
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Spaccarotella C, Mongiardo A, De Rosa S, Indolfi C. Transcatheter aortic valve implantation in patients at intermediate surgical risk. Int J Cardiol 2017; 243:161-168. [PMID: 28502734 DOI: 10.1016/j.ijcard.2017.04.107] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/06/2017] [Accepted: 04/30/2017] [Indexed: 02/07/2023]
Abstract
Transcatheter Aortic Valve Implantation (TAVI) has revolutionized the treatment of elderly patients with symptomatic severe aortic stenosis (AS). Initially tested in unoperable or high surgical risk patients, the safety and efficacy of TAVI has progressively improved, with increasing operators' experience and continuous technical refinements of the devices and of the delivery systems. Hence, the extension of clinical indications for TAVI to the intermediate-risk population has been attracting cardiologists in recent years. This idea was supported by the results of recent studies suggesting that transfemoral TAVI might be associated with a survival benefit in both high- and intermediate-risk patients with severe AS. Therefore, the aim of this review is to summarize the currently available evidence from multiple observational studies, substudies from large country registries, mached group comparisons, a substudy of randomized studies, and randomized trials, as well as in recent meta-analyses on the use of TAVI in patient at intermediate-risk for surgery.
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Affiliation(s)
- Carmen Spaccarotella
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Annalisa Mongiardo
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; URT of IFC of the CNR, Magna Graecia University, Catanzaro, Italy.
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Takimoto S, Saito N, Minakata K, Shirai S, Isotani A, Arai Y, Hanyu M, Komiya T, Shimamoto T, Goto T, Fuku Y, Ehara N, Furukawa Y, Koyama T, Nagasawa A, Tamura T, Miyake M, Yamanaka K, Sakaguchi H, Murata K, Onodera T, Yamazaki F, Nakai M, Taniguchi T, Sakata R, Kimura T. Favorable Clinical Outcomes of Transcatheter Aortic Valve Implantation in Japanese Patients - First Report From the Post-Approval K-TAVI Registry. Circ J 2016; 81:103-109. [PMID: 27916776 DOI: 10.1253/circj.cj-16-0546] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Very limited data exist on the outcomes of transcatheter aortic valve implantation (TAVI) since Japanese marketing approval of the first TAVI device.Methods and Results:The Kyoto University-related hospital Transcatheter Aortic Valve Implantation (K-TAVI) registry includes prospectively collected data from 6 participating hospitals in Japan. We included 302 patients with severe aortic stenosis who underwent TAVI using the SAPIEN XT balloon-expandable valve via transfemoral (TF; n=203, 67%) or transapical (TA; n=99, 33%) approach between October 2013 and September 2015. Device success rate, based on the Valve Academic Research Consortium-2 criteria, was very high in the TF (97.0%) and TA (99.0%) groups. The 30-day mortality rates were 1.5% and 1.0% in the TF and TA groups, respectively. Major complications included stroke (transient or persistent: 2.3%), annulus rupture (1.0%), coronary intervention (1.0%), major vascular complications (1.7%), and permanent pacemaker implantation (5.4%). The procedure times of the post-proctoring period (n=210) were decreased compared with those of the proctoring period (n=89) without affecting the clinical outcomes. The survival rates at 6 and 12 months were 96.9% and 92.5% in the TF group, and 93.9% and 91.8% in the TA group, respectively. CONCLUSIONS The K-TAVI registry data revealed that the early outcomes of TAVI using the SAPIEN XT were favorable in real-world Japanese patients.
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Affiliation(s)
- Shinya Takimoto
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
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Liu X, Xu Z. Osteogenesis in calcified aortic valve disease: From histopathological observation towards molecular understanding. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2016; 122:156-161. [DOI: 10.1016/j.pbiomolbio.2016.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/23/2016] [Accepted: 02/25/2016] [Indexed: 12/14/2022]
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Xiong TY, Liao YB, Zhao ZG, Xu YN, Wei X, Zuo ZL, Li YJ, Cao JY, Tang H, Jilaihawi H, Feng Y, Chen M. Causes of Death Following Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2015; 4:e002096. [PMID: 26391132 PMCID: PMC4599496 DOI: 10.1161/jaha.115.002096] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Transcatheter aortic valve replacement (TAVR) is an effective alternative to surgical aortic valve replacement in patients at high surgical risk. However, there is little published literature on the exact causes of death. Methods and Results The PubMed database was systematically searched for studies reporting causes of death within and after 30 days following TAVR. Twenty-eight studies out of 3934 results retrieved were identified. In the overall analysis, 46.4% and 51.6% of deaths were related to noncardiovascular causes within and after the first 30 days, respectively. Within 30 days of TAVR, infection/sepsis (18.5%), heart failure (14.7%), and multiorgan failure (13.2%) were the top 3 causes of death. Beyond 30 days, infection/sepsis (14.3%), heart failure (14.1%), and sudden death (10.8%) were the most common causes. All possible subgroup analyses were made. No significant differences were seen for proportions of cardiovascular deaths except the comparison between moderate (mean STS score 4 to 8) and high (mean STS score >8) -risk patients after 30 days post-TAVR (56.0% versus 33.5%, P=0.005). Conclusions Cardiovascular and noncardiovascular causes of death are evenly balanced both in the perioperative period and at long-term follow-up after TAVR. Infection/sepsis and heart failure were the most frequent noncardiovascular and cardiovascular causes of death. This study highlights important areas of clinical focus that could further improve outcomes after TAVR.
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Affiliation(s)
- Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Yan-Biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Zhen-Gang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Yuan-Ning Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Zhi-Liang Zuo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Yi-Jian Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Jia-Yu Cao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Hong Tang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Hasan Jilaihawi
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.J.)
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.)
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Influence of QRS infarct score and QRS duration prior to transcatheter aortic valve replacement on follow-up left ventricular end systolic volume in patients with new persistent left bundle branch block. J Electrocardiol 2015; 48:637-42. [PMID: 25959263 DOI: 10.1016/j.jelectrocard.2015.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND New-onset left bundle branch block (LBBB) is a known complication during Transcatheter Aortic Valve Replacement (TAVR). This study evaluated the influence of pre-TAVR cardiac conditions on left ventricular functions in patients with new persistent LBBB post-TAVR. METHODS Only 11 patients qualified for this study because of the strict inclusion criteria. Pre-TAVR electrocardiograms were evaluated for Selvester QRS infarct score and QRS duration, and left ventricular end-systolic volume (LVESV) was used as outcome variable. RESULTS There was a trend towards a positive correlation between QRS score and LVESV of r=0.59 (p=0.058), while there was no relationship between QRS duration and LVESV (r=-0.18 [p=0.59]). CONCLUSION This study showed that patients with new LBBB and higher pre-TAVR QRS infarct score may have worse post-TAVR left ventricular function, however, pre-TAVR QRS duration has no such predictive value. Because of the small sample size these results should be interpreted with caution and assessed in a larger study population.
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18
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Costopoulos C, Sutaria N, Ariff B, Fertleman M, Malik I, Mikhail GW. Balloon aortic valvuloplasty as a treatment option in the era of transcatheter aortic valve implantation. Expert Rev Cardiovasc Ther 2015; 13:457-60. [PMID: 25865236 DOI: 10.1586/14779072.2015.1036742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aortic valve stenosis is the commonest encountered valvular pathology and a frequent cause of morbidity and mortality in cases of severe stenosis. Definitive treatment has traditionally been offered in the form of surgical aortic valve replacement in patients with an acceptable surgical risk and more recently with the less invasive transcatheter aortic valve implantation (TAVI) in those where surgery is not a viable option. Prior to the introduction of TAVI, inoperable patients were treated medically and where appropriate with balloon aortic valvuloplasty, a procedure which although effective only provided short-term relief and was associated with high complication rates especially during its infancy. Here we discuss whether balloon aortic valvuloplasty continues to have a role in contemporary clinical practice in an era where significant advances have been achieved in the fields of surgical aortic valve replacement, TAVI and postoperative care.
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Affiliation(s)
- Charis Costopoulos
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
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19
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Lee M, Choi JO, Park SJ, Kim EY, Park P, Oh JK, Jeon ES. N-terminal pro-B-type natriuretic peptide measurement is useful in predicting left ventricular hypertrophy regression after aortic valve replacement in patients with severe aortic stenosis. HEART ASIA 2015; 7:23-8. [PMID: 27326209 DOI: 10.1136/heartasia-2014-010593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 03/17/2015] [Accepted: 03/28/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND The predictive factors for early left ventricular hypertrophy (LVH) regression after aortic valve replacement (AVR) have not been fully elucidated. This study was conducted to investigate which preoperative parameters predict early LVH regression after AVR. METHODS AND RESULTS 87 consecutive patients who underwent AVR due to isolated severe aortic stenosis (AS) were analysed. Patients with ejection fraction <50% or concomitant coronary artery disease were excluded from the analysis. Preoperative evaluation including echocardiography and N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement was performed and midterm follow-up echocardiography was done at a median of 9 months after AVR. The presence of complete regression of LVH at the midterm follow-up was determined. In multivariate analysis, including preoperative echocardiographic parameters, only E/e' ratio was associated with midterm LVH regression (OR 1.11, 95% CI 1.01 to 1.22; p=0.035). When preoperative NT-proBNP was added to the analysis, logNT-proBNP was found to be the single significant predictor of midterm LVH regression (OR 2.00, 95% CI 1.08 to 3.71; p=0.028). By receiver operating characteristic curve analysis, a cut-off value of 440 pg/mL for NT-proBNP yielded a sensitivity of 72% and a specificity of 77% for the prediction of LVH regression after AVR. CONCLUSIONS Preoperative NT-proBNP was an independent predictor for early LVH regression after AVR in patients with isolated severe AS.
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Affiliation(s)
- Mirae Lee
- Division of Cardiology , Samsung Changwon Hospital, Sungkyunkwan University School of Medicine , Changwon , Korea
| | - Jin-Oh Choi
- Division of Cardiology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - Sung-Ji Park
- Division of Cardiology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - Eun Young Kim
- Division of Cardiology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - PyoWon Park
- Department of Thoracic and Cardiovascular Surgery , Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
| | - Jae K Oh
- Division of Cardiovascular Diseases , Mayo Clinic College of Medicine , Rochester, Minnesota , USA
| | - Eun-Seok Jeon
- Division of Cardiology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
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McRee CW, Ray JC, Shapiro BP. 78-year-old-woman with dyspnea on exertion. Mayo Clin Proc 2014; 89:e109-13. [PMID: 25444495 DOI: 10.1016/j.mayocp.2014.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 04/15/2014] [Accepted: 04/21/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Chad W McRee
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Jacksonville, FL
| | - Jordan C Ray
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Jacksonville, FL
| | - Brian P Shapiro
- Advisor to residents and Consultant in Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL.
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21
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Similar improvement of left ventricular performance after valve replacement for aortic stenosis with small aortic annuli among three different implantation techniques. Indian J Thorac Cardiovasc Surg 2014. [DOI: 10.1007/s12055-014-0311-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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22
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Bayram H, Hidiroglu M, Cetin L, Cicek OF, Kucuker A, Uguz E, Erdogan KE, Sener E. Patient-prosthesis mismatch increases the mean platelet volume in patients with aortic valve replacement. Surg Today 2014; 45:559-63. [PMID: 24871953 DOI: 10.1007/s00595-014-0933-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Patient-prosthesis mismatch (PPM) is defined when the ratio of the effective orifice area of the normally functioning prosthetic valve to the body surface area of the patient is <0.85 cm(2)/m(2). The aim of this study was to assess the measurements of the mean platelet volume (MPV) as an indicator of platelet activation in patients with PPM. METHODS A total of 109 patients with isolated aortic valve replacement (AVR) procedures with a mechanical prosthesis and a control group from a normal population of 102 people compatible in terms of age and sex were chosen for the study. The AVR group was subdivided into a PPM group (n = 41) and non-PPM group (n = 68). All patients and control participants underwent echocardiographic examinations, with simultaneous measurements of the serum MPV values. RESULTS The MPV measurements were significantly higher in the patients with AVR compared to the control group (8.97 ± 0.93 vs. 8.26 ± 0.14, p < 0.001). Higher results were also obtained in the patients with PPM compared to the non-PPM group (9.36 ± 0.61 vs. 8.73 ± 1.01, p < 0.001). The platelet counts were found to be similar in both groups (p > 0.05). CONCLUSIONS We have herein shown that the PPM patients had a significantly higher MPV compared to the patients with AVR without PPM and healthy subjects.
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Affiliation(s)
- Huseyin Bayram
- Department of Cardiovascular Surgery, Ataturk Education and Research Hospital, 1426. Cad, No: 30/17, Cukurambar, 06510, Ankara, Turkey,
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Fuku Y, Goto T, Komiya T, Sakaguchi G, Shimamoto T, Maruo T, Hasegawa D, Otsuru S, Saito N, Hyodo Y, Ueno G, Kadota K, Mitsudo K. Thirty-day outcome of transcatheter aortic valve implantation with the edwards SAPIEN XT prosthesis via the transiliofemoral approach. Circ J 2014; 78:1357-63. [PMID: 24694765 DOI: 10.1253/circj.cj-13-1220] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Few data exist on the results of transcatheter aortic valve implantation (TAVI) via the transfemoral approach in small slightly built Japanese patients with severe aortic stenosis who are ineligible or at high-risk for conventional surgical aortic valve replacement (SAVR). Therefore, the purpose was to investigate the early outcomes of TAVI using the transiliofemoral approach in Japan. METHODS AND RESULTS Between June 2010 and June 2013, 21 consecutive patients (mean age, 81.0 years; 81.0% female) underwent TAVI with Edwards SAPIEN XT valves using the transiliofemoral approach. The mean body surface area was 1.44±0.15m(2). The device success rate was 90.5%. Although 2 patients did not meet the echocardiographic criteria for device success, no failure to deliver and deploy a valve occurred. The mean effective aortic valve area increased from 0.54±0.12cm(2) at baseline to 1.46±0.29cm(2) after the procedure (P<0.001), and the mean aortic transvalvular pressure gradient decreased from 51.0±15.6 at baseline to 11.2±3.6 after the procedure (P<0.001). The 30-day mortality and combined safety endpoint rates were 0% and 4.8%, respectively. All patients achieved New York Heart Association functional class I or II at 30 days. CONCLUSIONS Early outcome of TAVI with the Edwards-SAPIEN XT valve via the transiliofemoral approach at Kurashiki Central Hospital is satisfactory for patients who are ineligible or at high risk for SAVR.
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Affiliation(s)
- Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital
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Balanika M, Smyrli A, Samanidis G, Spargias K, Stavridis G, Karavolias G, Khoury M, Voudris V, Lacoumenta S. Anesthetic Management of Patients Undergoing Transcatheter Aortic Valve Implantation. J Cardiothorac Vasc Anesth 2014; 28:285-9. [PMID: 24315757 DOI: 10.1053/j.jvca.2013.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Indexed: 11/11/2022]
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Barasch E, Petillo F, Pollack S, Rhee PDY, Stovold W, Reichek N. Clinical and Echocardiographic Correlates of Mortality in Medically Treated Patients With Severe Isolated Aortic Stenosis and Normal Left Ventricular Ejection Fraction. Circ J 2014; 78:232-9. [DOI: 10.1253/circj.cj-13-0821] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Eddy Barasch
- St. Francis Hospital, Heart Center/State University of New York at Stony Brook, Department of Research and Education
| | - Florentina Petillo
- St. Francis Hospital, Heart Center/State University of New York at Stony Brook, Department of Research and Education
| | - Simcha Pollack
- St. Francis Hospital, Heart Center/State University of New York at Stony Brook, Department of Research and Education
| | - Peter D-Y. Rhee
- St. Francis Hospital, Heart Center/State University of New York at Stony Brook, Department of Research and Education
| | - Wendy Stovold
- St. Francis Hospital, Heart Center/State University of New York at Stony Brook, Department of Research and Education
| | - Nathaniel Reichek
- St. Francis Hospital, Heart Center/State University of New York at Stony Brook, Department of Research and Education
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Transcatheter aortic valve implantation reduces sympathetic activity and normalizes arterial spontaneous baroreflex in patients with aortic stenosis. JACC Cardiovasc Interv 2013; 6:1195-202. [PMID: 24139928 DOI: 10.1016/j.jcin.2013.06.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 06/14/2013] [Accepted: 06/20/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study sought to measure muscle sympathetic nerve activity (MSNA) in patients with aortic stenosis (AS) before and after transcatheter aortic valve implantation (TAVI) and to compare MSNA with that of control patients. BACKGROUND TAVI is an emerging therapeutic option in patients with severe AS at high risk of open heart surgery. Whether patients with AS have increased sympathetic activity remains to be established, and the effects of TAVI on the sympathetic nervous system are also unknown. METHODS We prospectively enrolled 14 patients with severe symptomatic AS treated by TAVI. Fourteen control patients matched for age, body mass index, and unscathed of AS were also included. All patients underwent MSNA and arterial baroreflex gain assessment at baseline and 1 week after TAVI for AS patients. RESULTS Patients with AS had lower blood pressure (BP) levels, a significant increase in MSNA (61.0 ± 1.7 burst/min vs. 55.4 ± 1.4 burst/min; p < 0.05), and a decrease in arterial baroreflex gain (2.13 ± 0.14% burst/mm Hg vs. 3.32 ± 0.19% burst/mm Hg; p < 0.01) compared with matched control patients. The TAVI procedures induced an increase in BP associated with a significant decrease in MSNA (from 61.0 ± 1.7 burst/min to 54.1 ± 1.0 burst/min; p < 0.01) and was associated with a significant increase in arterial baroreflex gain (from 2.13 ± 0.14% burst/mm Hg to 3.49 ± 0.33% burst/mm Hg; p < 0.01). CONCLUSIONS We report for the first time, through direct measurement of nerve activity, that patients with AS have increased sympathetic nervous system activity associated with a decrease in sympathetic baroreflex gain and that TAVI normalizes these parameters. This study provides evidence of a new beneficial effect of TAVI, namely, normalization of sympathetic nervous system hyperactivity.
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Marumoto A, Nakamura Y, Kishimoto Y, Saiki M, Nishimura M. Optimal timing of aortic valve replacement in elderly patients with severe aortic stenosis. Surg Today 2013; 44:84-93. [PMID: 23381220 DOI: 10.1007/s00595-012-0487-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 10/26/2012] [Indexed: 12/30/2022]
Abstract
PURPOSE The elderly population with severe aortic stenosis (AS) requiring aortic valve replacement (AVR) is increasing. The optimal timing of AVR in these patients has been under discussion. METHODS We retrospectively reviewed the data from severe AS patients (n = 84) who underwent AVR with/without concomitant procedures from 2005 to 2010. The symptom status, preoperative data, operative outcome, late survival and freedom from cardiac events were compared between elderly patients (age ≥80 years [n = 31]) and younger patients (age <80 years [n = 53]). RESULTS The operative mortality in elderly patients (3.2 %) and younger patients (3.8 %) was comparable. The symptoms in elderly patients were more severe and hospitalized heart failure (HF) was more frequently noted as the primary symptom (p = 0.017). Patients with and without hospitalized HF differed significantly in late survival and freedom from cardiac events (p = 0.001), but advanced age had no significant effect. The results of a Cox proportional hazards analysis revealed that hospitalized HF was a significant predictor for cardiac events after AVR, irrespective of age (hazard ratio 6.93, 95 % confidence interval 1.83-26.26, p < 0.004). CONCLUSIONS In elderly patients with severe AS, surgery should be recommended even in the presence of minimal symptoms and should be performed before the onset of life-threatening HF.
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Affiliation(s)
- Akira Marumoto
- Department of Cardiovascular Surgery, Tottori University Hospital, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan,
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Yamawaki K, Tanaka H, Matsumoto K, Hiraishi M, Miyoshi T, Kaneko A, Tsuji T, Ryo K, Norisada K, Fukuda Y, Tatsumi K, Onishi T, Okada K, Okita Y, Kawai H, Hirata KI. Impact of Left Ventricular Afterload on Longitudinal Dyssynchrony in Patients With Severe Aortic Stenosis and Preserved Ejection Fraction. Circ J 2012; 76:744-51. [DOI: 10.1253/circj.cj-11-1098] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kohei Yamawaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kensuke Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Mana Hiraishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Tatsuya Miyoshi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Akihiro Kaneko
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Takayuki Tsuji
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Keiko Ryo
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kazuko Norisada
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Yuko Fukuda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kazuhiro Tatsumi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Tetsuari Onishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kenji Okada
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine
| | - Yutaka Okita
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine
| | - Hiroya Kawai
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Ken-ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
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Okamura H, Yamaguchi A, Nagano H, Itoh S, Morita H, Naito K, Yuri K, Adachi H. Mid-term outcomes after aortic valve replacement with the 17-mm St. Jude Medical Regent valve. Circ J 2011; 76:365-71. [PMID: 22130314 DOI: 10.1253/circj.cj-11-0733] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND When aortic valve replacement (AVR) is performed in patients with a small aortic annulus, prosthesis-patient mismatch (PPM) is of concern. We investigated the mid-term outcomes of AVR with a 17-mm mechanical prosthesis. METHODS AND RESULTS Seventy-eight patients with aortic stenosis underwent AVR with a 17-mm St. Jude Medical Regent prosthesis. Echocardiography was performed preoperatively, at discharge, and at follow-up (mean follow-up, 33 months). Patients were divided into 2 groups: with and without PPM at discharge. Between-group differences in postoperative variables, particularly survival, were analyzed. Overall hospital mortality was 2.6%. Actuarial 1- and 5-year survival rates were 95% and 79%, respectively. Diabetes and renal insufficiency were associated with long-term mortality. Freedom from major adverse valve-related cardiac events at 1 year and 5 years was 97.3% and 93.9%, respectively. Diabetes was shown to be an independent risk factor for major adverse valve-related cardiac events. Echocardiography 13 months after AVR showed a significant increase in mean effective orifice area index, decrease in mean left ventricular-aortic pressure gradient, and decrease in mean left ventricular mass index. PPM at discharge did not influence long-term survival or left ventricular mass regression. CONCLUSIONS The 17-mm Regent prosthesis provided satisfactory clinical and hemodynamic results. It is a reliable choice for patients with a small aortic annulus.
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Affiliation(s)
- Homare Okamura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Japan.
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Okamura H, Yamaguchi A, Yoshizaki T, Nagano H, Itoh S, Morita H, Naito K, Yuri K, Adachi H. Clinical outcomes and hemodynamics of the 19-mm Perimount Magna bioprosthesis in an aortic position: comparison with the 19-mm Medtronic Mosaic Ultra Valve. Circ J 2011; 76:102-8. [PMID: 22094910 DOI: 10.1253/circj.cj-11-0728] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND When aortic valve replacement is performed in patients with a small aortic annulus, prosthesis-patient mismatch (PPM) is of concern because it can affect postoperative clinical outcomes. Although larger bioprosthetic valves have been well studied, the hemodynamics of 19-mm bioprostheses have been reported in only a small number of patients. The effectiveness as well as the impact of PPM on outcomes are thus still unclear. METHODS AND RESULTS Postoperative clinical and hemodynamic variables were compared in 67 patients with a 19-mm Carpentier Edwards Perimount Magna bioprosthesis and in 10 patients with a 19-mm Medtronic Mosaic Ultra valve. Mean follow-up time was 13 months. There was no in-hospital mortality. Echocardiography 6.5±4.0 months after surgery showed significant decreases in the mean left ventricular (LV)-aortic pressure gradient, and decreases in the mean LV mass index. Reduction in LV mass index did not differ between the valve groups, despite a higher pressure gradient in the Mosaic group. Although PPM was detected in 21 patients in the Magna group, it did not affect regression of the LV mass index during the follow-up period. CONCLUSIONS Use of the 19-mm Magna bioprosthesis appears to provide satisfactory clinical results. LV-aortic pressure gradient was lower in the Magna group. The present data suggest that PPM is not related to reduction in the LV mass index.
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Affiliation(s)
- Homare Okamura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
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Yamane K, Hirose H, Youdelman BA, Bogar LJ, Diehl JT. Conventional aortic valve replacement for elderly patients in the current era. Circ J 2011; 75:2692-8. [PMID: 21857141 DOI: 10.1253/circj.cj-11-0541] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Because of the rising expectation of prolonged life in the general population and the recent recognition of undertreated aortic valve disease in the elderly, updating the available results of aortic valve surgery is imperative, especially considering the rapid evolution of the transcatheter valve implantation procedure. METHODS AND RESULTS Between 1997 and 2010, 308 patients aged 70 years or older underwent aortic valve replacement (AVR) for aortic stenosis (AS). Short- and long-term results were analyzed and risk factors for long-term mortality were determined. Mean age was 78.5 years and 124 patients were aged 80 or older. Concomitant coronary artery bypass grafting (CABG) was performed in 46% of the cases. Mean left ventricular ejection fraction (LVEF) was 52%. Overall observed and expected operative mortality using the Society of Thoracic Surgeons-Predicted Risk of Mortality score was 3.9% and 4.8%, respectively. Overall survival rates at 1, 5, and 10 years were 88.6%, 71.6%, and 31.8%, respectively. Predictors of long-term mortality included diabetes; preoperative shock; LVEF ≤ 40%; New York Heart Association functional class III or IV; and age. CONCLUSIONS Short- and long-term results of conventional AVR in the elderly prove it to be durable and, especially in relatively low-risk patients and patients who require concomitant CABG, operative mortality is reasonably low. Conventional AVR ± CABG remains the gold standard for elderly patients with AS.
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Affiliation(s)
- Kentaro Yamane
- Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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Ohno M, Hashimoto Y, Suzuki M, Matsumura A, Isobe M. Current state of symptomatic aortic valve stenosis in the Japanese elderly. Circ J 2011; 75:2474-81. [PMID: 21785224 DOI: 10.1253/circj.cj-11-0012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There have been few reports regarding treatment selection and prognosis of symptomatic aortic valve stenosis (AS) in the elderly in Japan. METHODS AND RESULTS Sixty-one patients hospitalized between January 2000 and December 2007 for symptomatic severe AS were investigated. The average observation period was 27 months. Thirty-seven patients (61%) were diagnosed with AS for the first time on hospitalization. Thirty-six patients had onset of symptoms within 1 month before admission. Thirty-six patients received aortic valve replacement (group S) and 25 received medical therapy (group M). The patients in group M were older than those in group S (84.1 ± 5.3 years vs. 74.2 ± 4.6 years, P<0.001). Maximum flow velocity measured by echocardiography was lower in group M (4.5 ± 0.3 m/s vs. 4.9 ± 0.5 m/s, P<0 .01), but there was no difference in valve area between the 2 groups (0.62 ± 0.19 cm² vs. 0.57 ± 0.15 cm², P=0.12). One-year mortality rate derived from the Kaplan-Meier curve was higher in group M than group S (53.1% vs. 6.4%, respectively). On multivariate analysis, the only independent favorable prognostic factor was aortic valve replacement (HR: 0.02, 95%CI: 0.01-0.15, P<0.01). CONCLUSIONS Medical therapy is often selected for treatment of symptomatic AS in the elderly, but the prognosis is very poor. Symptomatic severe aortic stenosis should be treated surgically, or with transcatheter aortic valve implantation in cases with high surgical risk.
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Affiliation(s)
- Masakazu Ohno
- Department of Cardiology, Kameda Medical Center, Japan.
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Hiraoka A, Kuinose M, Chikazawa G, Totsugawa T, Katayama K, Yoshitaka H. Minimally Invasive Aortic Valve Replacement Surgery - Comparison of Port-Access and Conventional Standard Approach -. Circ J 2011; 75:1656-60. [DOI: 10.1253/circj.cj-10-1257] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Arudo Hiraoka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama
| | - Masahiko Kuinose
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama
| | - Genta Chikazawa
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama
| | - Toshinori Totsugawa
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama
| | - Keijiro Katayama
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama
| | - Hidenori Yoshitaka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama
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