1
|
Sawatari H, Chahal AA, Ahmed R, Collinss GB, Deshpande S, Khanji MY, Provedenciae R, Khan H, Wafa SEI, Salloum MN, Karim S, Shenthar J, Cha YM, Hyman M, Brady PA, Somers VK, Padmanabhan D, Nkomo VT. Impact of Cardiac Implantable Electronic Devices on Cost and Length of Stay in Patients With Surgical Aortic Valve Replacement and Transcutaneous Aortic Valve Implantation. Am J Cardiol 2023; 192:69-78. [PMID: 36753975 DOI: 10.1016/j.amjcard.2023.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/08/2022] [Accepted: 01/07/2023] [Indexed: 02/09/2023]
Abstract
Surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) in aortic stenosis are associated with arrhythmic complications that can require cardiac implantable electronic device (CIED) implantation, but impact on healthcare-associated cost (HAC) and length of stay (LOS) are unknown. This study aimed to assess differences among SAVR/TAVI patients with CIED implantation on HAC and LOS. Patients hospitalized for SAVR or TAVI between 2011 and 2017 on the National Inpatient Sample database were identified and stratified according to presence/type of CIED implantation. During this period, 95,262 patients were identified; 6,435 (6.8%) patients received CIED (median [interquartile range] age: 74.0 [66.0 to 82.0] years). The median adjusted HAC was $44,271 and LOS was 6 days. CIED implantation was associated with longer LOS and higher adjusted HAC in patients with SAVR and TAVI (p <0.0001). Patients with in-hospital death and complications because of SAVR or TAVI had longer preceding in-hospital days of admission. Male patients admitted to small hospitals and the West region had the highest HAC. In conclusion, CIED implantation for arrhythmias results in higher HAC and longer LOS in patients with aortic stenosis for both SAVR and TAVI.
Collapse
Affiliation(s)
- Hiroyuki Sawatari
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anwar A Chahal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Cardiology, Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; Division of Cardiac Electrophysiology, University of Pennsylvania, Philadelphia
| | - Raheel Ahmed
- Department of Cardiology, Northumbria Healthcare National Health Service Foundation Trust, Newcastle, New South Wales
| | - George B Collinss
- Department of Cardiology, Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Saurabh Deshpande
- Department of Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Mohammed Y Khanji
- Department of Cardiology, Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Rui Provedenciae
- Department of Cardiology, Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Hassan Khan
- Emory University School of Medicine, Atlanta, Georgia
| | - Syed Emir Irfan Wafa
- Department of Cardiology, Northampton General Hospital, Northampton, Massachusetts
| | - Mohammad N Salloum
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Queens Hospital Center, New York, New York
| | - Shahid Karim
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jayaprakash Shenthar
- Department of Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Matthew Hyman
- Division of Cardiac Electrophysiology, University of Pennsylvania, Philadelphia
| | - Peter A Brady
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Deepak Padmanabhan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiac Electrophysiology, University of Pennsylvania, Philadelphia; Department of Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
2
|
Rouleau SG, Brady WJ, Koyfman A, Long B. Transcatheter aortic valve replacement complications: A narrative review for emergency clinicians. Am J Emerg Med 2022; 56:77-86. [DOI: 10.1016/j.ajem.2022.03.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/11/2022] [Accepted: 03/20/2022] [Indexed: 02/07/2023] Open
|
3
|
Mitsis A, Eftychiou C, Christophides T, Sakellaropoulos S, Avraamides P. The conjunction conundrum in Transcatheter Aortic Valve Implantation. Curr Probl Cardiol 2022; 48:101130. [PMID: 35114293 DOI: 10.1016/j.cpcardiol.2022.101130] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
Abstract
A continuous discussion regarding the predictors for permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI) is ongoing, especially in the era of low and medium risk patients. The aim of this article is to review the data so far regarding the pathophysiology, risk factors, and the indications for permanent pacemaker implantation after TAVI. The factors that contribute to rhythm abnormalities post TAVI can be divided into pre-existing conduction abnormalities, patient-related anatomical factors, and peri-procedural technical factors. The latter components are potentially modifiable, and this is where attention should be directed, particularly now that in an era of TAVI expansion towards lower-risk patients.
Collapse
Key Words
- AF, Atrial fibrillation
- AS, Aortic stenosis
- AV, Atrioventricular
- BAV, Balloon aortic valvuloplasty
- BBB, Bundle branch block
- BEV, Balloon expandable valve
- CAVB, Complete Atrioventricular block
- CRT,
- CT, Computer tomography
- Cardiac resynchronization therapy
- ECG, Electrocardiogram
- EPS, Electrophysiology study
- ID, Implantation depth
- LAH, Left anterior hemiblock
- LBBB, Left bundle branch block
- LCC, Left coronary cusp
- LVEF, Left ventricular ejection function
- LVOT, Left ventricular outflow track
- LVOT- EI, Left ventricular outflow track eccentricity index
- LVOT-CA, Left ventricular outflow track calcification
- MS, Membranous septum
- NCC, Non coronary cusp
- PPI, Permanent pacemaker implantation
- PVL, Paravalvular leak
- RAO, Right anterior oblique
- RBBB, Right bundle branch block
- RCC, Right coronary cusp
- SAS, Severe aortic stenosis
- SEV, Self-expandable valve
- TAVI, Transcatheter aortic valve implantation
- Transcatheter aortic valve implantation, pacemaker implantation, LBBB, balloon expandable valves, self-expandable valves, LVOT. List of abbreviations, AMCC, Aortomitral continuity calcification
Collapse
Affiliation(s)
- Andreas Mitsis
- Cardiology Department, Nicosia General Hospital, 2029, Nicosia, Cyprus.
| | | | | | | | | |
Collapse
|
4
|
Poschner T, Werner P, Kocher A, Laufer G, Musumeci F, Andreas M, Russo M. The JenaValve pericardial transcatheter aortic valve replacement system to treat aortic valve disease. Future Cardiol 2021; 18:101-113. [PMID: 34647465 DOI: 10.2217/fca-2021-0065] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Transcatheter aortic valve replacement is a valuable alternative technique to surgery and the spectrum of therapy continues to evolve. The JenaValve Pericaridal transcatheter aortic valve replacement System allows prosthesis fixation in a native, noncalcified aortic annulus with a unique paper clip-like anchorage mechanism. The low rate of paravalvular leakage and permanent pacemaker implantation emphasizes the further widespread use of the JenaValve - despite the limited data available. In May 2021, a CE mark for the transfemoral implantation in both aortic regurgitation and aortic stenosis was granted. However, no data have been published so far. The ongoing ALIGN trials are expected to provide the pending long-term data.
Collapse
Affiliation(s)
- Thomas Poschner
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Paul Werner
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Alfred Kocher
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Francesco Musumeci
- Department of Cardiac Surgery & Heart Transplantation, San Camillo Forlanini Hospital of Rome, Rome, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Marco Russo
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria.,Department of Cardiac Surgery & Heart Transplantation, San Camillo Forlanini Hospital of Rome, Rome, Italy
| |
Collapse
|
5
|
Irles D, Salerno F, Cassagneau R, Eschalier R, Maupain C, Dupuis JM, Mansourati J, Guedon L, Marijon E, Frey P. Evolution of high-grade atrioventricular conduction disorders after transcatheter aortic valve implantation in patients who underwent implantation of a pacemaker with specific mode-that minimizes ventricular pacing-activated. J Cardiovasc Electrophysiol 2021; 32:1376-1384. [PMID: 33625762 DOI: 10.1111/jce.14970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/26/2021] [Accepted: 02/14/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The evolution of atrioventricular conduction disorders after transcatheter aortic valve implantation (TAVI) remains poorly understood. We sought to identify factors associated with late (occurring ≥7 days after the procedure) high-grade atrioventricular blocks after TAVI, based on specific pacemaker memory data. METHODS AND RESULTS STIM-TAVI (NCT03338582) was a prospective, multicentre, observational study that enrolled all patients (from November 2015 to January 2017) implanted with a specific dual chamber pacemaker after TAVI, with the SafeR algorithm activated, allowing continuous monitoring of atrioventricular conduction. The primary endpoint was the occurrence of centrally adjudicated late high-grade atrioventricular blocks during the year after TAVI. Among 197 patients, 138 (70.1%) had ≥1 late high-grade atrioventricular block. Whereas oversizing (p = .005), high-grade atrioventricular block during TAVI (p < .001), and early (within 6 days) high-grade atrioventricular block (p < .001) were associated with occurrence of late high-grade atrioventricular block, self-expanding prothesis (p = .88), prior right bundle branch block (p = .45), low implantation (p = .06), and new or wider left bundle branch block and lengthening of PR interval (p = .24) were not. In multivariable analysis, only post-TAVI early high-grade atrioventricular block remained associated with late high-grade atrioventricular blocks (Days 0-1: odds ratio [OR], 3.25; 95% confidence interval [CI], 1.57-6.74; p = .001; Days 2-6: OR, 4.13; 95% CI, 2.06-8.31; p < .001), whereas other conventionally used predictors were not. CONCLUSION One-third of pacemaker-implanted patients do not experience late high-grade atrioventricular block. Our findings suggest that post-TAVI early high-grade atrioventricular block is the main factor associated with occurrence of late high-grade atrioventricular blocks.
Collapse
Affiliation(s)
- Didier Irles
- Department of Cardiology, Hospital of Annecy, Pringy, France
| | - Fiorella Salerno
- Department of Cardiology, Institut Hospitalier Jacques Cartier, Massy, France
| | | | - Romain Eschalier
- Department of Cardiology, University Hospital Gabriel Montpied, Clermont-Ferrand, France
| | - Carole Maupain
- Department of Cardiology, Hospital Pitié-Salpêtrière, Paris, France
| | - Jean-Marc Dupuis
- Department of Cardiology, University Hospital of Angers, Angers, France
| | | | - Laurence Guedon
- Department of Cardiology, Regional University Hospital of Lille, Lille, France
| | - Eloi Marijon
- Department of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Pierre Frey
- Department of Cardiology, Hospital of Annecy, Pringy, France
| | | |
Collapse
|
6
|
Daeter EJ, van Veghel D, Houterman S, Olsthoorn J, Soliman-Hamad MA. Recent trends in aortic valve interventions: Data of the Netherlands heart registration. J Card Surg 2020; 36:573-581. [PMID: 33355951 DOI: 10.1111/jocs.15265] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/10/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Transcatheter aortic valve implantation (TAVI) has evolved from bailout for inoperable patients to an alternative to surgical aortic valve replacement (SAVR) in higher-risk groups. The aim of this study is to describe these clinical trends in TAVI and SAVR in patients with aortic valve disease. METHODS We analyzed data of the Netherlands Heart Registration (NHR) up to 2018 to explore the trends in TAVI and SAVR among 14 cardiac centers in the Netherlands. RESULTS Between 2013 and 2017, a total of 7432 isolated SAVR and 5929 TAVI procedures have been performed. A 43.9% increase in the total number of procedures was observed, mainly due to the considerable increase in the number of TAVI procedures. In 2017, there was a decrease in the number of SAVR procedures. In the TAVI group, 30- and 120-day mortality decreased significantly from 7.2% and 10.6% in 2013 to 3.4% and 5.7% in 2017, respectively. In the SAVR group, 30- and 120-day mortality decreased from 1.7% and 2.9% in 2013 to 1.2% and 1.7% in 2017, respectively. Outcomes showed a significant decrease in vascular complications after TAVI. The risk profile of TAVI patients has changed over time. CONCLUSIONS The recent developments in TAVI have contributed to the increasing numbers of aortic valve interventions in the Netherlands. Mortality rates after SAVR and TAVI decreased as did the rate of complications after TAVI. Furthermore, a trend towards decrease of preoperative risk was observed.
Collapse
Affiliation(s)
- Edgar J Daeter
- Netherlands Heart Registration, Utrecht, the Netherlands.,Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Dennis van Veghel
- Netherlands Heart Registration, Utrecht, the Netherlands.,Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Saskia Houterman
- Netherlands Heart Registration, Utrecht, the Netherlands.,Department of Education and Research, Catharina Hospital, Eindhoven, the Netherlands
| | - Jules Olsthoorn
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Mohamed A Soliman-Hamad
- Netherlands Heart Registration, Utrecht, the Netherlands.,Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | | |
Collapse
|
7
|
Errigo D, Golzio PG, D'Ascenzo F, Ragaglia E, Bruno F, Salizzoni S, Peyracchia M, Castagno D, Budano C, D'Amico M, Frea S, Baldi E, Giustetto C, DE Ferrari GM. Electrocardiographic and clinical predictors for permanent pacemaker requirement after transcatheter aortic valve implantation: a 10-year single center experience. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 62:169-174. [PMID: 32885926 DOI: 10.23736/s0021-9509.20.11342-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study is to identify clinical, electrocardiographic (ECG) and procedural predictors for permanent pacemaker (PPM) requirement after transaortic valve implantation (TAVI). METHODS All consecutive patients with severe symptomatic aortic stenosis (SSAS) undergoing TAVI at our single center were included in the study and prospectively followed. All patients had standard 12-leads ECGs recordings before and after TAVI and continuous ECG monitoring during hospital stay. Primary endpoint was to identify electrocardiographic predictors of PPM implantation after TAVI; secondary endpoint was to ascertain other clinical or procedure-related predictive factors of PPM need. PPM implantation was further arbitrarily divided into early and late one (beyond the 3rd day). RESULTS Among the 431 patients undergoing TAVI between 2008 and 2018, 77 (18%) needed PPM implantation; 47 (11%) had an early procedure, and 30 (7%) a late implant. Preoperative right bundle branch block (RBBB) implies more than five-fold increase of the risk of PPM implantation (OR 5.19, CI 1.99-13.56, P=0.001), whereas the use of a self-expandable prosthesis is associated with an almost three-fold increase of the risk (OR 2.60, CI 1.28-5.28, P=0.008). In the late PPM implantation subgroup, only the history of syncope retains a significant association with such an increased risk (OR 2.71, CI 1.09-6.75, P=0.032). CONCLUSIONS The need of a PPM in the individual TAVI patient is hardly predictable. However, the finding of pre-existing RBBB, the use of self-expandable prosthesis and history of syncope can individuate patients at increased risk.
Collapse
Affiliation(s)
- Daniele Errigo
- Division of Cardiology, Department of Internal Medicine, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy -
| | - Pier G Golzio
- Division of Cardiology, Department of Internal Medicine, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Enrico Ragaglia
- Division of Cardiology, Department of Internal Medicine, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, Department of Internal Medicine, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Stefano Salizzoni
- Division of Cardiology, Department of Internal Medicine, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Mattia Peyracchia
- Division of Cardiology, Department of Internal Medicine, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Davide Castagno
- Division of Cardiology, Department of Internal Medicine, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Carlo Budano
- Division of Cardiology, Department of Internal Medicine, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Department of Internal Medicine, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Simone Frea
- Division of Cardiology, Department of Internal Medicine, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Enrico Baldi
- Cardiac Intensive Care Unit, Division of Arrhythmia and Electrophysiology and Experimental Cardiology, Department of Medicine Science and Infective Disease, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carla Giustetto
- Division of Cardiology, Department of Internal Medicine, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Gaetano M DE Ferrari
- Division of Cardiology, Department of Internal Medicine, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| |
Collapse
|
8
|
Knecht S, Schaer B, Reichlin T, Spies F, Madaffari A, Vischer A, Fahrni G, Jeger R, Kaiser C, Osswald S, Sticherling C, Kühne M. Electrophysiology Testing to Stratify Patients With Left Bundle Branch Block After Transcatheter Aortic Valve Implantation. J Am Heart Assoc 2020; 9:e014446. [PMID: 32089049 PMCID: PMC7335581 DOI: 10.1161/jaha.119.014446] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Left bundle branch block (LBBB) is common after transcatheter aortic valve implantation (TAVI) and is an indicator of subsequent high-grade atrioventricular block (HAVB). No standardized protocol is available to identify LBBB patients at risk for HAVB. The aim of the current study was to evaluate the safety and efficacy of an electrophysiology study tailored strategy in patients with LBBB after TAVI. Methods and Results We prospectively analyzed consecutive patients with LBBB after TAVI. An electrophysiology study was performed to measure the HV-interval the day following TAVI. In patients with normal His-ventricular (HV)-interval ≤55 ms, a loop recorder was implanted (ILR-group), whereas pacemaker implantation was performed in patients with prolonged HV-interval >55 ms (PM-group). The primary end point was occurrence of HAVB during a follow-up of 12 months. Secondary end points were symptoms, hospitalizations, adverse events because of device implantation or electrophysiology study, and death. Of 373 patients screened after TAVI, 56 patients (82±6 years, 41% male) with LBBB were included. HAVB occurred in 4 of 41 patients (10%) in the ILR-group and in 8 of 15 patients (53%) in the PM-group (P<0.001). We did not identify other predictors for HAVB than the HV interval. The negative predictive value for the cut-off of HV 55 ms to detect HAVB was 90%. No HAVB-related syncope occurred in the 2 groups. Conclusions An electrophysiology study tailored strategy to LBBB after TAVI with a cut-off of HV >55 ms is a feasible and safe approach to stratify patients with regard to developing HAVB during a follow-up of 12 months.
Collapse
Affiliation(s)
- Sven Knecht
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| | - Beat Schaer
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| | - Tobias Reichlin
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland.,Department of Cardiology Inselspital Bern University Hospital University of Bern Switzerland
| | - Florian Spies
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| | - Antonio Madaffari
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| | - Annina Vischer
- Medical Outpatient Department University Hospital Basel University Basel Basel Switzerland
| | - Gregor Fahrni
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| | - Raban Jeger
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| | - Christoph Kaiser
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| | - Stefan Osswald
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| | - Christian Sticherling
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| | - Michael Kühne
- Cardiology/Electrophysiology University Hospital Basel University Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel University Basel Basel Switzerland
| |
Collapse
|
9
|
Arribas JM, Soriano L, Rivera-Caravaca JM, Lorenzo M, Muñoz C, Taboada R, Jiménez A, Martínez J, García-Puente J, Gutiérrez F, Manzano S, Cánovas S. Incidence and causes of pacemaker implantation during postoperative period of aortic valve replacement with rapid deployment prosthesis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1534-1540. [PMID: 31677175 DOI: 10.1111/pace.13824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/16/2019] [Accepted: 10/28/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Aortic stenosis is currently the most frequently occurring valve pathology. Developments, such as transcatheter prostheses and rapid deployment prostheses, allow for the offer of a valve replacement to higher risk patients, but these techniques are linked with a higher need for a permanent pacemaker during the immediate postoperative period. METHODS We studied the incidence and the factors associated with permanent pacemaker implantation after aortic valve replacement with Edwards Intuity rapid deployment prosthesis. RESULTS Between October 2012 and December 2016, the Edwards Intuity prosthesis was implanted in 71 patients (68% male, 75.3 ± 5 years old). Six patients (8%) required a permanent pacemaker during immediate postoperative period. Univariate analysis showed that a history of acute myocardial infarction (AMI) (P = .046, B = 7.5, 95% CI [1.039-54.1]) and preoperative amiodarone (P = .009, B = 31.5; 95% CI [2.32-426]) were associated with a higher need for a pacemaker during the postoperative period. CONCLUSIONS The incidence of permanent pacemaker implantation during the immediate postoperative period of aortic valve replacement with Edwards Intuity prosthesis was 8%, a value which is within the limits reported for conventional aortic prostheses. Preoperative amiodarone treatment and previous AMI may increase the need for a pacemaker during the postoperative period of these aortic prostheses.
Collapse
Affiliation(s)
- José María Arribas
- Cardiovascular Surgery Service, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Laura Soriano
- Cardiovascular Surgery Service, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - José Miguel Rivera-Caravaca
- Cardiology Service, University Hospital Virgen de la Arrixaca, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), IMIB-Arrixaca, Murcia, Spain
| | - Maydelin Lorenzo
- Cardiovascular Surgery Service, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Carmen Muñoz
- Cardiology Service, University Hospital Virgen de la Arrixaca, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), IMIB-Arrixaca, Murcia, Spain
| | - Rubén Taboada
- Cardiovascular Surgery Service, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Antonio Jiménez
- Cardiovascular Surgery Service, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Juan Martínez
- Cardiology Service, University Hospital Virgen de la Arrixaca, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), IMIB-Arrixaca, Murcia, Spain
| | - Julio García-Puente
- Cardiovascular Surgery Service, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Francisco Gutiérrez
- Cardiovascular Surgery Service, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Sergio Manzano
- Cardiology Service, University Hospital Virgen de la Arrixaca, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), IMIB-Arrixaca, Murcia, Spain
| | - Sergio Cánovas
- Cardiovascular Surgery Service, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University Hospital Virgen de la Arrixaca, Murcia, Spain
| |
Collapse
|
10
|
Endovascular Versus Transapical Transcatheter Aortic Valve Replacement: In-hospital Mortality, Hospital Outcomes, and 30-day Readmission. A Propensity Score-matched Analysis. Crit Pathw Cardiol 2019; 18:102-107. [PMID: 31094738 DOI: 10.1097/hpc.0000000000000180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Transapical transcatheter aortic valve replacement (TAVR) is associated with increased morbidity compared with endovascular TAVR. We sought to compare the differences in clinical outcomes between endovascular and transapical TAVR approaches utilizing a propensity score model. METHODS Patients undergoing TAVR (International Classification of Diseases, Ninth Revision, Clinical Modification codes 35.05 and 35.06) between January 2011 and November 2014 were identified in the Nationwide Readmissions Database, and a propensity score-matched analysis was performed comparing transapical versus endovascular approach. The primary outcome of interest was in-hospital mortality and 30-day all-cause readmission. We also evaluated trends in use of TAVR over the years. RESULTS We identified 28,302 endovascular TAVR and 7967 transapical TAVR performed during the study period. The propensity score-matching algorithm yielded 7879 well-matched patients in each group. The in-hospital mortality rates were significantly lower in endovascular TAVR compared with transapical TAVR (1.7% vs 6.7%; OR, 0.24; 95% CI, 0.17- 0.35; P < 0.001). The 30-day readmission rate was lower in endovascular TAVR (14.4% vs 16.8%; OR, 0.83; 95% CI, 0.70-0.98; P = 0.036). Use of TAVR increased from 585 (74% endovascular TAVR) in 2011 to 16,801 in 2014 (82.8% endovascular TAVR). CONCLUSIONS Endovascular TAVR is associated with significantly lower in-patient mortality and lower readmission rate when compared with transapical TAVR. Heart failure remains the most common cause for readmission after TAVR regardless of approach.
Collapse
|
11
|
Ghannam M, Cunnane R, Menees D, Grossman MP, Chetcuti S, Patel H, Deeb M, Jongnarangsin K, Pelosi F, Oral H, Latchamsetty R. Atrioventricular conduction in patients undergoing pacemaker implant following self-expandable transcatheter aortic valve replacement. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:980-988. [PMID: 30969440 DOI: 10.1111/pace.13694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/11/2019] [Accepted: 04/07/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Heart block requiring a pacemaker is common after self-expandable transcatheter aortic valve replacement (SE-TAVR); however, conduction abnormalities may improve over time. Optimal device management in these patients is unknown. OBJECTIVE To evaluate the long-term, natural history of conduction disturbances in patients undergoing pacemaker implantation following SE-TAVR. METHODS All patients who underwent new cardiac implantable electronic device (CIED) implantation at Michigan Medicine following SE-TAVR placement between January 1, 2012 and September 25, 2017 were identified. Electrocardiogram and device interrogation data were examined during follow-up to identify patients with recovery of conduction. Logistic regression analysis was used to compare clinical and procedural variables to predict conduction recovery. RESULTS Following SE-TAVR, 17.5% of patients underwent device placement for new atrioventricular (AV) block. Among 40 patients with an average follow-up time of 17.1 ± 8.1 months, 20 (50%) patients had durable recovery of AV conduction. Among 20 patients without long-term recovery, four (20%) had transient recovery. The time to transient conduction recovery was 2.2 ± 0.2 months with repeat loss of conduction at 8.2 ± 0.9 months. On multivariate analysis, larger aortic annular size (odds ratio: 0.53 [0.28-0.86]/mm, P = 0.02) predicted lack of conduction recovery. CONCLUSIONS Half of the patients undergoing CIED placement for heart block following SE-TAVR recovered AV conduction within several months and maintained this over an extended follow-up period. Some patients demonstrated transient recovery of conduction before recurrence of conduction loss. Larger aortic annulus diameter was negatively associated with conduction recovery.
Collapse
Affiliation(s)
- Michael Ghannam
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ryan Cunnane
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Daniel Menees
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael P Grossman
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Stanley Chetcuti
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Himanshu Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Frank Pelosi
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Hakan Oral
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rakesh Latchamsetty
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
12
|
Evaluation of Conduction Disorders after Aortic Valve Replacement with Rapid Deployment Bioprostheses. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:356-360. [DOI: 10.1097/imi.0000000000000558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective The aim of this retrospective, single-center study was to evaluate the occurrence of conduction disorders after rapid deployment aortic bioprosthesis implantation. Methods Electrocardiograms of patients undergoing INTUITY (Edwards Lifesciences, Irvine, CA USA) bioprosthesis implantation were collected at admission, during postoperative course, and at discharge. Primary end point was the occurrence of new-onset conduction disorders, defined as complete left bundle branch block, complete right bundle branch block, permanent pacemaker implantation, and worsening of pre-existing rhythm abnormalities. Secondary end points were the assessment of preoperative and postoperative QRS duration and the identification of transitory conduction disorders. Results Forty-four patients (July 2015–December 2016) were included in the analysis. Preoperatively, patients with normal conduction and with already existing disorders were 25 (56.8%) and 19 (43.2%), respectively. Primary end point occurred in 14 patients (31.8%). Two patients (4.5%) received pacemaker implantation. In patients with normal preoperative conduction, new abnormalities were found in eight cases (32%): all left bundle branch blocks with one pacemaker implantation. Worsening of pre-existing conduction disorders was found in six patients (31.6%) with one pacemaker implantation. QRS duration increased in 20 patients (45.4%), and average increase was 37 milliseconds. Overall, we observed a significant increase of QRS (96 ± 21 milliseconds vs. 111 ± 28 milliseconds, P < 0.001). Three patients experienced a new-onset temporary left bundle branch block. Conclusions New-onset conduction disorders or worsening of pre-existing rhythm abnormalities occur in one third of patients after rapid deployment aortic bioprosthesis implantation. Although the incidence of postoperative pacemaker implantation before discharge is low, strict follow-up is mandatory to identify a potential need for pacemaker implantation in a timely manner.
Collapse
|
13
|
Boriani G, Fauchier L, Aguinaga L, Beattie JM, Blomstrom Lundqvist C, Cohen A, Dan GA, Genovesi S, Israel C, Joung B, Kalarus Z, Lampert R, Malavasi VL, Mansourati J, Mont L, Potpara T, Thornton A, Lip GYH, Gorenek B, Marin F, Dagres N, Ozcan EE, Lenarczyk R, Crijns HJ, Guo Y, Proietti M, Sticherling C, Huang D, Daubert JP, Pokorney SD, Cabrera Ortega M, Chin A. European Heart Rhythm Association (EHRA) consensus document on management of arrhythmias and cardiac electronic devices in the critically ill and post-surgery patient, endorsed by Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin American Heart Rhythm Society (LAHRS). Europace 2018; 21:7-8. [DOI: 10.1093/europace/euy110] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/26/2018] [Indexed: 02/05/2023] Open
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Laurent Fauchier
- Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France
| | | | - James M Beattie
- Cicely Saunders Institute, King’s College London, London, UK
| | | | | | - Gheorghe-Andrei Dan
- Cardiology Department, University of Medicine and Pharmacy “Carol Davila”, Colentina University Hospital, Bucharest, Romania
| | - Simonetta Genovesi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano and Nephrology Unit, San Gerardo Hospital, Monza, Italy
| | - Carsten Israel
- Evangelisches Krankenhaus Bielefeld GmbH, Bielefeld, Germany
| | - Boyoung Joung
- Cardiology Division, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Zbigniew Kalarus
- SMDZ in Zabrze, Medical University of Silesia, Katowice; Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | | | - Vincenzo L Malavasi
- Cardiology Division, Department of Nephrologic, Cardiac, Vascular Diseases, Azienda ospedaliero-Universitaria di Modena, Modena, Italy
| | - Jacques Mansourati
- University Hospital of Brest and University of Western Brittany, Brest, France
| | - Lluis Mont
- Arrhythmia Section, Cardiovascular Clínical Institute, Hospital Clinic, Universitat Barcelona, Barcelona, Spain
| | - Tatjana Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | | | | | | | - Radosław Lenarczyk
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Harry J Crijns
- Cardiology Maastricht UMC+ and Cardiovascular Research Institute Maastricht, Netherlands
| | - Yutao Guo
- Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Marco Proietti
- Institute of Cardiovascular Sciences, University of Birmingham, UK
- Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Rome, Italy
| | | | - Dejia Huang
- Cardiology Division, Department of Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | | | - Sean D Pokorney
- Electrophysiology Section, Division of Cardiology, Duke University, Durham, NC, USA
| | - Michel Cabrera Ortega
- Department of Arrhythmia and Cardiac Pacing, Cardiocentro Pediatrico William Soler, Boyeros, La Havana Cuba
| | - Ashley Chin
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, South Africa
| | | |
Collapse
|
14
|
Mehaffey JH, Haywood NS, Hawkins RB, Kern JA, Teman NR, Kron IL, Yarboro LT, Ailawadi G. Need for Permanent Pacemaker After Surgical Aortic Valve Replacement Reduces Long-Term Survival. Ann Thorac Surg 2018; 106:460-465. [PMID: 29577930 DOI: 10.1016/j.athoracsur.2018.02.041] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 01/30/2018] [Accepted: 02/11/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Permanent pacemaker (PPM) implantation has been touted as an inconsequential complication after transcatheter aortic valve replacement. As transcatheter aortic valve replacement moves to lower risk patients, the long-term implications remain poorly understood; therefore, we evaluated the long-term outcomes of pacemaker for surgical aortic valve replacement patients. METHODS A total of 2,600 consecutive patients undergoing surgical aortic valve replacement over the past 15 years were reviewed using The Society of Thoracic Surgeons (STS) institutional database and Social Security death records. Patients were stratified by placement of a PPM within 30 days of surgery. The impact of PPM placement on long-term survival was assessed by Kaplan-Meier analysis and risk-adjusted survival by Cox proportional hazards modeling. RESULTS A total of 72 patients (2.7%) required PPM placement postoperatively. Patients requiring PPM had more postoperative complications, including atrial fibrillation (43.1% versus 27.0%, p = 0.003), prolonged ventilation (16.7% versus 5.7%, p < 0.0001), and renal failure (12.5% versus 4.6%, p = 0.002). These led to greater resource utilization including longer intensive care unit stay (89 versus 44 hours, p < 0.0001) and hospital length of stay (9 versus 6 days, p < 0.0001), and higher inflation-adjusted hospital cost ($81,000 versus $47,000, p < 0.0001). Median follow-up was 7.5 years, and patients requiring PPM had significantly worse long-term survival (p = 0.02), even after risk adjustment with STS predicted risk of mortality (hazard ratio 1.48, p = 0.02). CONCLUSIONS The need for PPM after aortic valve replacement independently reduces long-term survival. The rate of PPM placement after surgical aortic valve replacement remains very low but dramatically increases resource utilization. As transcatheter aortic valve replacement expands to low-risk patients, the impact of PPM placement on long-term survival warrants close monitoring.
Collapse
Affiliation(s)
- J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Nathan S Haywood
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Robert B Hawkins
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - John A Kern
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Nicholas R Teman
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Irving L Kron
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Leora T Yarboro
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
| |
Collapse
|
15
|
Conduction abnormalities after transcatheter aortic valve implantation. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2018; 15:105-112. [PMID: 29434632 PMCID: PMC5803544 DOI: 10.11909/j.issn.1671-5411.2018.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In the last few years, transcatheter aortic valve implantation (TAVI) has become an alternative procedure in patients with severe aortic stenosis and high risk for surgical aortic replacement. Due to the anatomic correlation between aortic valve structure and conduction system of the heart, one of the most common complications after TAVI is conduction system disturbances which including bundle branch block, complete heart block and need for permanent pacemaker implantation. Although these disturbances are usually not lethal, they may have a great influence on patients' state and long term-survival. Several risk factors for conduction disturbances have been identified which including age, anatomy of the heart, periprocedural factors, type of implanted valve, preexisting abnormalities and comorbidities. As this technique becomes more familiar to physicians, patients should be carefully screened for risk factors for the development of conduction abnormalities after TAVI in order to provide effective prevention and proper treatment.
Collapse
|
16
|
Monteiro C, Ferrari ADL, Caramori PRA, Carvalho LAF, Siqueira DADA, Thiago LEKS, Perin M, Lima VCD, Guérios E, Brito Junior FSD. Permanent Pacing After Transcatheter Aortic Valve Implantation: Incidence, Predictors and Evolution of Left Ventricular Function. Arq Bras Cardiol 2017; 109:550-559. [PMID: 29185614 PMCID: PMC5783436 DOI: 10.5935/abc.20170170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 07/12/2017] [Indexed: 12/21/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) is a well-established
procedure; however, atrioventricular block requiring permanent pacemaker
implantation (PPI) is a common complication. Objectives To determine the incidence, predictors and clinical outcomes of PPI after
TAVI, focusing on how PPI affects left ventricular ejection fraction (LVEF)
after TAVI. Methods The Brazilian Multicenter TAVI Registry included 819 patients submitted to
TAVI due to severe aortic stenosis from 22 centers from January/2008 to
January/2015. After exclusions, the predictors of PPI were assessed in 670
patients by use of multivariate regression. Analysis of the ROC curve was
used to measure the ability of the predictors; p < 0.05 was the
significance level adopted. Results Within 30 days from TAVI, 135 patients (20.1%) required PPI. Those patients
were older (82.5 vs. 81.1 years; p = 0.047) and mainly of the male sex
(59.3% vs 45%; p = 0.003). Hospital length of stay was longer in patients
submitted to PPI (mean = 15.7 ± 25.7 vs. 11.8 ± 22.9 days; p
< 0.001), but PPI affected neither all-cause death (26.7% vs. 25.6%; p =
0.80) nor cardiovascular death (14.1% vs. 14.8%; p = 0.84). By use of
multivariate analysis, the previous presence of right bundle-branch block
(RBBB) (OR, 6.19; 3.56-10.75; p ≤ 0.001), the use of
CoreValve® prosthesis (OR, 3.16; 1.74-5.72; p ≤
0.001) and baseline transaortic gradient > 50 mm Hg (OR, 1.86; 1.08-3.2;
p = 0.025) were predictors of PPI. The estimated risk of PPI ranged from 4%,
when none of those predictors was present, to 63%, in the presence of all of
them. The model showed good ability to predict the need for PPI: 0.69
(95%CI: 0.64 - 0.74) in the ROC curve. The substudy of 287 echocardiograms
during the 1-year follow-up showed worse LVEF course in patients submitted
to PPI (p = 0.01). Conclusion BRD prévio, gradiente aórtico médio > 50 mmHg e
CoreValve® são preditores independentes de implante de MPD
pós-TAVI. Ocorreu implante de MPD em aproximadamente 20% dos casos de
TAVI, o que prolongou a internação hospitalar, mas não
afetou a mortalidade. O implante de MPD afetou negativamente a FEVE
pós-TAVI.
Collapse
Affiliation(s)
- Cláudio Monteiro
- Centro de Pesquisas Cardiovasculares do Hospital São Lucas da PUCRS, Porto Alegre, RS - Brazil
| | - Andres Di Leoni Ferrari
- Centro de Pesquisas Cardiovasculares do Hospital São Lucas da PUCRS, Porto Alegre, RS - Brazil
| | | | | | | | | | - Marco Perin
- Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
| | - Valter C de Lima
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS - Brazil
| | - Enio Guérios
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR - Brazil - Brazil
| | | |
Collapse
|
17
|
Alkhalil A, Golbari S, Song D, Lamba H, Fares A, Alaiti A, Deo S, Attizzani GF, Ibrahim H, Ruiz CE. In-hospital outcomes of transcatheter versus surgical aortic valve replacement in end stage renal disease. Catheter Cardiovasc Interv 2017; 92:757-765. [DOI: 10.1002/ccd.27433] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 08/30/2017] [Accepted: 10/31/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Ahmad Alkhalil
- Department of Medicine/Division of Cardiology; Rutgers University School of Medicine; Newark New Jersey
| | - Shervin Golbari
- Department of Medicine/Division of Cardiology; Rutgers University School of Medicine; Newark New Jersey
| | - David Song
- Department of Medicine/Division of Cardiology; Rutgers University School of Medicine; Newark New Jersey
| | - Harveen Lamba
- Department of Medicine/Division of Cardiology; Case Western Reserve University; Cleveland Ohio
| | - Anas Fares
- Department of Medicine/Division of Cardiology; Case Western Reserve University; Cleveland Ohio
| | - Amer Alaiti
- Department of Medicine/Division of Cardiology; Case Western Reserve University; Cleveland Ohio
| | - Salil Deo
- Department of Medicine/Division of Cardiology; Case Western Reserve University; Cleveland Ohio
| | - Guilherme F. Attizzani
- Department of Medicine/Division of Cardiology; Case Western Reserve University; Cleveland Ohio
| | - Homam Ibrahim
- Department of Medicine/Division of Cardiology; University of Utah; Salt Lake City Utah
| | - Carlos E. Ruiz
- Department of Medicine/Division of Cardiology; Hackensack University Medical Center; Hackensack New Jersey
| |
Collapse
|
18
|
Moini C, Sidia B, Poindron D, Fiorina L, Farge A, Amara W, El Issa M. [Cardiac permanent pacemaker after transcatheter aortic valve implantation: A predictive and scientific review]. Ann Cardiol Angeiol (Paris) 2016; 65:346-351. [PMID: 27693168 DOI: 10.1016/j.ancard.2016.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 09/02/2016] [Indexed: 06/06/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is nowadays a worldwide technique in the field of treating aortic stenosis. One of the main side effects linked to the technique are mostly attached to rhythm disturbances, such as atrioventricular (AV) and intraventricular blocks. Consequently, a pacemaker implantation is often required. That implantation rate is estimated between 8 and 30%, depending on the valve chosen. Thanks to main meta analysis on the subject, it has been managed to isolate the following risks factors for AV block development: preoperative right bundle branch block (RBBB: the most powerful element), complete AV block during the procedure, male gender, a so-called porcelain aorta, the absence of previous valvular surgery, the aortic annulus size (i.e when that size is inferior to the valve's one) and the QRS duration after the procedure (the superior threshold has been set at 128ms for the Corevalve). The currently recommendations advice to implant a pacemaker are as followed: high grade AV block (in the main studies, the implantation occurs within the 5 days after the TAVI), complete and transient AV block during the TAVI, second degree AV block and RBBB associated with first degree AV block. Our article aims to review the arrhythmic issues of TAVI.
Collapse
Affiliation(s)
- C Moini
- Unité de rythmologie et de stimulation cardiaque, hôpital d'Antony, 1, rue Velpeau, 92160 Antony, France; Unité de rythmologie et de stimulation cardiaque, clinique Les Fontaines, 54, boulevard Aristide-Briand, 77000 Melun, France; Service de cardiologie, centre hospitalier de Melun, 2, rue Fréteau-de-Peny, 77011 Melun cedex, France
| | - B Sidia
- Unité de rythmologie et de stimulation cardiaque, hôpital d'Antony, 1, rue Velpeau, 92160 Antony, France
| | - D Poindron
- Unité de rythmologie et de stimulation cardiaque, hôpital d'Antony, 1, rue Velpeau, 92160 Antony, France; Unité de rythmologie et de stimulation cardiaque, clinique Les Fontaines, 54, boulevard Aristide-Briand, 77000 Melun, France
| | - L Fiorina
- Unité de rythmologie et de stimulation cardiaque, hôpital d'Antony, 1, rue Velpeau, 92160 Antony, France; Unité de rythmologie et de stimulation cardiaque, clinique Les Fontaines, 54, boulevard Aristide-Briand, 77000 Melun, France
| | - A Farge
- Unité de chirurgie cardiaque, hôpital Jacques-Cartier, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - W Amara
- Unité de rythmologie, GHI Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - M El Issa
- Unité de rythmologie et de stimulation cardiaque, hôpital d'Antony, 1, rue Velpeau, 92160 Antony, France.
| |
Collapse
|
19
|
Allahwala UK, Hansen PS, Danson EJ, Straiton N, Sinhal A, Walters DL, Bhindi R. Transcatheter aortic valve implantation: current trends and future directions. Future Cardiol 2015; 12:69-85. [PMID: 26696562 DOI: 10.2217/fca.15.73] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has been increasingly utilized for the treatment of severe symptomatic aortic stenosis in inoperable and high surgical risk patients. Recent advances in valve technology include repositionable scaffolds and smaller delivery systems, as well as improvement in periprocedural imaging. These advances have resulted in reduction of vascular complications, rates of paravalvular aortic regurgitation and periprocedural stroke and improved overall outcomes. Increasingly, TAVI is the preferred treatment for high-risk surgical patients with severe aortic stenosis. Consequently, there is growing interest for the use of TAVI in lower surgical risk patients. Furthermore, the role of TAVI has expanded to include valve-in-valve procedures for the treatment of degenerative bioprosthetic valves and bicuspid aortic valves. Questions remain in regard to the optimal management of concurrent coronary artery disease, strategies to minimize valve leaflet restriction and treatment of conduction abnormalities as well as identifying newer indications for its use.
Collapse
Affiliation(s)
- Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Peter S Hansen
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Edward J Danson
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Nicola Straiton
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Ajay Sinhal
- Department of Cardiology, Flinders Medical Centre, Adelaide, Australia
| | - Darren L Walters
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| |
Collapse
|
20
|
Vogt F, Pfeiffer S, Dell'Aquila AM, Fischlein T, Santarpino G. Sutureless aortic valve replacement with Perceval bioprosthesis: are there predicting factors for postoperative pacemaker implantation? Interact Cardiovasc Thorac Surg 2015; 22:253-8. [PMID: 26614526 DOI: 10.1093/icvts/ivv330] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 10/27/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Aortic valve replacement (AVR) with sutureless bioprostheses has become an alternative to conventional AVR for patients with intermediate to high operative risk. However, this technique is associated with an increased risk of postoperative conduction disorders. METHODS We analysed 258 patients who underwent AVR with the Perceval prosthesis from July 2010 to September 2014 at our centre. Electrocardiography were obtained at baseline to record preoperatively the presence of conduction disorders. Preoperative risk factors, intraoperative procedures and complications (61 variables) were compared between patients with permanent pacemaker (PPM group) and without (no-PPM group) need for postoperative PPM implantation. RESULTS One hundred and sixty-nine patients underwent isolated AVR with the Perceval bioprosthesis, 89 patients had associated surgery and 23 patients underwent redo operations. The mean age was 77.7 ± 5 years, 139 patients were female (46%) and the mean logistic EuroSCORE was 13.2 ± 11%. At baseline, 8 patients had already an implanted pacemaker. Postoperatively, 27 patients (10.5%) required new PPM implantation due to complete atrioventricular block. On univariate analysis, age (PPM vs no-PPM group: 80 ± 5 vs 77 ± 5 years, P = 0.009) and preoperative presence of right bundle branch block (RBBB) [overall n = 20 (7.8%); PPM vs no-PPM group: 9 vs 11 (33 vs 4.8%); P < 0.001] were identified as independent predictors of postoperative conduction disorders, but only pre-existing RBBB persisted on multivariate analysis (odds ratio 11.3-C-statistic 0.74, error estimate 0.064, confidence interval 0.672-0.801; P = 0.0002). Among patients undergoing sutureless AVR, the rate of PPM implantation was high. CONCLUSIONS The analysis of the data collected made it possible to identify preoperatively a subset of patients undergoing sutureless AVR at higher risk of postoperative atrioventricular block. Additional surgical precautions should be implemented to prevent the occurrence of conduction disorders after sutureless AVR.
Collapse
Affiliation(s)
- Ferdinand Vogt
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Steffen Pfeiffer
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | | | - Theodor Fischlein
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| |
Collapse
|
21
|
Kawaguchi AT, D'Allessandro C, Collet JP, Cluzel P, Makri R, Leprince P. Ventricular Conduction Defects After Transcatheter Aortic Valve Implantation: A Single-Institute Analysis. Artif Organs 2015; 39:409-15. [DOI: 10.1111/aor.12393] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Akira T. Kawaguchi
- Chirurgie Thoracique et Cardiovasculaire; Groupe Hospitalier Pitié-Salpêtrière; Paris France
| | - Cosimo D'Allessandro
- Chirurgie Thoracique et Cardiovasculaire; Groupe Hospitalier Pitié-Salpêtrière; Paris France
| | | | - Philippe Cluzel
- Department d'Imagerie et de Radiologie Interventionelle; Groupe Hospitalier Pitié-Salpêtrière; Paris France
| | - Ralouka Makri
- Department d'Anesthésie Reanimation, Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris; Groupe Hospitalier Pitié-Salpêtrière; Paris France
| | - Pascal Leprince
- Chirurgie Thoracique et Cardiovasculaire; Groupe Hospitalier Pitié-Salpêtrière; Paris France
| |
Collapse
|
22
|
Aversa E, Muratore CA, Nemesio ML, Tentori MC, Payaslian M. [New conduction disturbances and pacemaker indications after CoreValve® transcatheter aortic valve replacement. Incidence and follow up in a single center experience]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 85:278-83. [PMID: 25772651 DOI: 10.1016/j.acmx.2014.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 12/07/2014] [Accepted: 12/10/2014] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) is currently reserved for patients with symptomatic aortic stenosis and high surgical risk. One major limiting factor related to TAVI procedural complications is conduction abnormalities and the need for permanent pacemaker implantation. OBJECTIVES Evaluate the incidence of new conduction disturbances and pacemaker indications in patients with TAVI CoreValve® prosthesis (Medtronic Inc. Minneapolis, Minnesota, United States). METHODS We included 28 patients, mean age 80 years. ECG parameters were evaluated previous and after implantation. All patients were monitorized during TAVI. Follow up Holter monitoring was performed at one, 6 and 12 months after the procedure and we also evaluated telemetry of implanted pacemaker. RESULTS In previous ECG we found 7 patients had right bundle branch block and 7 patients had left bundle brunch block (LBBB). The post implant ECG showed 7 new LBBB: 3 during valvuloplasty and 4 on the end of it. Six patients required pacemaker implantation for permanent or paroxysmal complete AV block (CAVB). At one year follow up, 3 patients with LBBB during valvuloplasty had a normal ECG, one still had LBBB and one an asymptomatic CAVB found in Holter monitoring. CONCLUSIONS Conduction abnormalities are frequent after CoreValve® aortic valve prosthesis implantation. The incidence of new LBBB was 25%. CAVB during or post TAVI require PM implantation. New LBBB may need a closer follow up because in a 3% of the cases it may progress to CAVB.
Collapse
Affiliation(s)
- Eliana Aversa
- Servicio de Cardiología, Hospital Fernández, Buenos Aires, Argentina.
| | | | - M Laura Nemesio
- Servicio de Cardiología, Hospital Fernández, Buenos Aires, Argentina
| | | | - Miguel Payaslian
- Servicio de Cardiología, Hospital Fernández, Buenos Aires, Argentina
| |
Collapse
|
23
|
BOERLAGE-VAN DIJK KIRSTEN, KOOIMAN KIRSTENM, YONG ZEYIE, WIEGERINCK ESTHERM, DAMMAN PETER, BOUMA BERTOJ, TIJSSEN JANG, PIEK JANJ, KNOPS REINOUDE, BAAN JAN. Predictors and Permanency of Cardiac Conduction Disorders and Necessity of Pacing after Transcatheter Aortic Valve Implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1520-9. [DOI: 10.1111/pace.12460] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/06/2014] [Accepted: 05/31/2014] [Indexed: 11/29/2022]
Affiliation(s)
- KIRSTEN BOERLAGE-VAN DIJK
- Department of Cardiology; Academic Medical Center - University of Amsterdam; Amsterdam the Netherlands
| | - KIRSTEN M. KOOIMAN
- Department of Cardiology; Academic Medical Center - University of Amsterdam; Amsterdam the Netherlands
| | - ZE YIE YONG
- Department of Cardiology; Academic Medical Center - University of Amsterdam; Amsterdam the Netherlands
| | - ESTHER M.A. WIEGERINCK
- Department of Cardiology; Academic Medical Center - University of Amsterdam; Amsterdam the Netherlands
| | - PETER DAMMAN
- Department of Cardiology; Academic Medical Center - University of Amsterdam; Amsterdam the Netherlands
| | - BERTO J. BOUMA
- Department of Cardiology; Academic Medical Center - University of Amsterdam; Amsterdam the Netherlands
| | - JAN G.P. TIJSSEN
- Department of Cardiology; Academic Medical Center - University of Amsterdam; Amsterdam the Netherlands
| | - JAN J. PIEK
- Department of Cardiology; Academic Medical Center - University of Amsterdam; Amsterdam the Netherlands
| | - REINOUD E. KNOPS
- Department of Cardiology; Academic Medical Center - University of Amsterdam; Amsterdam the Netherlands
| | - JAN BAAN
- Department of Cardiology; Academic Medical Center - University of Amsterdam; Amsterdam the Netherlands
| |
Collapse
|
24
|
Ielasi A, Latib A, Tespili M. Current and new-generation transcatheter aortic valve devices: an update on emerging technologies. Expert Rev Cardiovasc Ther 2014; 11:1393-405. [PMID: 24138525 DOI: 10.1586/14779072.2013.837702] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has become an accepted treatment option for patients with symptomatic severe aortic stenosis who are at high risk for traditional surgical aortic valve replacement. In particular, TAVI has been shown to reduce mortality in a randomized comparison with medical treatment and to be non-inferior to surgical aortic valve replacement in 'high-risk operable' patients. From its early stages it became apparent that TAVI has tremendous potential and thus considerable efforts were made to design new devices and advance valve technology in order to improve outcomes and increase TAVI applications in complex anatomies and in patients with multiple co-morbidities. In this review, we present the advances in transcatheter aortic valve technology and discuss the current evidence on the new-generation TAVI devices.
Collapse
Affiliation(s)
- Alfonso Ielasi
- Cardiology Division, Azienda Ospedaliera "Bolognini", Seriate (BG), Italy
| | | | | |
Collapse
|
25
|
Transcatheter aortic valve implantation-induced left bundle branch block: causes and consequences. J Cardiovasc Transl Res 2014; 7:395-405. [PMID: 24800873 DOI: 10.1007/s12265-014-9560-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an alternative treatment option for patients with severe aortic valve stenosis who do not qualify for surgical aortic valve replacement (AVR). Besides its proven clinical benefits, one of the complications of TAVI is the creation of conduction abnormalities, like left bundle branch block (LBBB). New LBBB occurs between 7 and 65% of cases, numbers that differ considerably between devices. In this review, we discuss the possible causes and the clinical significance of TAVI-induced LBBB. Several device- and procedural-related factors seem responsible for the development of LBBB, of which depth of implantation and balloon-annulus diameter ratio are the most important ones. TAVI-induced LBBB negatively affects cardiac function and hospitalization, but its impact on mortality is subject of debate. Future research and registries should implement strict diagnostic criteria for LBBB together with recording of its timing and persistence.
Collapse
|
26
|
Transcatheter Aortic Valve Implantation by the Left Axillary Approach: A Single-Center Experience. Ann Thorac Surg 2014; 97:1549-54. [DOI: 10.1016/j.athoracsur.2013.11.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 09/20/2013] [Accepted: 11/11/2013] [Indexed: 11/21/2022]
|
27
|
Abstract
The JenaValve is a next-generation TAVI device which consists of a well-proven porcine root valve mounted on a low-profile nitinol stent. Feeler guided positioning and clip fixation on the diseased leaflets allow for anatomically correct implantation of the device without rapid pacing. Safety and efficacy of transapical aortic valve implantation using the JenaValve were evaluated in a multicentre prospective study that showed good short and midterm results. The valve was CE-mark released in Europe in September 2011. A post-market registry ensures on-going and prospective data collection in "real-world" patients. The transfemoral JenaValve delivery system will be evaluated in a first-in-man study in the near future.
Collapse
Affiliation(s)
- Hendrik Treede
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
| | | | | | | | | | | |
Collapse
|
28
|
Ghadimi K, Patel PA, Gutsche JT, Sophocles A, Anwaruddin S, Szeto WY, Augoustides JG. Perioperative Conduction Disturbances After Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2013; 27:1414-20. [DOI: 10.1053/j.jvca.2013.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Indexed: 11/11/2022]
|
29
|
|
30
|
Grando TA, Sarmento-Leite R, Lunardi Prates PR, Gomes CR, Specht F, Gheller AS, Bernardi G. Anesthetic management and complications of percutaneous aortic valve implantation. Rev Bras Anestesiol 2013; 63:279-86. [PMID: 23683452 DOI: 10.1016/s0034-7094(13)70231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 08/20/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Aortic stenosis is a highly prevalent and life-threatening disease. In elderly patients with comorbidities, percutaneous valve implantation is an option. The aim of the study was to describe the anesthetic management and complications of general anesthesia. METHOD Case series with 30-day and 24-month follow-ups after implantation of the CoreValve device performed at the Institute of Cardiology/University Foundation of Cardiology between December 2008 and January 2012. The patients underwent general anesthesia monitored with mean arterial pressure (PAM), electrocardiogram (ECG), pulse oximetry, capnography, transesophageal echocardiography, thermometry, and transvenous pacemaker. RESULTS Twenty-eight patients, mean age 82.46 years, 20.98% mean EuroSCORE, functional class III/IV, successfully underwent valve implantation. Nine patients required permanent pacemaker implantation. During follow-up, two patients died: one during surgery due to LV perforation and the other on the third day of unknown causes. At 24 months, one patient diagnosed with multiple myeloma died. This anesthetic technique proved to be safe. CONCLUSION The initial experience with percutaneous aortic valve implantation under general anesthesia has proven to be safe and effective, with no significant anesthetic complications during this procedure.
Collapse
Affiliation(s)
- Tailur Alberto Grando
- Center for Teaching and Training (CET), Society of Anesthesiology (SANE), Porto AlegreInstitute of Cardiology/Fundacao Universitaria de Cardiologia de Porto Alegre, Brazil.
| | | | | | | | | | | | | |
Collapse
|
31
|
McDonnell KMW, Shepard RK. Conduction Disorders after Transcatheter Aortic Valve Implantation: A Focused Review. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:488-96. [DOI: 10.1007/s11936-013-0245-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
32
|
Simms AD, Hogarth AJ, Hudson EA, Worsnop VL, Blackman DJ, O'Regan DJ, Tayebjee MH. Ongoing requirement for pacing post-transcatheter aortic valve implantation and surgical aortic valve replacement. Interact Cardiovasc Thorac Surg 2013; 17:328-33. [PMID: 23620339 DOI: 10.1093/icvts/ivt175] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Transcatheter aortic valve implantation (TAVI) is an established intervention for aortic stenosis. While it is known that the requirement for permanent pacing is higher following CoreValve (Medtronic, Inc., Minneapolis, MN, USA) TAVI than after surgical aortic valve replacement (SAVR), it remains uncertain whether pacing is required in the medium-to-long term. We hypothesized that complete heart block following TAVI is more likely to resolve than that following SAVR. METHODS A retrospective analysis of prospectively collated data on 528 patients undergoing TAVI or SAVR from May 2008 to December 2010 at a cardiac tertiary referral hospital. Demographic data, timing and indication for pacing post-procedure plus follow-up were recorded. Paced patients were compared and analysed by existing initial indication for pacing. RESULTS In total, 31 (5.9%) patients received a pacemaker, and there were limited differences between not paced and paced patient characteristics by procedure type. Of these, a greater proportion were implanted post-TAVI compared with SAVR (17 vs 3.2%, P<0.001). The mean time to pacemaker follow-up for TAVI and SAVR was 234 and 188 days, P=0.32, respectively. Fewer patients compared with pacing indication remained in complete heart block at latest follow-up for TAVI (76.5 vs 33.3%, P=0.02) and SAVR (92.9 vs 58.3%, P=0.04). Although, there was a trend towards a greater magnitude of TAVI patients regaining atrioventricular nodal conduction, this did not differ significantly from that seen in SAVR patients. CONCLUSIONS In keeping with previous reports, this single-centre experience demonstrates that patients undergoing TAVI have higher rates of pacemaker implantation than those following SAVR. However, pacing indication in the short-to-medium term may not persist for all paced patients post-TAVI and -SAVR with the suggestion that a significant proportion recover atrioventricular conduction, which tended to be greatest in TAVI paced patients.
Collapse
|
33
|
Akin I, Kische S, Paranskaya L, Schneider H, Rehders TC, Trautwein U, Turan G, Bänsch D, Thiele O, Divchev D, Bozdag-Turan I, Ortak J, Kundt G, Nienaber CA, Ince H. Predictive factors for pacemaker requirement after transcatheter aortic valve implantation. BMC Cardiovasc Disord 2012; 12:87. [PMID: 23035864 PMCID: PMC3509406 DOI: 10.1186/1471-2261-12-87] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Accepted: 09/28/2012] [Indexed: 11/17/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) has been established as a treatment option for inoperable patients with symptomatic aortic valve stenosis. However, patients suffer frequently from conduction disturbances after TAVI. Methods Baseline, procedural as well as surface and intracardiac ECG parameters were evaluated for patients treated with TAVI and a comparison between patients requiring pacemaker with those not suffering from relevant conduction disorders were done. Results TAVI was successfully in all patients (n=45). Baseline surface and intracardiac ECG recording revealed longer PQ (197.1±51.2 msec versus 154.1±32.1 msec; p<0.001), longer AH (153.6±43.4 msec versus 116.1±31.2 msec; p<0.001) and HV interval (81.7±17.8 msec versus 56.8±8.5 msec; p<0.001) in patients with need for a pacemaker (n=23) versus control group (n=22); furthermore, 7-day follow-up analysis showed a higher prevalence of new left bundle branch block (LBBB) (87.0% versus 31.9%; p<0.001). Multivariate analysis revealed that only new LBBB, QRS duration >120 msec and a PQ interval >200 msec immediately (within 60 minutes) after implantation of the aortic valve were predictors for high-grade (type II second-degree and third-degree) AV block. Other clinical parameters as well as baseline electrocardiographic parameters had no impact on critical conduction delay. Conclusion Cardiac conduction disturbances are common after TAVI. The need for pacing after TAVI is predictable by surface ECG evaluation immediately (within 60 minutes) after the procedure.
Collapse
Affiliation(s)
- Ibrahim Akin
- Heart Center Rostock, Department of Internal Medicine I, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str, 6, Rostock, 18057, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Bourantas CV, Farooq V, Onuma Y, Piazza N, Van Mieghem NM, Serruys PW. Transcatheter aortic valve implantation: new developments and upcoming clinical trials. EUROINTERVENTION 2012; 8:617-27. [PMID: 22995089 DOI: 10.4244/eijv8i5a94] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
35
|
Guarracino F, Landoni G. Con: Transcatheter Aortic Valve Implantation Should Not Be Performed Under General Anesthesia. J Cardiothorac Vasc Anesth 2012; 26:736-9. [DOI: 10.1053/j.jvca.2012.01.052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Indexed: 11/11/2022]
|
36
|
Cai J, Sheng Y, Zhang S, Sun W, Yang R, Miao L, Kong X. Preliminary feasibility and hemodynamic performance of a newly-developed self-expanding bioprosthesis and 16-F delivery system in transcatheter aortic valve implantation in sheep. J Biomed Res 2012; 26:211-8. [PMID: 23554751 PMCID: PMC3596071 DOI: 10.7555/jbr.26.20120011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 03/03/2012] [Accepted: 04/14/2012] [Indexed: 12/03/2022] Open
Abstract
We sought to evaluate the feasibility and hemodynamic performance of a new self-expanding bioprosthesis and 16-F delivery system in sheep. A 23-mm new self-expanding aortic bioprosthesis was implanted in sheep (n = 10) with a 16-F catheter via the right common carotid artery. Each sheep underwent angiography and coronary angiography before intervention, immediately and 1 h after stent implantation. Electrocardiographic monitoring was carried out during and 2 h after the procedure. Transthoracic echocardiography was employed to detect hemodynamic performance before intervention, immediately and 1 and 2 h after stent implantation. All sheep were euthanized 2 h after successful implantation for macroscopic inspection. In all cases, the new self-expanding aortic bioprosthesis was successfully delivered to the aortic root and released with a 16-F catheter. Successful implantation was achieved in 8 of 10 sheep. Hemodynamic performance and device position of successful implantation were stable 2 h after device deployment. Atrioventricular block was not observed. We conclude that it is feasible to implant the new self-expanding aortic valve with a 16-F delivery system into sheep hearts via the retrograde route.
Collapse
|
37
|
Muñoz-García AJ, Hernández-García JM, Jiménez-Navarro MF, Alonso-Briales JH, Domínguez-Franco AJ, Fernández-Pastor J, Peña Hernández J, Barrera Cordero A, Alzueta Rodríguez J, de Teresa-Galván E. Factors Predicting and Having an Impact on the Need for a Permanent Pacemaker After CoreValve Prosthesis Implantation Using the New Accutrak Delivery Catheter System. JACC Cardiovasc Interv 2012; 5:533-539. [DOI: 10.1016/j.jcin.2012.03.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 03/19/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
|
38
|
|
39
|
Treede H, Mohr FW, Baldus S, Rastan A, Ensminger S, Arnold M, Kempfert J, Figulla HR. Transapical transcatheter aortic valve implantation using the JenaValve system: acute and 30-day results of the multicentre CE-mark study. Eur J Cardiothorac Surg 2012; 41:e131-8. [DOI: 10.1093/ejcts/ezs129] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
40
|
Abstract
Surgical replacement of aortic valves is the gold standard for therapy of high grade aortic valve stenosis. However, the changes in demography confront the responsible medical discipline with an increasingly higher risk profile of patients which necessitates the development of new less invasive alternative forms of treatment for the surgical therapy of aortic valve stenosis. This developmental process has progressed from mini-thoracotomy to transcatheter aortic valve implantation (TAVI). The TAVI procedure is a new therapeutic option for treatment of patients with high grade aortic valve stenosis and high perioperative morbidity and mortality risks with conventional aortic valve replacement. Because TAVI can be carried out while the heart is still beating and without a sternotomy or heart-lung maschine, this procedure is particularly suitable for elderly multimorbid patients and/or patients with previous cardiac surgery. The initial results of large prospective multicenter studies underline the value of TAVI in the modern treatment of high risk patients with symptomatic aortic valve stenosis. In addition to an understanding of the surgical procedure, anesthetists must have precise knowledge of the perioperative anesthesia management and possible complications of the procedure.
Collapse
|
41
|
Caceres M, Braud R, Roselli EE. The Axillary/Subclavian Artery Access Route for Transcatheter Aortic Valve Replacement: A Systematic Review of the Literature. Ann Thorac Surg 2012; 93:1013-8. [DOI: 10.1016/j.athoracsur.2011.10.056] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/16/2011] [Accepted: 10/20/2011] [Indexed: 11/30/2022]
|
42
|
Abstract
This article contains a review of the current status of remote monitoring and follow-up involving cardiac pacing devices and of the latest developments in cardiac resynchronization therapy. In addition, the most important articles published in the last year are discussed.
Collapse
|
43
|
Toutouzas K, Michelongona A, Synetos A, Latsios G, Tsioufis C, Stefanadis C. Atrioventricular block 9days after transcatheter aortic valve implantation. Int J Cardiol 2011; 151:112-4. [DOI: 10.1016/j.ijcard.2011.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 05/16/2011] [Accepted: 06/05/2011] [Indexed: 10/18/2022]
|