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Kawamura A, Maeda K, Shimamura K, Yamashita K, Mukai T, Nakamura D, Mizote I, Sakata Y, Miyagawa S. Coronary access after repeat transcatheter aortic valve replacement in patients of small body size: A simulation study. J Thorac Cardiovasc Surg 2024; 168:76-85.e8. [PMID: 36604286 DOI: 10.1016/j.jtcvs.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/05/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Coronary artery access after repeat transcatheter aortic valve replacement (TAV-in-TAV) is reportedly more difficult because leaflet displacement of the first transcatheter heart valve (THV) impairs coronary cannulation; however, its effects in small patients are unknown. This study aimed to simulate coronary accessibility after TAV-in-TAV in patients of small body size. METHODS We retrospectively analyzed computed tomography scans after initial THV implantation and classified patients by THV and coronary artery location, valve-to-aorta distance, and valve-to-coronary distance. Risks were compared between the SAPIEN and CoreValve/Evolut series, among THV generations, and between bicuspid and tricuspid aortic valves in the CoreValve/Evolut series. RESULTS A total of 254 patients (SAPIEN series, n = 164; CoreValve/Evolut series, n = 90) were enrolled. The average body surface area of the patients was 1.44 m2. Patients were classified as "feasible" (26%), "theoretically feasible with low risk" (19.7%), "theoretically feasible with high risk" (8.7%), or "unfeasible" (45.8%). The "unfeasible" rate was significantly higher in the CoreValve/Evolut series than in the SAPIEN series (78.9% vs 26.2%; P < .001). A significantly higher "unfeasible" rate was identified in the current model of SAPIEN (SAPIEN, 8.3%; SAPIENXT, 1.8%; SAPIEN3, 48.2%; P < .001), but not in the CoreValve/Evolut series (CoreValve, 83.3%; Evolut R, 80.0%; Evolut PRO, 71.4%; P = .587). Patients with a bicuspid aortic valve had a lower "unfeasible" rate compared to those with a tricuspid aortic valve (60.0% vs 86.2%; P = .014). CONCLUSIONS Patients of small body size may have a high probability of "unfeasible" coronary access after TAV-in-TAV, especially when treated with current high-frame devices, suggesting the need for careful strategic planning for initial THV implantation.
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Affiliation(s)
- Ai Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koichi Maeda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kizuku Yamashita
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Mukai
- Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Nakamura
- Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Isamu Mizote
- Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Zhang J, Kong XQ, Gao XF, Chen J, Chen X, Li B, Shao YB, Wang Y, Jiang H, Zhu JC, Zhang JJ, Chen SL. Transfemoral transcatheter aortic valve replacement with VitaFlow TM valve for pure native aortic regurgitation in patients with high surgical risk: Rationale and design of a prospective, multicenter, and randomized SEASON-AR trial. Am Heart J 2024; 271:76-83. [PMID: 38412895 DOI: 10.1016/j.ahj.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/17/2024] [Accepted: 02/22/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Previous studies primarily demonstrated that transfemoral transcatheter aortic valve replacement (TAVR) with self-expanding valve appeared to be a safe and feasible treatment for patients with pure native aortic regurgitation (AR). However, the routine application of transfemoral TAVR for pure AR patients lacks support from randomized trials. TRIAL DESIGN SEASON-AR trial is a prospective, multicenter, randomized, controlled, parallel-group, open-label trial, involving at least 20 sites in China, aiming to enroll 210 patients with pure native severe AR and high surgical risk. All enrolled patients are randomly assigned in a 1:1 fashion to undergo transfemoral TAVR with VitaFlowTM valve and receive guideline-directed medical therapy (GDMT) or to receive GDMT alone. The primary endpoint is the rate of major adverse cardiac events (MACE) at 12 months after the procedure, defined by the composite of all-cause mortality, disabling stroke, and rehospitalization for heart failure. The major secondary endpoints encompass various measures, including procedure-related complications, device success, 6-minute walk distance, and the occurrence of each individual component of the primary endpoint. After hospital discharge, follow-up was conducted through clinical visits or telephone contact at 1, 6, and 12 months. The follow-up will continue annually until 5 years after the index procedure to assess the long-term outcomes. CONCLUSION SEASON-AR trial is the first study designed to investigate the clinical efficacy and safety of transfemoral TAVR with a self-expanding valve in patients with pure native severe AR with inoperable or high-risk, as compared to medical treatment only.
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Affiliation(s)
- Juan Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiang-Quan Kong
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao-Fei Gao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Chen
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Xiang Chen
- Department of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Bo Li
- Department of Cardiology, Zibo Central Hospital, Zibo, China
| | - Yi-Bing Shao
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao, China
| | - Yan Wang
- Department of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Jian-Cheng Zhu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jun-Jie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Shao-Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Aidietis A, Srimahachota S, Dabrowski M, Bilkis V, Buddhari W, Cheung GSH, Nair RK, Mussayev AA, Mattummal S, Chandra P, Mahajan AU, Chmielak Z, Govindan SC, Jose J, Hiremath MS, Chandra S, Shetty R, Mohanan S, John JF, Mehrotra S, Søndergaard L. 30-Day and 1-Year Outcomes With HYDRA Self-Expanding Transcatheter Aortic Valve: The Hydra CE Study. JACC Cardiovasc Interv 2022; 15:93-104. [PMID: 34991828 DOI: 10.1016/j.jcin.2021.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/17/2021] [Accepted: 09/07/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study sought to evaluate the 30-day and 1-year safety and performance of the Hydra transcatheter aortic valve (THV) (in the treatment of symptomatic severe aortic stenosis in patients at high or extreme surgical risk. BACKGROUND The Hydra THV is a novel repositionable self-expanding system with supra-annular bovine pericardial leaflets. METHODS The Hydra CE study was a premarket, prospective, multicenter, single-arm study conducted across 18 study centers in Europe and Asia-Pacific countries. The primary endpoint was all-cause mortality at 30 days. All endpoints were adjudicated by an independent clinical events committee. RESULTS A total of 157 patients (79.2 ± 7.1 years of age, 58.6% female; Society of Thoracic Surgeons score 4.7 ± 3.4%) were enrolled. Successful implantation was achieved in 94.3% cases. At 30 days, there were 11 (7.0%) deaths, including 9 (5.7%) cardiovascular deaths, of which 5 (3.2%) were device related. At 1 year, there were 23 (14.6%) deaths, including 13 (8.3%) cardiovascular deaths. At 30 days, there were significant improvement of effective orifice area (from 0.7 ± 0.2 cm2 to 1.9 ± 0.6 cm2) and mean aortic valve gradient (from 49.5 ± 18.5 mm Hg to 8.1 ± 3.7 mm Hg), which were sustained up to 1 year. Moderate or severe paravalvular leak was observed in 6.3% of patients at 30 days and 6.9% of patients at 1 year. The rate of new permanent pacemaker implantation was 11.7% at 30 days and 12.4% at 1 year. CONCLUSIONS The Hydra CE study demonstrated that transcatheter aortic valve replacement with Hydra THV offered favorable efficacy at 1 year, providing large effective orifice area and low transvalvular gradient as well as acceptable complication rates with regard to new permanent pacemaker and paravalvular leak. (A Clinical Evaluation of the HYDRA Self Expanding Transcatheter Aortic Valve; NCT02434263).
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Affiliation(s)
- Audrius Aidietis
- Cardiology and Angiology Centre, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Suphot Srimahachota
- Cardiac Center and Division of Cardiovascular Disease, Department of Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand
| | - Maciej Dabrowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Vaildas Bilkis
- Cardiology and Angiology Centre, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Wacin Buddhari
- Cardiac Center and Division of Cardiovascular Disease, Department of Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand
| | - Gary S H Cheung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR
| | - Rajesh K Nair
- Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
| | - Abdurashid A Mussayev
- Catheterization Laboratory, National Research Center for Cardiac Surgery, Astana, Kazakhstan
| | - Shafeeq Mattummal
- Department of Adult Cardiology, ASTER MIMS Hospital, Kozhikode, India
| | - Praveen Chandra
- Division of Interventional Cardiology, Medanta The Medicity Hospital, Gurgaon, India
| | - Ajay U Mahajan
- Department of Cardiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, India
| | - Zbigniew Chmielak
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Sajeev C Govindan
- Department of Cardiology, Government Medical College, Calicut, India
| | - John Jose
- Department of Cardiology, Cardiology Unit 2, Christian Medical College Hospital, Vellore, India
| | | | - Sharad Chandra
- Department of Cardiology (Lari Heart Center), King George's Medical University, Lucknow, India
| | - Ranjan Shetty
- Department of Cardiology, Manipal Hospital, Bengaluru, India
| | - Sandeep Mohanan
- KMCT Heart Institute, KMCT Medical College Hospital, Kozhikode, India
| | - John F John
- Department of Cardiology, Baby Memorial Hospital, Calicut, India
| | - Sanjay Mehrotra
- Department of Cardiology, NH Institute of Cardiac Sciences, Bangalore, India
| | - Lars Søndergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Kjønås D, Dahle G, Schirmer H, Malm S, Eidet J, Aaberge L, Steigen T, Aakhus S, Busund R, Rösner A. Risk scores for prediction of 30-day mortality after transcatheter aortic valve implantation: Results from a two-center study in Norway. Health Sci Rep 2021; 4:e283. [PMID: 33977165 PMCID: PMC8102057 DOI: 10.1002/hsr2.283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Transcatheter aortic valve implantation (TAVI)-specific risk scores have been developed based on large registry studies. Our aim was to evaluate how both surgical and novel TAVI risk scores performed in predicting all cause 30-day mortality. In addition, we wanted to explore the validity of our own previously developed model in a separate and more recent cohort. METHODS The derivation cohort included patients not eligible for open surgery treated with TAVI at the University Hospital of North Norway (UNN) and Oslo University Hospital (OUS) from February 2010 through June 2013. From this cohort, a logistic prediction model (UNN/OUS) for all cause 30-day mortality was developed. The validation cohort consisted of patients not included in the derivation cohort and treated with TAVI at UNN between June 2010 and April 2017. EuroSCORE, Logistic EuroSCORE, EurosSCORE 2, STS score, German AV score, OBSERVANT score, IRRMA score, and FRANCE-2 score were calculated for both cohorts. The discriminative accuracy of each score, including our model, was evaluated by receiver operating characteristic (ROC) analysis and compared using DeLong test where P< .05 was considered statistically significant. RESULTS The derivation cohort consisted of 218 and the validation cohort of 241 patients. Our model showed statistically significant better accuracy than all other scores in the derivation cohort. In the validation cohort, the FRANCE-2 had a significantly higher predictive accuracy compared to all scores except the IRRMA and STS score. Our model showed similar results. CONCLUSION Existing risk scores have shown limited accuracy in predicting early mortality after TAVI. Our results indicate that TAVI-specific risk scores might be useful when evaluating patients for TAVI.
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Affiliation(s)
- Didrik Kjønås
- Department of CardiologyUniversity Hospital of North NorwayTromsøNorway
| | - Gry Dahle
- Department of Cardiothoracic SurgeryOslo University Hospital RikshospitaletOsloNorway
| | - Henrik Schirmer
- Department of CardiologyAkershus University HospitalLørenskogNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Siri Malm
- Department of CardiologyUniversity Hospital of North NorwayHarstadNorway
| | - Jo Eidet
- Department of AnesthesiologyOslo University Hospital RikshospitaletOsloNorway
| | - Lars Aaberge
- Department of CardiologyOslo University Hospital RikshospitaletOsloNorway
| | - Terje Steigen
- Department of CardiologyUniversity Hospital of North NorwayTromsøNorway
- Institute of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
| | - Svend Aakhus
- Department of Circulation and Imaging, Faculty of Medicine and Health ScienceNorwegian University of Science and Technology, NTNUTrondheimNorway
- Clinic of CardiologySt. Olavs University HospitalTrondheimNorway
| | - Rolf Busund
- Institute of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
- Department of Cardiothoracic and Vascular SurgeryUniversity Hospital of North NorwayTromsøNorway
| | - Assami Rösner
- Department of CardiologyUniversity Hospital of North NorwayTromsøNorway
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Williams ML, Doyle MP, McNamara N, Tardo D, Mathew M, Robinson B. Epidemiology of infective endocarditis before versus after change of international guidelines: a systematic review. Ther Adv Cardiovasc Dis 2021; 15:17539447211002687. [PMID: 33784909 PMCID: PMC8020745 DOI: 10.1177/17539447211002687] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction: All major international guidelines for the management of infective endocarditis (IE) have undergone major revisions, recommending antibiotic prophylaxis (AP) restriction to high-risk patients or foregoing AP completely. We performed a systematic review to investigate the effect of these guideline changes on the global incidence of IE. Methods: Electronic database searches were performed using Ovid Medline, EMBASE and Web of Science. Studies were included if they compared the incidence of IE prior to and following any change in international guideline recommendations. Relevant studies fulfilling the predefined search criteria were categorized according to their inclusion of either adult or pediatric patients. Incidence of IE, causative microorganisms and AP prescription rates were compared following international guideline updates. Results: Sixteen studies were included, reporting over 1.3 million cases of IE. The crude incidence of IE following guideline updates has increased globally. Adjusted incidence increased in one study after European guideline updates, while North American rates did not increase. Cases of IE with a causative pathogen identified ranged from 62% to 91%. Rates of streptococcal IE varied across adult and pediatric populations, while the relative proportion of staphylococcal IE increased (range pre-guidelines 16–24.8%, range post-guidelines 26–43%). AP prescription trends were reduced in both moderate and high-risk patients following guideline updates. Discussion: The restriction of AP to only high-risk patients has not resulted in an increase in the incidence of streptococcal IE in North American populations. The evidence of the impact of AP restriction on IE incidence is still unclear for other populations. Future population-based studies with adjusted incidence of IE, AP prescription rates and accurate pathogen identification are required to delineate findings further in these other regions.
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Affiliation(s)
- Michael L Williams
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW 2050, Australia
| | - Mathew P Doyle
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Centre for Human and Applied Physiology, School of Medicine, University of Wollongong, Keiraville, Australia
| | - Nicholas McNamara
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Daniel Tardo
- Department of Medicine, St Vincents Hospital, Sydney, NSW, Australia.,School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Manish Mathew
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Benjamin Robinson
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
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Long-Term Follow-Up of Transcatheter Aortic Valve Implantation With Portico Versus Evolut Devices. Am J Cardiol 2020; 125:1209-1215. [PMID: 32087996 DOI: 10.1016/j.amjcard.2020.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 02/08/2023]
Abstract
New-generation devices such as Evolut and Portico have provided favorable results in patients who underwent transcatheter aortic valve implantation (TAVI) for aortic stenosis, but their comparative effectiveness remains debated, despite its relevance when envisioning TAVI in low-risk patients. We evaluated the safety and efficacy of 2 leading TAVI devices (Evolut and Portico) used by the same team of experienced TAVI operators, focusing on long-term outcomes, including major adverse events (i.e., the composite of death, stroke, myocardial infarction, major vascular complication, or major bleeding). Unadjusted and propensity score-adjusted analyses were carried out. A total of 233 patients were included, 119 (51.1%) receiving Evolut and 114 (49%) Portico. Baseline and procedural data showed significant between-device differences, including functional class, surgical risk, chronic obstructive pulmonary disease, renal function, transesophageal guidance, device size, postdilation, and procedural time (all p <0.05). Yet, acute and in-hospital outcomes were not significantly different (all p >0.05). Follow-up status was ascertained in 228 (98%) patients after 15.0 ± 7.6 months. Unadjusted analysis showed similar rates of major adverse events, as well as the individual risk of death, stroke, myocardial infarction, major vascular complication, major bleeding, and pacemaker implantation (all p >0.05). Even at propensity score-adjusted analysis outcomes were not significantly different with Evolut and Portico (all p >0.05). In conclusion, Evolut and Portico devices yield similarly favorable results at long-term follow-up when used by experienced TAVI operators.
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Changes in cognitive functions and quality of life in patients after transcatheter aortic valve implantation. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:82-88. [PMID: 32368240 PMCID: PMC7189141 DOI: 10.5114/aic.2020.93915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 12/29/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction Transcatheter aortic valve implantation (TAVI) has emerged as a therapeutic option for patients with severe aortic stenosis (AS). However, an association between cognitive functions (CF) and health-related quality of life (HRQoL) in TAVI patients is still unclear. Aim To assess the long-term changes in CF and HRQoL in elderly patients with AS after TAVI. Material and methods A total of 259 patients who underwent cardiological and psychological TAVI qualification were enrolled and divided into the normal (n = 174) and impaired cognition group (n = 85). CF and HRQoL characteristics assessed at baseline and 13 months were compared between groups. The analysis of multiple linear regression was performed to identify the association between HRQoL and CF and to assess the influence of TAVI on HRQoL. Results There was no difference in CF between baseline and follow-up. However, an improvement in attention functions and memory skills in the cognitively impaired group was noted at follow-up. In addition, HRQoL scores increased in both groups. An independent predictor associated with HRQoL was global CF (β = –213, p = 0.01), which explained 7% of CF variation. Improvements in all five dimensions of HRQoL, from 4.8% in self-care and up to 33.6% in pain/discomfort, were found. At follow-up, 60% of TAVI patients had improved health, 12% had worse health, 4% showed no change and 24% had a “mixed” change. Conclusions TAVI is associated with positive changes in the functioning of elderly patients at long-term follow-up.
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Ovcharenko EA, Klyshnikov KU, Ganyukov VI, Shilov AA, Vereshchagin IE, Sizova IN, Tarasov RS, Barbarash LS. Prognostic Model of Typical Complications Caused by Transcatheter Aortic Valve Replacement. Sovrem Tekhnologii Med 2020; 12:27-32. [PMID: 34513050 PMCID: PMC8353678 DOI: 10.17691/stm2020.12.2.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Indexed: 11/14/2022] Open
Abstract
The aim of the study was to develop a prognostic model based on statistical discriminant analysis to assess the risk of postoperative disturbance of cardiac conduction and paraprosthetic regurgitation after transcatheter aortic valve replacement. Materials and Methods Clinical data of 10 patients implanted with CoreValveTM prostheses (Medtronic Inc., USA) were used to develop prognostic models. To that end, we analyzed changes in hemodynamic and functional parameters provided by echocardiography in the pre- and postoperative periods. Results We observed significant positive changes in the severity of left ventricular myocardial hypertrophy; on the contrary, volume indicators did not significantly change, which might be associated with the concentric type of left ventricular hypertrophy. The discriminant analysis made it possible to determine major (preoperative) morphological and functional indicators associated with the two most common complications of the procedure: left bundle branch block and paraprosthetic regurgitation. Left ventricular posterior wall thickness, interventricular septal thickness, left atrium dimension, and myocardial mass are the critical factors that determine the development of these complications. Conclusion In the prognostic model, the proposed weighting coefficients allow one to assess the risk of postoperative complications; however, the presence of false-positive results requires further refinement of these coefficients within the linear equation.
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Affiliation(s)
- E A Ovcharenko
- Head of Laboratory, Department of Experimental and Clinical Cardiology, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Blvd, Kemerovo, 650002, Russia
| | - K U Klyshnikov
- Researcher, Department of Experimental and Clinical Cardiology, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Blvd, Kemerovo, 650002, Russia
| | - V I Ganyukov
- Head of Laboratory, Department of Multifocal Atherosclerosis, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Blvd, Kemerovo, 650002, Russia
| | - A A Shilov
- Senior Researcher, Department of Multifocal Atherosclerosis, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Blvd, Kemerovo, 650002, Russia
| | - I E Vereshchagin
- Junior Researcher, Department of Multifocal Atherosclerosis, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Blvd, Kemerovo, 650002, Russia
| | - I N Sizova
- Senior Researcher, Department of Cardiovascular Disease Diagnostics, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Blvd, Kemerovo, 650002, Russia
| | - R S Tarasov
- Head of Laboratory, Department of Multifocal Atherosclerosis, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Blvd, Kemerovo, 650002, Russia
| | - L S Barbarash
- Professor, Member of the Russian Academy of Sciences, Chief Researcher, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Blvd, Kemerovo, 650002, Russia
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Tarro Genta F. Cardiac Rehabilitation for Transcatheter Aortic Valve Replacement. Clin Geriatr Med 2019; 35:539-548. [DOI: 10.1016/j.cger.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Dhamija Y, Kalra A, Puri R. Delayed Coronary Obstruction After Transcatheter Aortic Valve Replacement. JACC Case Rep 2019; 1:319-321. [PMID: 34316816 PMCID: PMC8288806 DOI: 10.1016/j.jaccas.2019.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Ankur Kalra
- Cleveland Clinic Akron General, Akron, Ohio
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Lv Z, Zhou B, Yang C, Wang H. Preoperative Anemia and Postoperative Mortality in Patients with Aortic Stenosis Treated with Transcatheter Aortic Valve Implantation (TAVI): A Systematic Review and Meta-Analysis. Med Sci Monit 2019; 25:7251-7257. [PMID: 31559972 PMCID: PMC6778413 DOI: 10.12659/msm.916185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with severe aortic stenosis who have comorbidities that prevent general anesthesia and open cardiothoracic surgery are candidates for transcatheter aortic valve implantation (TAVI). However, TAVI can result in patient mortality following the procedure. This systematic review of the literature and meta-analysis aimed to determine the relationship between preoperative anemia and postoperative mortality in patients following TAVI. MATERIAL AND METHODS PubMed, EMBASE, the Cochrane Library, and the Web of Science were systematically searched from their inception to February 2019 for relevant published studies that included patients with bicuspid aortic valve stenosis and tricuspid aortic valve stenosis who underwent TAVI and who had preoperative data on hemoglobin levels. The pooled odds ratios (OR) and 95% confidence interval (CI) were calculated using a random-effects generic inverse variance method. RESULTS Six published studies that involved 6,406 patients with aortic stenosis were included in the meta-analysis. There was no significant difference observed for the final pooled result for patients with and without anemia for the short-term 30-day postoperative mortality (OR, 1.34; 95% CI, 0.77-2.35). However, long-term mortality rates were significantly worse in patients with preoperative anemia compared with those without anemia (OR, 1.77; 95% CI, 1.34-2.35). CONCLUSIONS Systematic review of the literature and meta-analysis showed that pre-procedural anemia reduced long-term mortality following TAVI. This finding supports the need to correct preoperative anemia in patients with aortic stenosis to improve patient outcome following TAVI.
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Affiliation(s)
- Zhenqian Lv
- Department of Cardiovascular Surgery, Qingdao Fuwai Hospital, Qingdao, Shandong, China (mainland)
| | - Baoguo Zhou
- Department of Cardiovascular Surgery, Qingdao Fuwai Hospital, Qingdao, Shandong, China (mainland)
| | - Chunyue Yang
- Department of Cardiovascular Medicine, Qingdao Fuwai Hospital, Qingdao, Shandong, China (mainland)
| | - Haiping Wang
- Department of Cardiovascular Surgery, Qingdao Fuwai Hospital, Qingdao, Shandong, China (mainland)
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