1
|
Spence MS, Baan J, Iacovelli F, Martinelli GL, Muir DF, Saia F, Bortone AS, Densem CG, Owens CG, van der Kley F, Vis M, van Mourik MS, Costa G, Sykorova L, Lüske CM, Deutsch C, Kurucova J, Thoenes M, Bramlage P, Tamburino C, Barbanti M. Prespecified Risk Criteria Facilitate Adequate Discharge and Long-Term Outcomes After Transfemoral Transcatheter Aortic Valve Implantation. J Am Heart Assoc 2020; 9:e016990. [PMID: 32715844 PMCID: PMC7792272 DOI: 10.1161/jaha.120.016990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Despite the availability of guidelines for the performance of transcatheter aortic valve implantation (TAVI), current treatment pathways vary between countries and institutions, which impact on the mean duration of postprocedure hospitalization. Methods and Results This was a prospective, multicenter registry of 502 patients to validate the appropriateness of discharge timing after transfemoral TAVI, using prespecified risk criteria from FAST‐TAVI (Feasibility and Safety of Early Discharge After Transfemoral [TF] Transcatheter Aortic Valve Implantation), based on hospital events within 1‐year after discharge. The end point—a composite of all‐cause mortality, vascular access–related complications, permanent pacemaker implantation, stroke, cardiac rehospitalization, kidney failure, and major bleeding—was reached in 27.0% of patients (95% CI, 23.3–31.2) within 1 year after intervention; 7.5% (95% CI, 5.5–10.2) had in‐hospital complications before discharge and 19.6% (95% CI, 16.3–23.4) within 1 year after discharge. Overall mortality within 1 year after discharge was 7.3% and rates of cardiac rehospitalization 13.5%, permanent pacemaker implantation 4.2%, any stroke 1.8%, vascular‐access–related complications 0.7%, life‐threatening bleeding 0.7%, and kidney failure 0.4%. Composite events within 1 year after discharge were observed in 18.8% and 24.3% of patients with low risk of complications/early (≤3 days) discharge and high risk and discharged late (>3 days) (concordant discharge), respectively. Event rate in patients with discordant discharge was 14.3% with low risk but discharged late and increased to 50.0% in patients with high risk but discharged in ≤3 days. Conclusions The FAST‐TAVI risk assessment provides a tool for appropriate, risk‐based discharge that was validated with the 1‐year event rate after transfemoral TAVI. Registration URL: https://www.ClinicalTrials.gov; Unique identifier: NCT02404467.
Collapse
Affiliation(s)
- Mark S. Spence
- Cardiology DepartmentRoyal Victoria HospitalBelfastUnited Kingdom
| | - Jan Baan
- Department of CardiologyAmsterdam UMCUniversity of AmsterdamThe Netherlands
| | - Fortunato Iacovelli
- Cardiology DepartmentDepartment of Advanced Biomedical SciencesUniversity of NaplesItaly
- Cardiac Surgery DepartmentClinica San GaudenzioNovaraItaly
| | | | - Douglas F. Muir
- Cardiothoracic DivisionThe James Cook University HospitalMiddlesbroughUnited Kingdom
| | - Francesco Saia
- Cardiovascular and Thoracic DepartmentS. Orsola‐Malpighi University HospitalBolognaItaly
| | | | | | - Colum G. Owens
- Cardiology DepartmentRoyal Victoria HospitalBelfastUnited Kingdom
| | - Frank van der Kley
- Cardiology DepartmentLeiden University Medical CenterLeidenThe Netherlands
| | - Marije Vis
- Department of CardiologyAmsterdam UMCUniversity of AmsterdamThe Netherlands
| | | | - Giuliano Costa
- Catania Division of CardiologyPoliclinico‐Vittorio Emanuele HospitalUniversity of CataniaItaly
| | | | - Claudia M. Lüske
- Institute for Pharmacology and Preventive MedicineCloppenburgGermany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive MedicineCloppenburgGermany
| | | | | | - Peter Bramlage
- Institute for Pharmacology and Preventive MedicineCloppenburgGermany
| | - Corrado Tamburino
- Catania Division of CardiologyPoliclinico‐Vittorio Emanuele HospitalUniversity of CataniaItaly
| | - Marco Barbanti
- Catania Division of CardiologyPoliclinico‐Vittorio Emanuele HospitalUniversity of CataniaItaly
| |
Collapse
|
2
|
Costa G, Barbanti M, Picci A, Todaro D, La Spina K, Di Simone E, D’Arrigo P, Criscione E, Valvo R, Reddavid C, Deste W, Sgroi C, Tamburino C, Giuffrida A, Garretto V, Privitera G, Cannizzaro MT, Inserra C, Veroux P. Predictors and safety of next-day discharge in patients undergoing transfemoral transcatheter aortic valve implantation. EUROINTERVENTION 2020; 16:e494-e501. [DOI: 10.4244/eij-d-19-01080] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
3
|
Barbanti M, van Mourik MS, Spence MS, Icovelli F, Martinelli GL, Muir DF, Saia F, Bortone AS, Densem CG, van der Kley F, Bramlage P, Vis M, Tamburino C. Optimising patient discharge management after transfemoral transcatheter aortic valve implantation: the multicentre European FAST-TAVI trial. EUROINTERVENTION 2019; 15:147-154. [DOI: 10.4244/eij-d-18-01197] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
4
|
Forcillo J, Condado JF, Binongo JN, Lasanajak Y, Caughron H, Babaliaros V, Devireddy C, Leshnower B, Guyton RA, Block PC, Simone A, Keegan P, Khairy P, Thourani VH. Readmission rates after transcatheter aortic valve replacement in high- and extreme-risk patients with severe aortic stenosis. J Thorac Cardiovasc Surg 2017; 154:445-452. [PMID: 28532575 DOI: 10.1016/j.jtcvs.2017.03.144] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 03/03/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE In high- or extreme-risk patients undergoing transcatheter aortic valve replacement, readmissions have not been adequately studied and are the subject of increased scrutiny by healthcare systems. The objectives of this study were to determine the incidence of 30-day and 1-year cardiac and noncardiac readmissions, identify predictors of readmission, and assess the association between readmission and 1-year mortality. METHODS A retrospective review was performed on 714 patients who underwent transcatheter aortic valve replacement from September 2007 to January 2015 at Emory University. RESULTS Patients' median age was 83 years, and 46.6% were female. Early all-cause readmission for the cohort was 10.5%, and late readmission was 18.8%. Anemia was related to both early all-cause (hazard ratio [HR], 0.74) and cardiovascular-related readmission (HR, 0.60). A 23-mm valve implanted was associated with early all-cause readmission (HR, 1.73). Length of hospital stay was related to late all-cause (HR, 1.14) and cardiovascular-related readmission (HR, 1.21). Postoperative permanent stroke had an impact on late cardiovascular-related readmission (HR, 3.60; 95% confidence interval, 1.13-11.49). Multivariable analysis identified anemia as being associated with 30-day all-cause readmission, and anemia and postoperative stroke were associated with 30-day cardiovascular-related readmission. Readmissions seemed to be related to 1-year mortality (HR, 2.04; 95% confidence interval, 1.33-3.12). CONCLUSIONS We show some baseline comorbidities and procedural complications that are directly associated with early and late readmissions, and anemia and postoperative stroke were associated with an increase in mortality. Moreover, we found that readmission was associated with double the hazard of death within 1 year. Whether treatment of identified risk factors could decrease readmission rates and mortality warrants further investigation.
Collapse
Affiliation(s)
- Jessica Forcillo
- Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Emory University, Atlanta, Ga; Cardiology Department, Université de Montréal, Montréal, Québec, Canada
| | - Jose F Condado
- Division of Cardiology, Structural Heart and Valve Center, Emory University, Atlanta, Ga
| | - Jose N Binongo
- Department of Biostatistics, School of Public Health, Emory University, Atlanta, Ga
| | - Yi Lasanajak
- Department of Biostatistics, School of Public Health, Emory University, Atlanta, Ga
| | - Hope Caughron
- Division of Cardiology, Structural Heart and Valve Center, Emory University, Atlanta, Ga
| | - Vasilis Babaliaros
- Division of Cardiology, Structural Heart and Valve Center, Emory University, Atlanta, Ga
| | - Chandan Devireddy
- Division of Cardiology, Structural Heart and Valve Center, Emory University, Atlanta, Ga
| | - Bradley Leshnower
- Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Emory University, Atlanta, Ga
| | - Robert A Guyton
- Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Emory University, Atlanta, Ga
| | - Peter C Block
- Division of Cardiology, Structural Heart and Valve Center, Emory University, Atlanta, Ga
| | - Amy Simone
- Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Emory University, Atlanta, Ga
| | - Patricia Keegan
- Division of Cardiology, Structural Heart and Valve Center, Emory University, Atlanta, Ga
| | - Paul Khairy
- Cardiology Department, Université de Montréal, Montréal, Québec, Canada
| | - Vinod H Thourani
- Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Emory University, Atlanta, Ga.
| |
Collapse
|
5
|
Kocaaslan C, Ketenci B, Yılmaz M, Kehlibar T, Memetoğlu ME, Ertaş G, Eren M, Demirtaş MM. Comparison of Transcatheter Aortic Valve Implantation versus Surgical Aortic Valve Replacement to Improve Quality of Life in Patients >70 Years of Age with Severe Aortic Stenosis. Braz J Cardiovasc Surg 2016; 31:1-6. [PMID: 27074268 PMCID: PMC5062689 DOI: 10.5935/1678-9741.20150092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/15/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Transcatheter aortic valve implantation has recently been used in the treatment of severe aortic valve stenosis, particularly in patients with high mortality and morbidity rates for open surgery. The purpose of this study was to compare quality of life in patients over 70 years of age undergoing surgical or transcatheter aortic valve implantation, before the procedure and in the early post-procedural period. METHODS Seventy-nine patients were included in the study, 38 (48.1%) male and 41 (51.9%) female. Mean age of patients was 74.3±5.2 (70-91) years. The surgical aortic valve replacement group consisted of 51 (64.6%) patients and the transcatheter aortic valve replacement group of 28 (35.4%). Quality of life data before the procedure and at the 3rd month postoperatively in patients aged 70 years and older undergoing surgical or transcatheter aortic valve implantation were assessed using the 36-item Short Form Health Survey form. RESULTS Positive increases in physical task difficulty (13.2±9.8vs. 5.1±7.3) (P=0.001), emotional task difficulty (14.4±11.9 vs.8.5±6.4) (P=0.035), and mental health (0.4±10.4 vs. 9.6±15.1) (P=0.001; P<0.01) scores in patients undergoing transcatheter aortic valve replacement were significantly higher compared to the surgical aortic valve replacement group. No statistically significant difference was determined between the groups in terms of pain, vitality, social function, physical function or general health scores in the preoperative and postoperative periods. CONCLUSION The positive increase in quality of life parameters in the transcatheter aortic valve implantation group at the 3rd month postoperatively was significantly higher compared to the surgical aortic valve replacement group.
Collapse
Affiliation(s)
- Cemal Kocaaslan
- Dr.Siyami Ersek Cardiovascular and Thoracic Surgery Hospital, İstanbul, Turkey
| | - Bülend Ketenci
- Dr.Siyami Ersek Cardiovascular and Thoracic Surgery Hospital, İstanbul, Turkey
| | - Mehmet Yılmaz
- Dr.Siyami Ersek Cardiovascular and Thoracic Surgery Hospital, İstanbul, Turkey
| | - Tamer Kehlibar
- Dr.Siyami Ersek Cardiovascular and Thoracic Surgery Hospital, İstanbul, Turkey
| | | | - Gökhan Ertaş
- Dr.Siyami Ersek Cardiovascular and Thoracic Surgery Hospital, İstanbul, Turkey
| | - Mehmet Eren
- Dr.Siyami Ersek Cardiovascular and Thoracic Surgery Hospital, İstanbul, Turkey
| | | |
Collapse
|
6
|
Armoiry X, Obadia JF, Iung B, Polazzi S, Duclos A. Clinical outcomes and direct costs after transcatheter aortic valve implantation in French centres: a longitudinal study of 1332 patients using a national database. Interact Cardiovasc Thorac Surg 2016; 23:883-888. [DOI: 10.1093/icvts/ivw278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/23/2016] [Accepted: 07/20/2016] [Indexed: 11/14/2022] Open
|
7
|
Keshavarzi F, MacCarthy P. Transcatheter aortic valve implantation: past, present and future. Br J Hosp Med (Lond) 2016; 77:132, 134-40. [PMID: 26961440 DOI: 10.12968/hmed.2016.77.3.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Transcatheter aortic valve implantation is one of the most significant technological advances in cardiovascular medicine. It offers a safe alternative in high risk cardiac patients with proven durability, economical viability and survival advantage. Current trials may expand its application in intermediate or low risk groups.
Collapse
Affiliation(s)
- Freidoon Keshavarzi
- Consultant Interventional Cardiologist in the Cardiology Department, University Hospital of South Manchester, Manchester
| | - Philip MacCarthy
- Consultant Interventional Cardiologist in the Department of Cardiology, King's College Hospital, London SE5 9RS
| |
Collapse
|
8
|
Ruparelia N, Prendergast BD. Transcatheter aortic valve implantation - what the general physician needs to know. Clin Med (Lond) 2015; 15:420-5. [PMID: 26430178 PMCID: PMC4953224 DOI: 10.7861/clinmedicine.15-5-420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
With an increasingly elderly population, the incidence of aortic stenosis (AS) is rising. While surgical aortic valve replacement remains the gold standard treatment for patients with severe symptomatic AS, transcatheter aortic valve implantation (TAVI) has emerged as the treatment of choice for patients who are inoperable or high surgical risk. TAVI has been shown to be associated with a clear mortality benefit when compared with medical therapy and to be at least as good as surgical aortic valve replacement in this patient group. The last few years have seen rapid development in this revolutionary technology in conjunction with increasing centre and operator experience, and indications for the procedure are swiftly expanding. In this review, we summarise the current evidence base and discuss factors that need to be considered by the general physician when contemplating TAVI as a treatment option, including practical aspects, emerging indications and future directions.
Collapse
Affiliation(s)
- Neil Ruparelia
- Hammersmith Hospital, Imperial College, London, UK, and Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK
| | | |
Collapse
|
9
|
Affiliation(s)
- Neil Ruparelia
- Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK Hammersmith Hospital, London, UK
| | | |
Collapse
|