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Ten Berg JM, Overduin DC, van Ginkel DJ. What Oral Anticoagulant Is Best After TAVR: Vitamin K Antagonists or Direct Oral Anticoagulants? JACC Cardiovasc Interv 2024; 17:419-421. [PMID: 38355270 DOI: 10.1016/j.jcin.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024]
Affiliation(s)
- Jurriën M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Cardiology, University Medical Center Maastricht, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
| | - Daniël C Overduin
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Dirk-Jan van Ginkel
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
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Pajjuru VS, Warren BM, Daoud H, Radaideh Q, Walters RW, Alla VM. Impact of Center Procedural Volume on Mortality and Readmission Rates Following Pericardiectomy in the United States. Am J Cardiol 2023; 205:298-301. [PMID: 37633064 DOI: 10.1016/j.amjcard.2023.08.011] [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: 03/14/2023] [Revised: 07/29/2023] [Accepted: 08/05/2023] [Indexed: 08/28/2023]
Abstract
Our study aimed to explore the national trends in the rates of perioperative complications, in-hospital mortality, and readmissions after pericardiectomy and the impact of center volume on these outcomes. Using the Nationwide Readmission Database, we identified patients who underwent isolated pericardiectomy from 2010 to 2019. In-hospital mortality and readmission rates were assessed using orthogonal polynomial contrasts, with the linear and nonlinear trends evaluated as needed. Multivariable logistic regression models were constructed to identify the independent predictors of mortality and readmission. All analyses accounted for the Nationwide Readmission Database sampling design and were performed using SAS version 9.4 (SAS Institute Inc. Cary, NC.) with p <0.05 used to indicate statistical significance. A total of 26,169 hospitalizations for pericardiectomy were identified during the study period. The median age was 59 years and 44% were female. In-hospital mortality was 5.2%, and the median length of stay was 7 days. Advanced age, higher co-morbidity index, and lower annual facility pericardiectomy volume were independent predictors of in-hospital mortality. The 30- and 90-day readmission rates after pericardiectomy were 18% and 28%, respectively. Previous cardiac surgery, diagnosis of constrictive pericarditis, and greater co-morbidity score were independent predictors of readmission. In conclusion, isolated pericardiectomy rates have remained mostly constant, with relatively small changes in in-hospital mortality and 30- and 90-day readmission rates over the last decade. Advanced age, lower facility pericardiectomy volume, and higher Elixhauser co-morbidity index are independent predictors of surgical mortality.
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Affiliation(s)
- Venkata S Pajjuru
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska.
| | - Blair M Warren
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Hussein Daoud
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Qais Radaideh
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Ryan W Walters
- Department of Clinical Research and Public Health, Creighton University School of Medicine, Omaha, Nebraska
| | - Venkata M Alla
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska
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Elbaz-Greener G, Rahamim E, Abu Ghosh Z, Carasso S, Yarkoni M, Radhakrishnan S, Wijeysundera HC, Igor T, Planer D, Rozen G, Amir O. Sex difference and outcome trends following transcatheter aortic valve replacement. Front Cardiovasc Med 2022; 9:1013739. [PMID: 36329995 PMCID: PMC9623151 DOI: 10.3389/fcvm.2022.1013739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/08/2022] [Indexed: 01/09/2023] Open
Abstract
Background Based on worldwide registries, approximately 50% of patients who underwent transcatheter aortic valve replacement (TAVR) are female patients. Although TAVR procedures have improved tremendously in recent years, differences in outcome including mortality between sexes remain. We aimed to investigate the trends in TAVR in the early and new eras of utilization and to assess TAVR outcomes in female patients vs. male patients. Methods Using the 2011–2017 National Inpatient Sample (NIS) database, we identified hospitalizations for patients with the diagnosis of aortic stenosis during which a TAVR was performed. Patients' sociodemographic and clinical characteristics, procedure complications, and mortality were analyzed. Piecewise regression analyses were performed to assess temporal trends in TAVR utilization in female patients and in male patients. Multivariable analysis was performed to identify predictors of in-hospital mortality. Results A total of 150,647 hospitalizations for TAVR across the United States were analyzed during 2011–2017. During the study period, a steady upward trend was observed for TAVR procedures in both sexes. From 2011 to 2017, there were significantly more TAVR procedures performed in men [80,477 (53.4%)] than in women [70,170 (46.6%)]. Male patients had significantly higher Deyo-CCI score and comorbidities. Differences in mortality rates among sexes were observed, presenting with higher in-hospital mortality in women than in men, OR 1.26 [95% CI 1.18–1.35], p < 0.001. Conclusion Utilization of TAVR demonstrated a steady upward trend during 2011–2017, and a similar trend was presented for both sexes. Higher in-hospital mortality was recorded in female patients compared to male patients. Complication rates decreased over the years but without effect on mortality differences between the sex groups.
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Affiliation(s)
- Gabby Elbaz-Greener
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- *Correspondence: Gabby Elbaz-Greener
| | - Eldad Rahamim
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Zahi Abu Ghosh
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shemy Carasso
- Division of Cardiovascular Medicine, Baruch Padeh Medical Center, Poria, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Merav Yarkoni
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sam Radhakrishnan
- Schulich Heart Program, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Harindra C. Wijeysundera
- Schulich Heart Program, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Tomas Igor
- Institute for Cardiovascular Disease of Vojvodina, Sremska Kamenica Institute, Belgrade, Serbia
| | - David Planer
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Guy Rozen
- Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
- Tufts University School of Medicine, Boston, MA, United States
- Cardiac Arrhythmia Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Offer Amir
- Department of Cardiology, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
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Oxidative Stress in Calcific Aortic Valve Stenosis: Protective Role of Natural Antioxidants. Antioxidants (Basel) 2022; 11:antiox11061169. [PMID: 35740065 PMCID: PMC9219756 DOI: 10.3390/antiox11061169] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 01/01/2023] Open
Abstract
Calcific aortic valve stenosis (CAVS) is the most prevalent heart valvular disease worldwide and a slowly progressive disorder characterized by thickening of the aortic valve, calcification, and subsequent heart failure. Valvular calcification is an active cell regulation process in which valvular interstitial cells involve phenotypic conversion into osteoblasts/chondrocytes-like cells. The underlying pathophysiology is complicated, and there have been no pharmacological treatments for CAVS to date. Recent studies have suggested that an increase in oxidative stress is the major trigger of CAVS, and natural antioxidants could ameliorate the detrimental effects of reactive oxygen species in the pathogenesis of CAVS. It is imperative to review the current findings regarding the role of natural antioxidants in CAVS, as they can be a promising therapeutic approach for managing CAVS, a disorder currently without effective treatment. This review summarizes the current findings on molecular mechanisms associated with oxidative stress in the development of valvular calcification and discusses the protective roles of natural antioxidants in the prevention and treatment of CAVS.
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Donà C, Koschutnik M, Nitsche C, Winter MP, Seidl V, Siller-Matula J, Mach M, Andreas M, Bartko P, Kammerlander AA, Goliasch G, Lang I, Hengstenberg C, Mascherbauer J. Cerebral Protection in TAVR-Can We Do Without? A Real-World All-Comer Intention-to-Treat Study-Impact on Stroke Rate, Length of Hospital Stay, and Twelve-Month Mortality. J Pers Med 2022; 12:jpm12020320. [PMID: 35207808 PMCID: PMC8878932 DOI: 10.3390/jpm12020320] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Stroke associated with transcatheter aortic valve replacement (TAVR) is a potentially devastating complication. Until recently, the Sentinel™ Cerebral Protection System (CPS; Boston Scientific, Marlborough, MA, USA) has been the only commercially available device for mechanical prevention of TAVR-related stroke. However, its effectiveness is still undetermined. Objectives: To explore the impact of Sentinel™ on stroke rate, length of hospital stay (LOS), and twelve-month mortality in a single-center, real-world, all-comers TAVR cohort. Material and Methods: Between January 2019 and August 2020 consecutive patients were assigned to TAVR with or without Sentinel™ in a 1:1 fashion according to the treating operator. We defined as primary endpoint clinically detectable cerebrovascular events within 72 h after TAVR and as secondary endpoints LOS and 12-month mortality. Logistic and linear regression analyses were used to assess associations of Sentinel™ use with endpoints. Results: Of 411 patients (80 ± 7 y/o, 47.4% female, EuroSCORE II 6.3 ± 5.9%), Sentinel™ was used in 213 (51.8%), with both filters correctly deployed in 189 (46.0%). Twenty (4.9%) cerebrovascular events were recorded, ten (2.4%) of which were disabling strokes. Patients with Sentinel™ suffered 71% less (univariate analysis; OR 0.29, 95%CI 0.11–0.82; p = 0.02) and, respectively, 76% less (multivariate analysis; OR 0.24, 95%CI 0.08–0.76; p = 0.02) cerebrovascular events compared to patients without Sentinel™. Sentinel™ use was also significantly associated with shorter LOS (Regression coefficient −2.47, 95%CI −4.08, −0.87; p < 0.01) and lower 12-month all-cause mortality (OR 0.45; 95%CI 0.22–0.93; p = 0.03). Conclusion: In the present prospective all-comers TAVR cohort, patients with Sentinel™ use showed (1) lower rates of cerebrovascular events, (2) shortened LOS, and (3) improved 12-month survival. These data promote the use of a CPS when implanting TAVR valves.
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Affiliation(s)
- Carolina Donà
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (M.K.); (C.N.); (M.-P.W.); (V.S.); (J.S.-M.); (P.B.); (A.A.K.); (G.G.); (I.L.); (C.H.)
| | - Matthias Koschutnik
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (M.K.); (C.N.); (M.-P.W.); (V.S.); (J.S.-M.); (P.B.); (A.A.K.); (G.G.); (I.L.); (C.H.)
| | - Christian Nitsche
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (M.K.); (C.N.); (M.-P.W.); (V.S.); (J.S.-M.); (P.B.); (A.A.K.); (G.G.); (I.L.); (C.H.)
| | - Max-Paul Winter
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (M.K.); (C.N.); (M.-P.W.); (V.S.); (J.S.-M.); (P.B.); (A.A.K.); (G.G.); (I.L.); (C.H.)
| | - Veronika Seidl
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (M.K.); (C.N.); (M.-P.W.); (V.S.); (J.S.-M.); (P.B.); (A.A.K.); (G.G.); (I.L.); (C.H.)
| | - Jolanta Siller-Matula
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (M.K.); (C.N.); (M.-P.W.); (V.S.); (J.S.-M.); (P.B.); (A.A.K.); (G.G.); (I.L.); (C.H.)
| | - Markus Mach
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (M.A.)
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (M.A.)
| | - Philipp Bartko
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (M.K.); (C.N.); (M.-P.W.); (V.S.); (J.S.-M.); (P.B.); (A.A.K.); (G.G.); (I.L.); (C.H.)
| | - Andreas Anselm Kammerlander
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (M.K.); (C.N.); (M.-P.W.); (V.S.); (J.S.-M.); (P.B.); (A.A.K.); (G.G.); (I.L.); (C.H.)
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Georg Goliasch
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (M.K.); (C.N.); (M.-P.W.); (V.S.); (J.S.-M.); (P.B.); (A.A.K.); (G.G.); (I.L.); (C.H.)
| | - Irene Lang
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (M.K.); (C.N.); (M.-P.W.); (V.S.); (J.S.-M.); (P.B.); (A.A.K.); (G.G.); (I.L.); (C.H.)
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (M.K.); (C.N.); (M.-P.W.); (V.S.); (J.S.-M.); (P.B.); (A.A.K.); (G.G.); (I.L.); (C.H.)
| | - Julia Mascherbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (C.D.); (M.K.); (C.N.); (M.-P.W.); (V.S.); (J.S.-M.); (P.B.); (A.A.K.); (G.G.); (I.L.); (C.H.)
- Department of Internal Medicine 3, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
- Correspondence: ; Tel.: +43-1-40400-46140; Fax: +43-1-40400-42160
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