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Buchwald CLV, Jabri A, Fadel R, Alhuneafat L, Wang DD, Mariscal E, Alqarqaz M, Engel P, O'Neill B, Frisoli T, Lee J, Abbas A, O'Neill WW, Villablanca PA. The various perioperative issues of structural heart diseases and cardiogenic shock. Curr Probl Cardiol 2024; 49:102646. [PMID: 38820919 DOI: 10.1016/j.cpcardiol.2024.102646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024]
Abstract
Up to 20 % of patients presenting with acute heart failure and cardiogenic shock have a structural etiology. Despite efforts in timely management, mortality rates remain alarmingly high, ranging from 50 % to 80 %. Surgical intervention is often the definitive treatment for structural heart disease; however, many patients are considered high risk or unsuitable candidates for such procedures. Consequently, there has been a paradigm shift towards the development of novel percutaneous management strategies and temporizing interventions. This article aims to provide a comprehensive review of the pathophysiology of valvular and structural heart conditions presenting in cardiogenic shock, focusing on the evolving landscape of mechanical circulatory support devices and other management modalities.
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Affiliation(s)
| | - Ahmad Jabri
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA.
| | - Raef Fadel
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA
| | - Laith Alhuneafat
- Division of Cardiovascular medicine, University of Minnesota, Minneapolis, USA
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA
| | - Enrique Mariscal
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA
| | - Mohammad Alqarqaz
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA
| | - Pedro Engel
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA
| | - Brian O'Neill
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA
| | - Tiberio Frisoli
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA
| | - James Lee
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA
| | - Amr Abbas
- Division of Cardiovascular Medicine, William Beaumont University Hospital, Royal Oak, MI, USA
| | - William W O'Neill
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, USA
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Khalefa BB, Ayyad M, Albandak M, Ayyad A, Yassin MNA, Awad AK. Left versus right ventricular pacing during TAVR and balloon aortic valvuloplasty: A systematic review and meta-analysis. Pacing Clin Electrophysiol 2024. [PMID: 38946136 DOI: 10.1111/pace.15032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/08/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION While right ventricular pacing (RVP) is the conventional temporary pacing modality used for transcatheter aortic valve replacement (TAVR), this approach possesses inherent risks and procedural challenges. We aim to assess and compare the safety and efficacy of left ventricular pacing (LVP) and RVP during TAVR and balloon aortic valvuloplasty (BAV). METHODS Following PRISMA guidelines, a comprehensive literature search was conducted in four databases from inception to December 15th, 2023. We included observational studies and clinical trials comparing LVP with RVP during TAVR and BAV procedures. Primary outcomes included short-term mortality, mortality due to cardiac tamponade, and procedural complications including bleeding, vascular complications, and cardiac tamponade. Secondary outcomes comprised procedure duration and length of hospital stay. RESULTS Five studies involving 830 patients with RVP and 1577 with LVP were included. Short-term mortality was significantly higher in the RVP group (RR 2.32, 95% CI: [1.37-3.93], P = .002), as was the incidence of cardiac tamponade (RR 2.19, 95% CI: [1.11-4.32], P = .02). LVP demonstrated shorter hospital stays (MD = 1.34 d, 95% CI: [0.90, 1.78], P < .001) and reduced procedure duration (MD = 7.75 min, 95% CI: [5.08, 10.41], P < .00001) compared to RVP. New pacemaker implantation was higher in the RVP group (RR 2.23, 95% CI: [1.14, 4.39], P = .02). CONCLUSION LVP during TAVR and BAV emerges a safer alternative to RVP, offering reduced mortality, hospital stays, and procedure durations.
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Affiliation(s)
| | - Mohammed Ayyad
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Maram Albandak
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Alaa Ayyad
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Ahmed K Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Esposito A, Foffa I, Vecoli C, Bastiani L, Berti S, Mazzone A. The Impact of Acute Heart Failure on Frailty Degree and Outcomes in Elderly Patients with Severe Aortic Stenosis and Chronic Heart Failure with Preserved Ejection Fraction. J Cardiovasc Dev Dis 2024; 11:150. [PMID: 38786972 PMCID: PMC11122270 DOI: 10.3390/jcdd11050150] [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: 03/22/2024] [Revised: 04/24/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Frailty degree plays a critical role in the decision-making and outcomes of elderly patients with severe aortic stenosis (AS). Acute heart failure (AHF) results in a severely worse clinical hemodynamic status in this population. This study aimed to evaluate the impact of AHF on frailty degree and outcomes in older patients referred for tailored interventional treatment due to AS. A total of 109 patients (68% female; mean age 83.3 ± 5.4), evaluated by a multidisciplinary path for "frailty-based management" of valve disease, were divided into two groups, one with (AHF+) and one without AHF (AHF-) and preserved ejection fraction (mean value EF: 57.4 ± 8.6). AHF occurred a mean value of 55 days before geriatric, clinical, and surgical assessment. A follow-up for all-cause mortality and readmission was conducted at 20 months. AHF+ patients showed a higher frequency of advanced frailty (53.3% vs. 46.7%, respectively), rehospitalization (35.5% vs. 12.8; p = 0.007), and death (41.9% vs. 12.8%; p < 0.001). In stepwise logistic regression analysis, AHF emerged as an independent risk factor for advanced frailty (OR: 3.8 CI 1.3-10.7; p = 0.01) and hospital readmission (OR: 3.6 CI 1.1-11.6; p = 0.03). In addition, preceding AHF was an independent determinant associated with a higher risk of mortality (HR 2.65; CI 95% 1.04-6.74; p-value 0.04). AHF is independently associated with advanced frailty and poor outcomes in elderly patients with severe AS. So, this population needs careful clinical and geriatric monitoring and the implementation of interventional therapy for AS in the early stages of frailty to avoid the occurrence of AHF and poor outcomes.
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Affiliation(s)
- Augusto Esposito
- Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy; (A.E.); (C.V.); (L.B.); (S.B.); (A.M.)
| | - Ilenia Foffa
- Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy; (A.E.); (C.V.); (L.B.); (S.B.); (A.M.)
- CNR Institute of Clinical Physiology, 54100 Massa, Italy
| | - Cecilia Vecoli
- Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy; (A.E.); (C.V.); (L.B.); (S.B.); (A.M.)
- CNR Institute of Clinical Physiology, 54100 Massa, Italy
| | - Luca Bastiani
- Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy; (A.E.); (C.V.); (L.B.); (S.B.); (A.M.)
- CNR Institute of Clinical Physiology, 54100 Massa, Italy
| | - Sergio Berti
- Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy; (A.E.); (C.V.); (L.B.); (S.B.); (A.M.)
- CNR Institute of Clinical Physiology, 54100 Massa, Italy
| | - Annamaria Mazzone
- Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy; (A.E.); (C.V.); (L.B.); (S.B.); (A.M.)
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Saleemi SA, Noaman S, Brookes J, Dick RJL. Clinical Outcomes Associated With Balloon Aortic Valvuloplasty in the Contemporary Era. Heart Lung Circ 2024; 33:33-37. [PMID: 38142218 DOI: 10.1016/j.hlc.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/05/2023] [Accepted: 10/29/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Severe aortic stenosis is the most common acquired valvular disorder. Balloon aortic valvuloplasty (BAV) is considered for patients who are not suitable for surgical aortic valve replacement (SAVR) and transcatheter aortic valve insertion (TAVI). The American Heart Association and European Society of Cardiology recommend BAV as a bridging procedure for SAVR and TAVI due to the significant morbidity and mortality associated with it. We aim to investigate the morbidity and mortality associated with BAV only, BAV bridged to TAVI and TAVI-only patients over 3 years in Epworth Richmond, a tertiary hospital in Victoria, Australia. METHODS We divided patients into three groups including BAV only, BAV bridged to TAVI and TAVI only and assessed the baseline demographics, procedural complications, and mortality between the groups. RESULTS Of 438 patients, 26 patients underwent BAV only, 36 patients bridged to TAVI post-BAV and 376 patients underwent TAVI directly. All patients had significant reductions in their mean AV pressure gradient (p<0.01). There was no significant difference in periprocedural morbidity and mortality between the groups. At 6-month follow-up, the mortality in patients undergoing only BAV was 31%, compared with 8.3% in BAV bridged to TAVI and 1.9% in TAVI-only group (p<0.01). The 12-month follow-up demonstrated a similar pattern; 42.3% vs 13.9% vs 4.5% (p<0.01). CONCLUSIONS This study suggests no significant difference in inpatient and periprocedural morbidity and mortality between the three groups but a significant mortality benefit at 6-month and 12-month post valve insertion, either directly or post BAV.
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Affiliation(s)
- Saadat Ali Saleemi
- Department of Cardiology, Epworth Richmond, Richmond, Vic, Australia; Department of General Medicine, Monash Health, Melbourne, Vic, Australia.
| | - Samer Noaman
- Department of Cardiology, Epworth Richmond, Richmond, Vic, Australia
| | - John Brookes
- Department of Cardiothoracic Surgery, Epworth Richmond, Richmond, Vic, Australia
| | - Ronald J L Dick
- Department of Cardiology, Epworth Richmond, Richmond, Vic, Australia
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Iwasaki M, Konishi A, Takahara M, Kohsaka S, Okuda M, Hayashi T, Takamisawa I, Ishii H, Amano T, Shinke T, Ikari Y. Volume-outcome relationship in balloon aortic valvuloplasty: results of a consecutive, patient-level data analysis from a Japanese nationwide multicentre registry (J-SHD). BMJ Open 2023; 13:e073597. [PMID: 37848296 PMCID: PMC10582855 DOI: 10.1136/bmjopen-2023-073597] [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: 03/10/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE Transcatheter balloon aortic valvuloplasty (BAV) remains an important alternative treatment for severe, symptomatic aortic stenosis. With increasing numbers of BAVs being performed, the need for large-scale volume-outcome relationship assessments has become evident. Here, we aimed to explain such relationships by analysing consecutive, patient-level BAV data recorded in a prospective Japanese nationwide multicentre registry. DESIGN Prospective study. SETTING Data of 1920 BAVs performed in 200 Japanese hospitals from January 2015 to December 2019. PARTICIPANTS The mean patient age was 85 years, and 36.9% of procedures involved male patients. METHODS The efficacy of BAV was assessed by reducing the mean transaortic valve gradient after the procedure. We also assessed in-hospital complication rates, including in-hospital death, bleeding, urgent surgery, distal embolism, vessel rupture and contrast-induced nephropathy. Based on the distribution of case volume (median 20, IQR 10-46), we divided the patients into high-volume (≥20) and low-volume (<20) groups. In-hospital complication risk was assessed with adjustment by logistic regression modelling. RESULTS Indications for BAV included palliative/destination (44.2%), bridge to transcatheter aortic valve replacement (34.5%), bridge to surgical aortic valve replacement (7.4%) and salvage (9.7%). Reduction of the mean transaortic valve gradient was similar between the high-volume and low-volume groups (20 mm Hg vs 20 mm Hg, p=0.12). The proportion of in-hospital complications during BAV was 4.2%, and the incidence of complications showed no difference between the high-volume and low-volume groups (4.2% vs 4.1%, p=1.00). Rather than hospital volume, salvage procedure was an independent predictor of in-hospital complications (OR, 4.04; 95% CI, 2.03 to 8.06; p<0.001). CONCLUSION The current study demonstrated that procedural outcomes of BAV were largely independent of its institutional volume.
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Affiliation(s)
- Masamichi Iwasaki
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Akihide Konishi
- Kobe University Hospital Clinical & Translational Research Center, Kobe, Hyogo, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University, Minato-ku, Tokyo, Japan
| | - Masanori Okuda
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Takatoshi Hayashi
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi-gun, Aichi, Japan
| | - Toshiro Shinke
- Division of Cardiology Department of Medicine, Showa University, Shinagawa-ku, Tokyo, Japan
| | - Yuji Ikari
- Division of Cardiovascular Medicine, Tokai University Hospital, Hiratsuka, Kanagawa, Japan
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The Heart in the Transcatheter Intervention Era: Where Are We? J Clin Med 2022; 11:jcm11175173. [PMID: 36079102 PMCID: PMC9456719 DOI: 10.3390/jcm11175173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/27/2022] [Indexed: 11/17/2022] Open
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Balloon aortic valvuloplasty for severe aortic stenosis may reduce mitral regurgitation in mid-term follow-up. Adv Cardiol 2022; 18:255-260. [PMID: 36751280 PMCID: PMC9885222 DOI: 10.5114/aic.2022.121004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 11/18/2022]
Abstract
Introduction Mitral regurgitation (MR) is a frequent complication in patients with severe aortic stenosis (AS). Material and methods Echocardiographic assessment of MR was performed at baseline, at 30 days and at 6 months after balloon aortic valvuloplasty (BAV). Results Data of 271 patients were included in our final analysis, of which 21.2% (n = 85) had at least moderate MR at baseline (in 19 (22.3%) subjects MR was diagnosed as primary). Both groups showed similar severity of AS, but patients in the MR group had a greater left ventricle (LV) size (p = 0.003 for LVESD, p = 0002 for LVEDD) and slightly lower LV ejection fraction (p = 0.04). Mitral regurgitation parameters significantly improved both at 30 days and 6 months after BAV in the MR group (MR jet area: 7.2 (4.5-9.9) vs. 3.6 (2.3-7.2) cm2, and 7.2 (4.5-9.9) vs. 3.2 (2.1-6.7) cm2; %MR/left atrial area 34.5 (23.4-42.7) vs. 17.5 (9.3-29.5) and 34.5 (23.4-42.7) vs. 14.5 (8.3-24.5), p < 0.001 for all). In multivariate logistic regression analysis, the change at 30 days, from baseline, in the LVESD (OR = 1.87; 95% CI: 1.23-2.87; p < 0.001) and LVEF (OR = 0.95; 95% CI: 0.87-1.01; p < 0.001); MR jet area (OR = 2.2, 95% CI: 1.5-4.6; p < 0.001) and the presence of primary MR (OR = 3.2, 95% CI: 1.04-5.98; p < 0.001) were retained as independent predictors of significant persisting MR at 6 months. Conclusions Balloon aortic valvuloplasty may reduce MR in mid-term follow-up. Predictors of persistent MR at 6 months after BAV included an increase of LVESD and MR jet area and decrease of LVEF at 30 days.
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Kojima Y, Higuchi R, Hagiya K, Saji M, Takamisawa I, Iguchi N, Takanashi S, Doi S, Okazaki S, Sato K, Tamura H, Takayama M, Ikeda T, Isobe M. Prognosis of patients with active cancer undergoing transcatheter aortic valve implantation: An insight from Japanese multicenter registry. IJC HEART & VASCULATURE 2022; 40:101045. [PMID: 35514877 PMCID: PMC9066355 DOI: 10.1016/j.ijcha.2022.101045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/23/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022]
Abstract
Background Malignancy is common in older adults undergoing transcatheter aortic valve implantation (TAVI), and may affect prognosis. The present study aimed to examine whether active cancer affects all-cause mortality rates among patients undergoing TAVI. Methods This retrospective study examined data from 1,114 consecutive patients treated between April 2010 and June 2019. Patients with life expectancy of <1 year due to non-cardiac causes were excluded. Results Active cancer was defined as cancer under treatment or cured within 1 year, and was recognized in 62 patients (5.6%) with (n = 17) and without (n = 45) metastases. In multivariate analysis, being female (hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.39–0.77, p < 0.001), body mass index (BMI) (HR = 0.92 per 1 kg/m2 increase, 95% CI 0.87–0.97, p = 0.001), New York Heart Association (NYHA) class III/IV (HR = 1.53, 95% CI 1.06–2.20, p = 0.022), atrial fibrillation (HR = 2.40, 95% CI 1.70–3.38, p < 0.001), albumin levels (HR = 0.41 per 1-g/dl, 95% CI 0.30–0.57, p < 0.001), and cancer metastasis (HR = 5.28, 95% CI 1.86–14.9, p = 0.001) were associated with all-cause mortality after TAVI. Conclusion In patients undergoing TAVI, being female, high BMI, NYHA class III/IV, atrial fibrillation, albumin levels, and cancer metastasis were factors associated with mortality. Meanwhile, active cancer without metastasis was not associated with increased mortality rates. These findings would help clinical decision-making by patients and physicians. Clinical trial registration: UMIN000031133.
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Dall'Ara G, Grotti S, Guerrieri G, Compagnone M, Spartà D, Galvani M, Tarantino F. Balloon aortic valvuloplasty: current status and future prospects. Expert Rev Cardiovasc Ther 2022; 20:389-402. [PMID: 35514027 DOI: 10.1080/14779072.2022.2074837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Balloon aortic valvuloplasty (BAV) improves hemodynamic and clinical status of patients with severe aortic stenosis (AS) for a limited period of 6-12 months. However, there is a high number of procedures performed worldwide and an upward trend over the last decades. AREAS COVERED Epidemiology of AS and the advent of transcatheter aortic valve implantation (TAVI) contribute to the extensive referral of patients. The expansion of recommendations for TAVI has occasionally led to financial reimbursement-related problems that do not exist for BAV. BAV is indicated as a bridge to valve replacement, to decision in complex cases, and to extracardiac surgery. BAV may play a role in preparing for TAVI and optimizing procedural results. The minimalist approach and reduced complication rate make it applicable in fragile patients. EXPERT OPINION In the near future, BAV will continue to be a useful asset in managing patients with AS given the multiple indications, broad applicability, safety profile, low cost, and repeatability. Specific studies are necessary to explore technical solutions, stronger indications, the finest technique, and to standardize the procedural result. Pending the development of potential competitive devices, the role that BAV plays will remain closely intertwined with the one played by TAVI.
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Affiliation(s)
| | - Simone Grotti
- Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | | | | | - Daniela Spartà
- Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Marcello Galvani
- Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.,Cardiovascular Research Unit, Myriam Zito Sacco Heart Foundation, Forlì, Italy
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