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Topalkatti U, Prasad RC, Koppu BR, Reddy KS, Mekala SK, Banothu R, Vasireddy H, Peddireddi RSS. Comparative Analysis of TAVR (Transcatheter Aortic Valve Replacement) and Surgical Valve Replacement for Low-Risk Patients. Cureus 2023; 15:e47234. [PMID: 38022257 PMCID: PMC10654047 DOI: 10.7759/cureus.47234] [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: 09/08/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
"Aortic stenosis" (AS) refers to a cardiac condition in which the aortic valve narrows, creating an obstruction that hinders the flow of blood from the left ventricle to the aorta. This contraction of the arteries influences normal blood circulation, leading to elevated pressure within the left ventricle and potentially culminating in heart failure. The management of AS typically involves two primary treatments, i.e. "surgical aortic valve replacement" (SAVR) and "transcatheter aortic valve replacement" (TAVR). In both cases, the goal is to replace a dysfunctional aortic valve with a functional substitute. Presently, TAVR has gained much preference over SAVR in clinical practice. However, there is a dearth of comprehensive research directly comparing the real-world outcomes of TAVR and SAVR. In recent years, TAVR has emerged as an attractive alternative to SAVR, yet studies that provide a detailed comparison of their real-world solutions are limited. This review article assesses the mortality of patients who underwent TAVR vis-a-vis patients who underwent SAVR.
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Affiliation(s)
- Usha Topalkatti
- Internal Medicine, Spartan Health Sciences University, Vieux Fort, LCA
| | - Ram Chandra Prasad
- Internal Medicine, MediCiti Institute of Medical Sciences, Hyderabad, IND
| | - Bhagya Raju Koppu
- Pediatric Medicine, Apollo DRDO (Defence Research and Development Organisation) Hospitals, Hyderabad, IND
| | - Kalva Suchitra Reddy
- Internal Medicine, SVS (Sri Venkata Sai) Medical College and Hospital, Hyderabad, IND
| | | | | | - Hemanth Vasireddy
- Internal Medicine, Indira Gandhi Medical College and Research Institute, Puducherry, IND
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Brown C, Terrell K, Goodwin R, Nathaniel T. Stroke Severity in Ischemic Stroke Patients with a History of Diastolic Blood Pressure Treated in a Telestroke Network. J Cardiovasc Dev Dis 2022; 9:jcdd9100345. [PMID: 36286297 PMCID: PMC9604184 DOI: 10.3390/jcdd9100345] [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: 08/17/2022] [Revised: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background: The relationship between diastolic blood pressure (DBP), risk factors, and stroke severity in acute ischemic stroke (AIS) patients treated in a telestroke network is not fully understood. The present study aims to determine the effect of risk factors on stroke severity in AIS patients with a history of elevated DBP. Material and Methods: We retrospectively analyzed data on stroke severity for AIS patients treated between January 2014 and June 2016 treated in the PRISMA Health telestroke network. Data on the severity of stroke on admission were evaluated using NIHSS scores ≤7 for reduced, and >7 for increased, stroke severity. DBP was stratified as ≤80 mmHg for reduced DBP and >80 mmHg for elevated DBP. The study’s primary outcomes were risk factors associated with improving neurologic functions or reduced stroke severity and deteriorating neurologic functions or increased stroke severity. The associations between risk factors and stroke severity for AIS with elevated DBP were determined using multi-level logistic and regression models. Results: In the adjusted analysis, AIS patients with a DBP ≤ 80 mmHg, obesity (OR = 0.388, 95% Cl, 0.182−0.828, p = 0.014) was associated with reduced stroke severity, while an increased heart rate (OR = 1.025, 95% Cl, 1.001−1.050, p = 0.042) was associated with higher stroke severity. For AIS patients with a DBP > 80 mmHg, hypertension (OR = 3.453, 95% Cl, 1.137−10.491, p = 0.029), history of smoking (OR = 2.55, 95% Cl, 1.06−6.132, p = 0.037), and heart rate (OR = 1.036, 95% Cl, 1.009−1.064, p = 0.009) were associated with higher stroke severity. Caucasians (OR = 0.294, 95% Cl, 0.090−0.964, p = 0.002) and obesity (OR = 0.455, 95% Cl, 0.207−1.002, p = 0.05) were more likely to be associated with reduced stroke severity. Conclusions: Our findings reveal specific risk factors that can be managed to improve the care of AIS patients with elevated DBP treated in the telestroke network.
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Affiliation(s)
- Christina Brown
- Department of Biology, College of Charleston, Charleston, SC 29424, USA
| | - Kameron Terrell
- Department of Biology, College of Charleston, Charleston, SC 29424, USA
| | - Richard Goodwin
- Department of Biology, College of Charleston, Charleston, SC 29424, USA
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29605, USA
| | - Thomas Nathaniel
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29605, USA
- Correspondence:
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Kanwar M, Thayer KL, Garan AR, Hernandez-Montfort J, Whitehead E, Mahr C, Sinha SS, Vorovich E, Harwani NM, Zweck E, Abraham J, Burkhoff D, Kapur NK. Impact of Age on Outcomes in Patients With Cardiogenic Shock. Front Cardiovasc Med 2021; 8:688098. [PMID: 34368248 PMCID: PMC8342768 DOI: 10.3389/fcvm.2021.688098] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Advanced age is associated with poor outcomes in cardiovascular emergencies. We sought to determine the association of age, use of support devices and shock severity on mortality in cardiogenic shock (CS). Methods: Characteristics and outcomes in CS patients included in the Cardiogenic Shock Work Group (CSWG) registry from 8 US sites between 2016 and 2019 were retrospectively reviewed. Patients were subdivided by age into quintiles and Society for Cardiovascular Angiography & Interventions (SCAI) shock severity. Results: We reviewed 1,412 CS patients with a mean age of 59.9 ± 14.8 years, including 273 patients > 73 years of age. Older patients had significantly higher comorbidity burden including diabetes, hypertension and coronary artery disease. Veno-arterial extracorporeal membrane oxygenation was used in 332 (23%) patients, Impella in 410 (29%) and intra-aortic balloon pump in 770 (54%) patients. Overall in-hospital survival was 69%, which incrementally decreased with advancing age (p < 0.001). Higher age was associated with higher mortality across all SCAI stages (p = 0.003 for SCAI stage C; p < 0.001 for SCAI stage D; p = 0.005 for SCAI stage E), regardless of etiology (p < 0.001). Conclusion: Increasing age is associated with higher in-hospital mortality in CS across all stages of shock severity. Hence, in addition to other comorbidities, increasing age should be prioritized during patient selection for device support in CS.
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Affiliation(s)
- Manreet Kanwar
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, PA, United States
| | - Katherine L Thayer
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
| | | | | | - Evan Whitehead
- Massachusetts General Hospital, Boston, MA, United States
| | - Claudius Mahr
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, United States
| | - Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | | | - Neil M Harwani
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
| | - Elric Zweck
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
| | - Jacob Abraham
- Providence Center for Cardiovascular Analytics, Research, and Data Science, Portland, OR, United States
| | - Daniel Burkhoff
- Cardiovascular Research Foundation, New York, NY, United States
| | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
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Saito Y, Lewis EE, Raval A, Gimelli G, Jacobson KM, Osaki S. The Prognosis of Elderly Patients with Aortic Stenosis after Transcatheter Aortic Valve Replacement. Intern Med 2021; 60:517-523. [PMID: 33028765 PMCID: PMC7946496 DOI: 10.2169/internalmedicine.5047-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective Aortic stenosis (AS) is common among elderly patients. Since transcatheter aortic valve replacement (TAVR) is a less invasive procedure than surgical aortic valve replacement for symptomatic severe AS, super-elderly patients have tended to undergo TAVR. We retrospectively investigated the post-TAVR outcome in super-elderly patients with severe AS. Methods This analysis included 433 patients who underwent TAVR in the University of Wisconsin Hospital and Clinics from 2012 to 2017. Post-TAVR mortality, complications in-hospital, rehospitalization, the New York Heart Association (NYHA) functional class and echocardiographic parameters were compared between patients <85 years old (n = 290) and ≥85 years old (n = 143). Results The patients ≥85 years old less frequently had a history of coronary artery disease (73.1% vs. 62.2%, p=0.026) and hypertension (87.2% vs. 77.6%, p=0.012) than younger patients. Furthermore, the patients ≥85 years old had moderate-severe mitral regurgitation more frequently (19.3% vs. 28.7%, p=0.037) at baseline than younger patients. There was no significant difference in in-hospital outcomes between the age groups. The 30-day mortality was worse in patients ≥85 years old than in younger ones (0.7% vs. 3.5%, p=0.042). While there was no significant difference in the long-term mortality between the 2 groups, the estimated 1-year mortality from Kaplan-Meier curves were 9.6% in patients <85 years old and 14.9% in patients ≥85 years old. The rate of in-hospital complications, rehospitalization rate, improvement in the NYHA functional class and echocardiographic parameters were comparable between the two groups. Conclusion The outcomes of super-elderly patients after TAVR were acceptable, suggesting that these patients could benefit from TAVR.
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Affiliation(s)
- Yukihiro Saito
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, USA
| | - Erik E Lewis
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, USA
| | - Amish Raval
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, USA
| | - Giorgio Gimelli
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, USA
| | - Kurt M Jacobson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, USA
| | - Satoru Osaki
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, USA
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Ammar A, Hassan Rizvi SN, Saghir T, Khan N, Akhtar P, Mengal N, Sial JA, Qamar N. Pakistan Following Foot Prints of Developed World in Structural Interventions: Experience of Transcatheter Aortic Valve Implantation Reported First Time. Cureus 2020; 12:e11497. [PMID: 33354443 PMCID: PMC7744204 DOI: 10.7759/cureus.11497] [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] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to evaluate the safety and efficacy of transcatheter aortic valve implantation (TAVI) program in a Tertiary care hospital in Karachi, Pakistan. Methodology This study was conducted by interventional cardiology department of the National Institute of Cardiovascular Diseases (NICVD), Karachi from July 2015 to February 2020. All patients of severe aortic stenosis (AS) who underwent TAVI were included. Baseline characteristics, in-hospital course and one-month follow-up data were collected. Results This study included 100 consecutive patients with severe AS undergoing TAVI. Sixty-three (63.0%) patients were males and the mean age was 67.38 ± 10.73 years. Eighty-five (85%) patients were in the New York Heart Association (NYHA) class III-IV. Aortic valve mean gradient was 51.33±10.47 mmHg and 50% of patients had bicuspid aortic valves. Core valve was implanted in 86 (86%) and evolute-R aortic valve was implanted in 14 (14%) patients. TAVI was successfully done in 94% of patients. Post-deployment aortic valve mean gradient was 5.33±4.13 mmHg. Major vascular access site complications were noted in 14% and atrioventricular (AV) blocks were seen in 22% of cases. There was a significant difference in symptoms of patients before and after the procedure. Overall, eight (8%) patients expired during hospital stay. At one-month follow-up, 76% of patients were found to have no limitation of physical activities. Conclusions Results of this study showed that TAVI is a safe procedure in these high-risk patients and is an alternative to surgery for AS patients in the region.
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Affiliation(s)
- Ali Ammar
- Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Syed N Hassan Rizvi
- Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Tahir Saghir
- Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Naveedullah Khan
- Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Parveen Akhtar
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Naeem Mengal
- Cardiology/Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Jawaid A Sial
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Nadeem Qamar
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
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Kara K, Kloppe A, Ewers A, Bösche L, Aweimer A, Erdogan H, Schöne D, Schiedat F, Patsalis N, Haldenwang PL, Strauch JT, Mügge A, Patsalis PC. Outcomes after transcatheter aortic valve replacement in older patients. Herz 2020; 46:222-227. [PMID: 33026482 PMCID: PMC8413158 DOI: 10.1007/s00059-020-04986-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/09/2020] [Accepted: 09/04/2020] [Indexed: 11/25/2022]
Abstract
Background The prevalence of aortic valve stenosis is increasing due to the continuously growing geriatric population. Data on procedural success and mortality of very old patients are sparse, raising the question of when this population may be deemed as “too old even for transcatheter aortic valve replacement (TAVR).” We, therefore, sought to evaluate the influence of age on outcome after TAVR and the impact of direct implantation. Methods The data of 394 consecutive patients undergoing TF-TAVR were analyzed. Patients were divided into four age groups: ≤75 (group 1, n = 28), 76–80 (group 2, n = 107), 81–85 (group 3, n = 148), and >85 (group 4, n = 111) years. Direct implantation was performed when possible according to current recommendations. Survival was evaluated by Kaplan–Meier analysis. Results Mortality at 30 days and 1 year was not significantly different between the four age groups (3.6 vs. 6.7 vs. 5.4 vs. 2.7% and 7.6 vs. 17 vs. 14.5 vs. 13%m respectively, log-rank p = 0.59). Direct implantation without balloon aortic valvuloplasty was more frequently performed on patients aged >85 vs. ≤85 years (33.3 vs. 14.1%, p < 0.001). the incidence of procedural complications frequently associated with advanced age (stroke, vascular complications) was not significantly increased in group 4. Conclusion Outcome after TF-TAVR is comparable among different age cohorts, even in very old patients. Direct implantation simplifies the procedure and could therefore play a role in reducing the incidence of peri-interventional complications in patients of advanced age.
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Affiliation(s)
- Kaffer Kara
- Department of Cardiology, Agaplesion General Hospital Hagen, Hagen, Germany
| | - Axel Kloppe
- Heart Center Bergmannsheil, Department of Cardiology and Angiology, University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Aydan Ewers
- Heart Center Bergmannsheil, Department of Cardiology and Angiology, University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Leif Bösche
- Heart Center Bergmannsheil, Department of Cardiology and Angiology, University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Assem Aweimer
- Heart Center Bergmannsheil, Department of Cardiology and Angiology, University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Habib Erdogan
- Heart Center Bergmannsheil, Department of Cardiology and Angiology, University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Dominik Schöne
- Heart Center Bergmannsheil, Department of Cardiology and Angiology, University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Fabian Schiedat
- Heart Center Bergmannsheil, Department of Cardiology and Angiology, University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Nikolaos Patsalis
- Department of Cardiology, Angiology and Intensive Care Medicine, Philipps University Marburg, Marburg, Germany
| | - Peter Lukas Haldenwang
- Heart Center Bergmannsheil, Department of Cardiothoracic Surgery, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Justus Thomas Strauch
- Heart Center Bergmannsheil, Department of Cardiothoracic Surgery, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Andreas Mügge
- Heart Center Bergmannsheil, Department of Cardiology and Angiology, University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Polykarpos C Patsalis
- Heart Center Bergmannsheil, Department of Cardiology and Angiology, University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
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Lei X, Wei Z, Liu S, Liang F, Song B. The short-term and long-term outcomes of transcatheter or surgical aortic valve replacement in elderly patients: A protocol for a systematic review. Medicine (Baltimore) 2020; 99:e19307. [PMID: 32118752 PMCID: PMC7478717 DOI: 10.1097/md.0000000000019307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has become an essential alternate option for people suffering from aortic stenosis. However, the efficacy and safety of TAVR for elderly population (aged over 80 years) is still unclear. METHODS We plan to perform a systematic review and meta-analysis of clinical controlled trials and propensity-match cohort studies to evaluate the short- and long-term outcomes in elderly aortic stenosis patients who undergo a transcatheter or surgical aortic valve replacement. We will search PubMed, EMBASE, and Cochrane Library using a comprehensive strategy. The related conference proceedings and reference lists of the included studies will also be checked to identify additional studies. Two reviewers will screen retrieved records, extract information, and assess the risk of bias independently. STATA software will be used to conduct data synthesis. There is no requirement of ethical approval and informed consent. RESULTS This study will be submitted to a peer-reviewed journal for publication. CONCLUSION This is the first systematic assessment of TAVR for elderly patients with aortic stenosis. We hope it will provide a relatively comprehensive reference for clinical practice and future relevant clinical trials. ETHICS AND DISSEMINATION Ethics approval and patient consent are not required as this study is a systematic review and meta-analysis. PROSPERO REGISTRATION NUMBER CRD42019140857. STUDY PROTOCOL REGISTRY The protocol has been registered in PROSPERO, which is an International Prospective Register of Systematic Reviews. The registration number is CRD42019140857.
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Affiliation(s)
- Xiang Lei
- First Clinical Medical College, Lanzhou University
- Department of Cardiovascular Surgery, First Hospital of Lanzhou University, Lanzhou, China
| | - Zhili Wei
- First Clinical Medical College, Lanzhou University
| | - Shidong Liu
- First Clinical Medical College, Lanzhou University
- Department of Cardiovascular Surgery, First Hospital of Lanzhou University, Lanzhou, China
| | - Fuxiang Liang
- First Clinical Medical College, Lanzhou University
- Department of Cardiovascular Surgery, First Hospital of Lanzhou University, Lanzhou, China
| | - Bing Song
- Department of Cardiovascular Surgery, First Hospital of Lanzhou University, Lanzhou, China
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Chino S, Yamanaka E, Takasusuki T, Hamaguchi S, Yamaguchi S. Comparison of Cardiac Repolarization After Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement: A Longitudinal Study. Cardiol Ther 2019; 9:97-105. [PMID: 31696437 PMCID: PMC7237665 DOI: 10.1007/s40119-019-00154-6] [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: 08/29/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) has been established as an alternative to surgical aortic valve replacement (SAVR) for high-risk patients. To assess the impact of TAVI on cardiac repolarization, we compared QT dispersion (QTD) and the interval from the peak to the end of the T wave (Tpeak-Tend: TpTe) between the patients who underwent TAVI and those who underwent SAVR and TpTe between the patients who underwent TAVI or SAVR. METHODS This retrospective study was approved by the ethics committee of Dokkyo Medical University Hospital. The study included 45 patients who underwent TAVI and 45 patients who underwent SAVR. The QT, corrected QT (QTc), QTD, QTc dispersion (QTcD), Tp-Te, Tp-Te/QT, and Tp-Te/QTc were manually measured in standard 12-lead electrocardiogram (ECG) recordings obtained before surgery, immediately after surgery, 1 month, 3 months, and 6 months after surgery and compared between the two groups. RESULTS No change was observed in RR, QT, QTc, Tp-Te, Tp-Te/QT, and Tp-Te/QTc in the two groups throughout the study. The QTD and QTcD significant decreased immediately after surgery in the TAVI group as compared to the SAVR group (P < 0.001). In contrast, QTD and QTcD in the SAVR group gradually, but not significantly declined 6 months after surgery. CONCLUSIONS QTD and QTcD immediately decreased after TAVI as compared to SAVR. Our findings indicate that TAVI more rapidly improved dispersion of spatial repolarization than SAVR.
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Affiliation(s)
- Satoru Chino
- Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0293, Japan
| | - Eriko Yamanaka
- Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0293, Japan
| | - Toshifumi Takasusuki
- Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0293, Japan.
| | - Shinsuke Hamaguchi
- Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0293, Japan
| | - Shigeki Yamaguchi
- Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0293, Japan
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Development of a Novel Human Cell-Derived Tissue-Engineered Heart Valve for Transcatheter Aortic Valve Replacement: an In Vitro and In Vivo Feasibility Study. J Cardiovasc Transl Res 2018; 11:470-482. [PMID: 30105605 DOI: 10.1007/s12265-018-9821-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/20/2018] [Indexed: 12/19/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is being extended to younger patients. However, TAVR-compatible bioprostheses are based on xenogeneic materials with limited durability. Off-the-shelf tissue-engineered heart valves (TEHVs) with remodeling capacity may overcome the shortcomings of current TAVR devices. Here, we develop for the first time a TEHV for TAVR, based on human cell-derived extracellular matrix and integrated into a state-of-the-art stent for TAVR. The TEHVs, characterized by a dense acellular collagenous matrix, demonstrated in vitro functionality under aortic pressure conditions (n = 4). Next, transapical TAVR feasibility and in vivo TEHV functionality were assessed in acute studies (n = 5) in sheep. The valves successfully coped with the aortic environment, showing normal leaflet motion, free coronary flow, and absence of stenosis or paravalvular leak. At explantation, TEHVs presented full structural integrity and initial cell infiltration. Its long-term performance proven, such TEHV could fulfill the need for next-generation lifelong TAVR prostheses.
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Zegrean M. Never Too Late: A Case Report on Transcatheter Aortic Valve Implantation in a 97-Year-Old Patient. Geriatrics (Basel) 2017; 2:geriatrics2030025. [PMID: 31011035 PMCID: PMC6371167 DOI: 10.3390/geriatrics2030025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 06/29/2017] [Accepted: 07/12/2017] [Indexed: 11/24/2022] Open
Abstract
Aortic valve stenosis is a well-recognized valvular problem in the aging population. Transcatheter aortic valve implantation (TAVI) is becoming an increasingly popular treatment alternative to surgical aortic valve replacement for frail elderly individuals with symptomatic severe aortic valve stenosis. There are multiple research reports documenting the effectiveness of TAVI in octogenarians; however, few authors discuss the success of this procedure in nonagenarians. This case report depicts the successful transfemoral implantation of a prosthetic aortic valve in a 97-year-old man. Moreover, the current literature on TAVI outcomes in nonagenarians is reviewed.
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Voga G, Kovačić D. The relativity of age or geriatric medicine at the crossroads. Wien Klin Wochenschr 2016; 128:430-432. [PMID: 27873025 DOI: 10.1007/s00508-016-1128-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 10/31/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Gorazd Voga
- Dpt. of Intensive Internal Medicine, General Hospital Celje, Oblakova 5, 3000, Celje, Slovenia.
| | - Dragan Kovačić
- Dpt. of Cardiology, General Hospital Celje, Oblakova 5, 3000, Celje, Slovenia
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12
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Thoracic Malignancies and Pulmonary Nodules in Patients under Evaluation for Transcatheter Aortic Valve Implantation (TAVI): Incidence, Follow Up and Possible Impact on Treatment Decision. PLoS One 2016; 11:e0155398. [PMID: 27171441 PMCID: PMC4865104 DOI: 10.1371/journal.pone.0155398] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/28/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has become the treatment of choice in patients with severe aortic valve stenosis who are not eligible for operative replacement and an alternative for those with high surgical risk. Due to high age and smoking history in a high proportion of TAVI patients, suspicious findings are frequently observed in pre-procedural chest computer tomography (CCT). METHODS CCT scans of 484 consecutive patients undergoing TAVI were evaluated for incidentally discovered solitary pulmonary nodules (SPN). RESULTS In the entire study population, SPN ≥ 5 mm were found in 87 patients (18%). These patients were compared to 150 patients who were incidentally collected from the 397 patients without SPN or with SPN < 5 mm (control group). After a median follow-up of 455 days, lung cancer was diagnosed in only two patients. Neither SPN ≥ 5 mm (p = 0.579) nor SPN > 8 mm (p = 0.328) were significant predictors of overall survival. CONCLUSIONS Despite the high prevalence of SPNs in this single center TAVI cohort lung cancer incidence at midterm follow-up seems to be low. Thus, aggressive diagnostic approaches for incidentally discovered SPN during TAVI evaluation should not delay the treatment of aortic stenosis. Unless advanced thoracic malignancy is obvious, the well documented reduction of morbidity and mortality by TAVI outweighs potentially harmful delays regarding further diagnostics. Standard guideline-approved procedure for SPN can be safely performed after TAVI.
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Balcı KG, Balcı MM, Yılmaz S, Maden O. Short-long-short sequence-induced torsade de pointes after transcatheter aortic-valve implantation. Anatol J Cardiol 2015; 15:426-7. [PMID: 25993717 PMCID: PMC5779183 DOI: 10.5152/akd.2015.6120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Kevser Gülcihan Balcı
- Clinic of Cardiology, Türkiye Yüksek İhtisas Education and Research Hospital; Ankara-Turkey.
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Tully PJ, Roshan P, Rice GD, Sinhal A, Bennetts JS, Baker RA. Change in quality of life after transcatheter aortic valve implantation and aortic valve replacement surgery in Australian patients aged ≥ 75 years: the effects of EuroSCORE and patient operability. J Geriatr Cardiol 2015; 12:30-6. [PMID: 25678902 PMCID: PMC4308456 DOI: 10.11909/j.issn.1671-5411.2015.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/21/2014] [Accepted: 11/28/2014] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVE To determine the extent to which differences in generic quality of life (QOL) between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (AVR) patients explained by EuroSCORE and heart-team operability assessment. METHODS A total of 146 high-risk patients with EuroSCORE > 6 and aged ≥ 75 years underwent TAVI (n = 80) or aortic valve replacement (n = 66) between February 2010 and July 2013. A total of 75 patients also completed preoperative and six month SF-12 QOL measures. Analyses examined incident major morbidity, compared six month QOL between groups adjusted for EuroSCORE and operability, and quantified rates of clinically significant QOL improvement and deterioration. RESULTS The AVR group required longer ventilation (> 24 h) (TAVI 5.0% vs. AVR 20.6%, P = 0.004) and more units of red blood cells [TAVI 0 (0-1) vs. AVR 2 (0-3), P = 0.01]. New renal failure was higher in TAVI (TAVI 5.0% vs. AVR 0%, P = 0.06). TAVI patients reported significantly lower vitality (P = 0.01) by comparison to AVR patients, however these findings were no longer significant after adjustment for operability. In both procedures, clinically significant QOL improvement was common [range 25.0% (general health) - 62.9% (physical role)] whereas deterioration in QOL occurred less frequently [range 9.3% (physical role) - 33.3% (mental health)]. CONCLUSIONS Clinically significant improvement and deterioration in QOL was evident at six months in high risk elderly aortic valve replacement patients. Overall QOL did not differ between TAVI and AVR once operability was taken into consideration.
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Affiliation(s)
- Phillip J. Tully
- Cardiac Surgery Research, Department of Surgery, School of Medicine, Flinders University of South Australia, Bedford Park 5042, Australia
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, University of Adelaide, North Terrace, Adelaide 5005, Australia
| | - Prakash Roshan
- Department of Cardiovascular Medicine, Flinders Medical Centre, Flinders Medical Centre, Level 6 Flinders Private Hospital, Bedford Park 5042, Australia
| | - Greg D Rice
- Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Level 6 Flinders Private Hospital, Bedford Park 5042, Australia
| | - Ajay Sinhal
- Department of Cardiovascular Medicine, Flinders Medical Centre, Flinders Medical Centre, Level 6 Flinders Private Hospital, Bedford Park 5042, Australia
| | - Jayme S Bennetts
- Cardiac Surgery Research, Department of Surgery, School of Medicine, Flinders University of South Australia, Bedford Park 5042, Australia
- Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Level 6 Flinders Private Hospital, Bedford Park 5042, Australia
| | - Robert A Baker
- Cardiac Surgery Research, Department of Surgery, School of Medicine, Flinders University of South Australia, Bedford Park 5042, Australia
- Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Level 6 Flinders Private Hospital, Bedford Park 5042, Australia
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