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Nasir MM, Ikram A, Usman M, Sarwar J, Ahmed J, Hamza M, Farhan SA, Siddiqi R, Qadar LT, Shah SR, Khalid MR, Memon RS, Hameed I. Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Redo-Surgical Aortic Valve Replacement in Patients With Aortic Stenosis: A Systematic Review and Meta-analysis. Am J Cardiol 2024:S0002-9149(24)00339-4. [PMID: 38723857 DOI: 10.1016/j.amjcard.2024.04.057] [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: 02/11/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/21/2024]
Abstract
Aortic stenosis is a common and significant valve condition requiring bioprosthetic heart valves with transcatheter aortic valve replacement (TAVR) being strongly recommended for high-risk patients or patients over 75 years. This meta-analysis aimed to pool existing data on postprocedural clinical as well as echocardiographic outcomes comparing valve-in-valve (ViV)-TAVR to redo-surgical aortic valve replacement to assess the short-term and medium-term outcomes for both treatment methods. A systematic literature search on Cochrane Central, Scopus, and Medline (PubMed interface) electronic databases from inception to August 2023. We used odds ratios (OR) for dichotomous outcomes and mean differences (MD) for continuous outcomes. Twenty-four studies (25,216 patients) were pooled with a mean follow-up of 16.4 months. The analysis revealed that ViV-TAVR group showed a significant reduction in 30-day mortality (OR 0.50, 95% confidence interval [CI] 0.43 to 0.58, p <0.00001), new-onset atrial fibrillation (OR 0.34, 95% CI 0.17 to 0.67, p = 0.002), major bleeding event (OR 0.28, 95% CI 0.17 to 0.45, p <0.00001) and lower rate of device success (OR 0.25, 95% CI 0.12 to 0.53, p = 0.0003). There were no significant differences between either group when assessing 1-year mortality, stroke, myocardial infarction, postoperative left ventricular ejection fraction, and effective orifice area. ViV-TAVR cohort showed a significantly increased incidence of paravalvular leaks, aortic regurgitation, and increased mean aortic valve gradient. ViV-TAVR is a viable short-term option for elderly patients with high co-morbidities and operative risks, reducing perioperative complications and improving 30-day mortality with no significant cardiovascular adverse events. However, both treatment methods present similar results on short-term to medium-term complications assessment.
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Affiliation(s)
- Muhammad Moiz Nasir
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.
| | - Armeen Ikram
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Usman
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Jawad Sarwar
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Jawad Ahmed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mohammad Hamza
- Department of Internal Medicine, Guthrie Medical Group, Cortland, New York
| | - Syed Ali Farhan
- Department of Surgery, Ohio State University, Columbus, Ohio
| | - Rabbia Siddiqi
- Department of Internal Medicine, University of Toledo, Ohio
| | - Laila Tul Qadar
- Department of Internal Medicine, St Vincent's Medical Center, Bridgeport, Connecticut
| | - Syed Raza Shah
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky
| | | | - Roha Saeed Memon
- Department of Internal Medicine, Jacobi Medical Center-New York City Health + Hospitals Corporation/Albert Einstein College of Medicine, Bronx, New York
| | - Irbaz Hameed
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
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Chamoun N, Jdaidani J, Iskandarani DZ, Ghalayini S, Zgheib A, Khoury A, Alam S, Rebeiz AG, Ghazzal Z, Sawaya F. Short-Term Clinical Outcomes of Transcatheter Aortic Valve Replacement in a Developing Country. Cureus 2024; 16:e58334. [PMID: 38752027 PMCID: PMC11095913 DOI: 10.7759/cureus.58334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) is an effective alternative to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis in all surgical risk groups. Reports of clinical outcomes post-TAVR in developing countries are scarce. We aimed to address the clinical outcomes and safety profile of TAVR in a developing country. METHODS We conducted a single-center, retrospective study on patients undergoing TAVR at the American University of Beirut Medical Center (AUBMC) from January 2016 to April 2023. We included a total of 399 patients. Our primary endpoint was to assess the rate of TAVR in-hospital and 30-day mortality, neurologic events, and new permanent pacemaker implantation (PPI) in patients, stratified by the Society of Thoracic Surgeons (STS) risk of mortality score. RESULTS Survival rates were 98.7% (394) at discharge vs. 97.5% (389) at 30 days post-procedure. The technical success rate was 95% (379) at the end of the procedure. Device success and early safety rates were 93.5% (373) and 83% (331), respectively at 30 days post-procedure. The all-cause mortality rate increased from 1.3% (5) at discharge to 2.5% (10) at 30-day intervals. The rate of ischemic stroke was 1.3% (five) at discharge and increased to 2% (eight) at 30 days post-procedure. PPI was needed in 5.8% (23) of patients at discharge with an increase to 7% (28) at one-month interval. Overall, the rates of TAVR outcomes among the three risk groups were comparable including neurologic events, valve-related complications, bleeding problems, vascular and access-related complications, and myocardial infarction. CONCLUSION This study at AUBMC highlights the successful implementation of the TAVR program in a developing country, showcasing its efficacy and safety within 30 days post-operation, despite challenges such as financial constraints and limited access to specialized training. Larger cohorts and longer follow-up periods are needed to accurately represent clinical outcomes in developing countries.
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Affiliation(s)
- Nadia Chamoun
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Jennifer Jdaidani
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | | | - Sarah Ghalayini
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Ali Zgheib
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Alessandro Khoury
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Samir Alam
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Abdallah G Rebeiz
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Ziyad Ghazzal
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
| | - Fadi Sawaya
- Cardiology, American University of Beirut Medical Center, Beirut, LBN
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Vinayak M, Leone PP, Tanner R, Dhulipala V, Camaj A, Makhija RRK, Hooda A, Kini AS, Sharma SK, Khera S. Transcatheter Aortic Valve Replacement: Current Status and Future Indications. J Clin Med 2024; 13:373. [PMID: 38256506 PMCID: PMC10817053 DOI: 10.3390/jcm13020373] [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: 12/12/2023] [Revised: 12/31/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
In the past two decades, transcatheter aortic valve replacement (TAVR) has transformed the management of aortic stenosis and has become the standard of care regardless of surgical risk levels. Advances in transcatheter valve design across newer generations, improved imaging, greater operator expertise, and technical enhancements have collectively contributed to increased safety and a decline in procedural complications over this timeframe. The application of TAVR has progressively expanded to include younger patients with lower risks, who have longer life expectancies. This article offers an up-to-date review of the latest innovations in transcatheter delivery systems, devices, and its possible future indications.
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Affiliation(s)
- Manish Vinayak
- Mount Sinai Heart, Mount Sinai Hospital, New York, NY 10029, USA; (P.P.L.); (R.T.); (V.D.); (A.C.); (R.R.K.M.); (A.H.); (A.S.K.); (S.K.S.)
| | | | | | | | | | | | | | | | | | - Sahil Khera
- Mount Sinai Heart, Mount Sinai Hospital, New York, NY 10029, USA; (P.P.L.); (R.T.); (V.D.); (A.C.); (R.R.K.M.); (A.H.); (A.S.K.); (S.K.S.)
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Begun X, Butt JH, Kristensen SL, Weeke PE, De Backer O, Strange JE, Schou M, Køber L, Fosbøl EL. Patient characteristics and long-term outcomes in patients undergoing transcatheter aortic valve implantation in a failed surgical prosthesis vs in a native valve: A Danish nationwide study. Am Heart J 2023; 264:183-189. [PMID: 37178995 DOI: 10.1016/j.ahj.2023.05.007] [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: 03/08/2023] [Revised: 04/18/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Valve-in-valve-transcatheter aortic valve implantation (TAVI) is a feasible and increasingly used treatment option for failed surgical aortic prosthesis, but data from clinical practice are limited. We aimed to examine patient characteristics and outcomes of patients undergoing TAVI in a surgival valve (valve-in-valve TAVI) compared with patients undergoing TAVI in a native valve. METHODS Using nationwide registries, we identified all Danish citizens, who underwent TAVI from January 1, 2008, to December 31, 2020. RESULTS A total of 6,070 patients undergoing TAVI were identified; 247 (4%) patients had a history of SAVR (The valve-in-valve cohort). The median age of the study population was 81 (25th-75th percentile 77-85) and 55% were men. Patients with valve-in-valve-TAVI were younger but had a greater burden of cardiovascular comorbidities compared with patients with native-valve-TAVI. Within 30 days post procedure, 11 (0.2%) and 748 (13.8%) patients who underwent valve-in-valve-TAVI and native-valve-TAVI, respectively, had a pacemaker implantation. The cumulative 30-day risk of death among patients with valve-in-valve-TAVI was 2.4% (95% CI: 1.0%-5.0%) and 2.7% (95% CI: 2.3%-3.1%) in patients with native-valve-TAVI, respectively. Correspondingly, the cumulative 5-year risk of death was 42.5% (95% CI: 34.2%-50.6%) and 44.8% (95% CI: 43.2%-46.4%), respectively. In multivariable Cox proportional hazard analysis, valve-in-valve-TAVI was not associated with a significantly different risk of death at 30 days (Hazard ratio (HR) = 0.95, 95% CI 0.41-2.19) and 5 years (HR = 0.79, 95% CI 0.62-1.00) post-TAVI compared with native-valve-TAVI. CONCLUSIONS TAVI in a failed surgical aortic prosthesis as compared to TAVI in a native valve, was not associated with significantly different short- and long-term mortality, suggesting that valve-in-valve-TAVI is a safe procedure.
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Affiliation(s)
- Xenia Begun
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Jawad H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Søren L Kristensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter E Weeke
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jarl E Strange
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Concistrè G, Gasbarri T, Ravani M, Al Jabri A, Trianni G, Bianchi G, Margaryan R, Chiaramonti F, Murzi M, Kallushi E, Varone E, Simeoni S, Leone A, Farneti A, Berti S, Solinas M. Transcatheter Aortic Valve Replacement in Degenerated Perceval Bioprosthesis: Clinical and Technical Aspects in 32 Cases. J Clin Med 2023; 12:6265. [PMID: 37834910 PMCID: PMC10573422 DOI: 10.3390/jcm12196265] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Sutureless aortic bioprostheses are increasingly being used to provide shorter cross-clamp time and facilitate minimally invasive aortic valve replacement. As the use of sutureless valves has increased over the past decade, we begin to encounter their degeneration. We describe clinical outcomes and technical aspects in patients with degenerated sutureless Perceval (CorCym, Italy) aortic bioprosthesis treated with valve-in-valve transcatheter aortic valve replacement (VIV-TAVR). METHODS Between March 2011 and March 2023, 1310 patients underwent aortic valve replacement (AVR) with Perceval bioprosthesis implantation. Severe bioprosthesis degeneration treated with VIV-TAVR occurred in 32 patients with a mean of 6.4 ± 1.9 years (range: 2-10 years) after first implantation. Mean EuroSCORE II was 9.5 ± 6.4% (range: 1.9-35.1%). RESULTS Thirty of thirty-two (94%) VIV-TAVR were performed via transfemoral and two (6%) via transapical approach. Vascular complications occurred in two patients (6%), and mean hospital stay was 4.6 ± 2.4 days. At mean follow-up of 16.7 ± 15.2 months (range: 1-50 months), survival was 100%, and mean transvalvular pressure gradient was 18.7 ± 5.3 mmHg. CONCLUSION VIV-TAVR is a useful option for degenerated Perceval and appears safe and effective. This procedure is associated with good clinical results and excellent hemodynamic performance in our largest single-center experience.
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Affiliation(s)
- Giovanni Concistrè
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Tommaso Gasbarri
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Marcello Ravani
- Department of Cardiology, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (M.R.); (A.A.J.); (G.T.); (S.B.)
| | - Anees Al Jabri
- Department of Cardiology, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (M.R.); (A.A.J.); (G.T.); (S.B.)
| | - Giuseppe Trianni
- Department of Cardiology, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (M.R.); (A.A.J.); (G.T.); (S.B.)
| | - Giacomo Bianchi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Rafik Margaryan
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Francesca Chiaramonti
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Michele Murzi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Enkel Kallushi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Egidio Varone
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Simone Simeoni
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Alessandro Leone
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Andrea Farneti
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
| | - Sergio Berti
- Department of Cardiology, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (M.R.); (A.A.J.); (G.T.); (S.B.)
| | - Marco Solinas
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR—G. Monasterio, 54100 Massa, Italy; (T.G.); (G.B.); (R.M.); (F.C.); (M.M.); (E.K.); (E.V.); (S.S.); (A.L.); (A.F.); (M.S.)
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Lanz J. Coronary Obstruction Risk in Valve-in-Valve TAVR: Planning Is More Than Half the Battle. JACC Cardiovasc Interv 2023; 16:2031-2033. [PMID: 37480893 DOI: 10.1016/j.jcin.2023.06.029] [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: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/24/2023]
Affiliation(s)
- Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland.
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Lauten P, Costello-Boerrigter LC, Goebel B, Gonzalez-Lopez D, Schreiber M, Kuntze T, Al Jassem M, Lapp H. Transcatheter Aortic Valve Implantation: Addressing the Subsequent Risk of Permanent Pacemaker Implantation. J Cardiovasc Dev Dis 2023; 10:230. [PMID: 37367395 PMCID: PMC10299451 DOI: 10.3390/jcdd10060230] [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: 04/26/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is now a commonly used therapy in patients with severe aortic stenosis, even in those patients at low surgical risk. The indications for TAVI have broadened as the therapy has proven to be safe and effective. Most challenges associated with TAVI after its initial introduction have been impressively reduced; however, the possible need for post-TAVI permanent pacemaker implantation (PPI) secondary to conduction disturbances continues to be on the radar. Conduction abnormalities post-TAVI are always of concern given that the aortic valve lies in close proximity to critical components of the cardiac conduction system. This review will present a summary of noteworthy pre-and post-procedural conduction blocks, the best use of telemetry and ambulatory device monitoring to avoid unnecessary PPI or to recognize the need for late PPI due to delayed high-grade conduction blocks, predictors to identify those patients at greatest risk of requiring PPI, important CT measurements and considerations to optimize TAVI planning, and the utility of the MInimizing Depth According to the membranous Septum (MIDAS) technique and the cusp-overlap technique. It is stressed that careful membranous septal (MS) length measurement by MDCT during pre-TAVI planning is necessary to establish the optimal implantation depth before the procedure to reduce the risk of compression of the MS and consequent damage to the cardiac conduction system.
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Affiliation(s)
- Philipp Lauten
- Department of Cardiology, Heart Center, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437 Bad Berka, Germany (B.G.); (H.L.)
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Tarantini G, Fabris T. Redo Aortic Valve Interventions: A Good Start Is Half the Job to Subsequent Permutations. JACC Cardiovasc Interv 2023; 16:954-957. [PMID: 37100558 DOI: 10.1016/j.jcin.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 04/28/2023]
Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy.
| | - Tommaso Fabris
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
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Beaupré F, Garot P. 3 Ways to Mitigate the Risk of Transcatheter Heart Valve Underexpansion and Dysfunction in Valve-in-Valve TAVR. JACC Cardiovasc Interv 2023; 16:527-529. [PMID: 36922037 DOI: 10.1016/j.jcin.2023.02.001] [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: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Frédéric Beaupré
- ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie, Pitié Salpêtrière (AP-HP), Paris, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay-Santé, Massy, France.
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Matta A, Levai L, Roncalli J, Elbaz M, Bouisset F, Nader V, Blanco S, Campelo Parada F, Carrié D, Lhermusier T. Comparison of in-hospital outcomes and long-term survival for valve-in-valve transcatheter aortic valve replacement versus the benchmark native valve transcatheter aortic valve replacement procedure. Front Cardiovasc Med 2023; 10:1113012. [PMID: 36844743 PMCID: PMC9949886 DOI: 10.3389/fcvm.2023.1113012] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
Background In recent years, the number of patients with failed surgically implanted aortic bioprostheses and the number of candidates for valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) have been increasing. Objectives The purpose of this study is to evaluate the efficacy, safety, and long-term survival outcomes of VIV-TAVR compared with the benchmark native valve transcatheter aortic valve replacement (NV-TAVR). Methods A cohort study was conducted on patients who underwent TAVR in the department of cardiology at Toulouse University Hospital, Rangueil, France between January 2016 and January 2020. The study population was divided into two groups: NV-TAVR (N = 1589) and VIV-TAVR (N = 69). Baseline characteristics, procedural data, in-hospital outcomes, and long-term survival outcomes were observed. Results In comparison with NV-TAVR, there are no differences in TAVR success rate (98.6 vs. 98.8%, p = 1), per-TAVR complications (p = 0.473), and length of hospital stay (7.5 ± 50.7 vs. 4.4 ± 2.8, p = 0.612). The prevalence of in-hospital adverse outcomes did not differ among study groups, including acute heart failure (1.4 vs. 1.1%), acute kidney injury (2.6, 1.4%), stroke (0 vs. 1.8%, p = 0.630), vascular complications (p = 0.307), bleeding events (0.617), and death (1.4 vs. 2.6%). VIV-TAVR was associated with a higher residual aortic gradient [OR = 1.139, 95%CI (1.097-1.182), p = 0.001] and a lower requirement for permanent pacemaker implantation [OR = 0.235 95%CI (0.056-0.990), p = 0.048]. Over a mean follow-up period of 3.44 ± 1.67 years, no significant difference in survival outcomes has been observed (p = 0.074). Conclusion VIV-TAVR shares the safety and efficacy profile of NV-TAVR. It also represents a better early outcome but a higher non-significant long-term mortality rate.
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Affiliation(s)
- Anthony Matta
- Department of Cardiology, Toulouse University Hospital, Toulouse, France,Department of Cardiology, Hôpitaux Civils de Colmar, Colmar, France
| | - Laszlo Levai
- Department of Cardiology, Hôpitaux Civils de Colmar, Colmar, France
| | - Jerome Roncalli
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Meyer Elbaz
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Frederic Bouisset
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Vanessa Nader
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Stephanie Blanco
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | | | - Didier Carrié
- Department of Cardiology, Toulouse University Hospital, Toulouse, France,*Correspondence: Didier Carrié,
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Zhou C, Xia Z, Chen B, Song Y, Lian Z. Gender Differences in Age-Stratified Early Outcomes in Patients With Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 187:100-109. [PMID: 36459732 DOI: 10.1016/j.amjcard.2022.10.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/27/2022] [Accepted: 10/17/2022] [Indexed: 11/30/2022]
Abstract
Few researchers have discussed the differences in gender between the age groups of patients who underwent transcatheter aortic valve implantation (TAVI). We searched the National Readmissions Database from 2012 to 2019 to identify adults who underwent TAVI. We studied hospital outcomes and short- to medium-term outcomes by age stratification (18 to 59, 60 to 69, 70 to 79, and 80 to 90 years) after TAVI and categorized by gender. We included 147,481 patients who underwent TAVI, and 54,802 pairs were matched using propensity score matching separately for each age group. Compared with men, women in all age groups had a similar rate of hospital death. Except the 18- to 59-year-old groups, female patients were less likely to undergo permanent pacemaker implantation and transfusion. Records of readmission at 30 days and 6 months were used as the follow-up outcome according to the presence or absence of readmission. Major adverse cardiovascular events (MACEs) were a composite of cardiovascular readmission, all-cause mortality during readmission, and stroke readmission. At the 30-day follow-up visit, there was no difference in the all-cause readmission and MACE between women and men in any group. At the 6-month follow-up visit, women in the 70- to 79-year-old and 80- to 90-year-old groups had a high risk of all-cause readmission. In conclusion, we reported that female patients have similar in-hospital death rates to male patients who underwent TAVI. During the 30-day follow-up visit, the all-cause readmission and MACE were not different in all age groups between men and women. At 6 months, women in the 70- to 79-year-old and 80- to 90-year-old groups had a higher risk of all-cause readmission.
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Affiliation(s)
- Chi Zhou
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zongyi Xia
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Bing Chen
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yanxu Song
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zhexun Lian
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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12
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Formica F, Gallingani A, Tuttolomondo D, Hernandez-Vaquero D, D’Alessandro S, Pattuzzi C, Çelik M, Singh G, Ceccato E, Niccoli G, Lorusso R, Nicolini F. Redo Surgical Aortic Valve Replacement versus Valve-In-Valve Transcatheter Aortic Valve Implantation: A Systematic Review and Reconstructed Time-To-Event Meta-Analysis. J Clin Med 2023; 12:jcm12020541. [PMID: 36675469 PMCID: PMC9866823 DOI: 10.3390/jcm12020541] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/21/2022] [Accepted: 12/29/2022] [Indexed: 01/11/2023] Open
Abstract
Objective. Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) has emerged as a useful alternative intervention to redo-surgical aortic valve replacement (Redo-SVAR) for the treatment of degenerated bioprosthesis valve. However, there is no robust evidence about the long-term outcome of both treatments. The aim of this meta-analysis was to analyze the long-term outcomes of Redo-SVAR versus ViV-TAVI by reconstructing the time-to-event data. Methods. The search strategy consisted of a comprehensive review of relevant studies published between 1 January 2000 and 30 September 2022 in three electronic databases, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE. Relevant studies were retrieved for the analysis. The primary endpoint was the long-term mortality for all death. The comparisons were made by the Cox regression model and by landmark analysis and a fully parametric model. A random-effect method was applied to perform the meta-analysis. Results. Twelve studies fulfilled the eligibility criteria and were included in the final analysis. A total of 3547 patients were included. Redo-SAVR group included 1783 patients, and ViV-TAVI included 1764 subjects. Redo-SAVR showed a higher incidence of all-cause mortality within 30-days [Hazard ratio (HR) 2.12; 95% CI = 1.49−3.03; p < 0.0001)], whereas no difference was observed between 30 days and 1 year (HR = 1.03; 95% CI = 0.78−1.33; p = 0.92). From one year, Redo-SAVR showed a longer benefit (HR = 0.52; 95% CI = 0.40−0.67; p < 0.0001). These results were confirmed for cardiovascular death (HR = 2.04; 95% CI = 1.29−3.22; p = 0.001 within one month from intervention; HR = 0.35; 95% CI = 0.18−0.71; p = 0.003 at 4-years follow-up). Conclusions. Although the long-term outcomes seem similar between Redo-SAVR and ViV-TAVI at a five-year follow-up, ViV-TAVI shows significative lower mortality within 30 days. This advantage disappeared between 30 days and 1 year and reversed in favor of redo-SAVR 1 year after the intervention.
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Affiliation(s)
- Francesco Formica
- Department of Medicine and Surgery, University of Parma, 43124 Parma, Italy
- Correspondence: or
| | - Alan Gallingani
- Cardiac Surgery Clinic, University Hospital of Parma, Via Gramsci 14, 43125 Parma, Italy
| | | | | | | | - Claudia Pattuzzi
- Department of Medicine and Surgery, University of Parma, 43124 Parma, Italy
- Cardiac Surgery Clinic, University Hospital of Parma, Via Gramsci 14, 43125 Parma, Italy
| | - Mevlüt Çelik
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, 3062 Rotterdam, The Netherlands
| | - Gurmeet Singh
- Division of Cardiac Surgery, Department of Critical Care Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB 11220, Canada
| | - Evelina Ceccato
- Department of Medicine and Surgery, University of Parma, 43124 Parma, Italy
- Medical Library, University of Parma, 43124 Parma, Italy
| | - Giampaolo Niccoli
- Department of Medicine and Surgery, University of Parma, 43124 Parma, Italy
- Cardiology Unit, University Hospital of Parma, Via Gramsci 14, 43125 Parma, Italy
| | - Roberto Lorusso
- Cardiovascular Research Institute Maastricht (CARIM), 6200 Maastricht, The Netherlands
| | - Francesco Nicolini
- Department of Medicine and Surgery, University of Parma, 43124 Parma, Italy
- Cardiac Surgery Clinic, University Hospital of Parma, Via Gramsci 14, 43125 Parma, Italy
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13
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Kalogeropoulos AS, Redwood SR, Allen CJ, Hurrell H, Chehab O, Rajani R, Prendergast B, Patterson T. A 20-year journey in transcatheter aortic valve implantation: Evolution to current eminence. Front Cardiovasc Med 2022; 9:971762. [PMID: 36479570 PMCID: PMC9719928 DOI: 10.3389/fcvm.2022.971762] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/31/2022] [Indexed: 07/26/2023] Open
Abstract
Since the first groundbreaking procedure in 2002, transcatheter aortic valve implantation (TAVI) has revolutionized the management of aortic stenosis (AS). Through striking developments in pertinent equipment and techniques, TAVI has now become the leading therapeutic strategy for aortic valve replacement in patients with severe symptomatic AS. The procedure streamlining from routine use of conscious sedation to a single arterial access approach, the newly adapted implantation techniques, and the introduction of novel technologies such as intravascular lithotripsy and the refinement of valve-bioprosthesis devices along with the accumulating experience have resulted in a dramatic reduction of complications and have improved associated outcomes that are now considered comparable or even superior to surgical aortic valve replacement (SAVR). These advances have opened the road to the use of TAVI in younger and lower-risk patients and up-to-date data from landmark studies have now established the outstanding efficacy and safety of TAVI in patients with low-surgical risk impelling the most recent ESC guidelines to propose TAVI, as the main therapeutic strategy for patients with AS aged 75 years or older. In this article, we aim to summarize the most recent advances and the current clinical aspects involving the use of TAVI, and we also attempt to highlight impending concerns that need to be further addressed.
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Affiliation(s)
- Andreas S. Kalogeropoulos
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Cardiology, MITERA General Hospital, Hygeia Healthcare Group, Athens, Greece
| | - Simon R. Redwood
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Christopher J. Allen
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Harriet Hurrell
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Omar Chehab
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Ronak Rajani
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Bernard Prendergast
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Tiffany Patterson
- St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
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14
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Arjomandi Rad A, Naruka V, Vardanyan R, Salmasi MY, Tasoudis PT, Kendall S, Casula R, Athanasiou T. Renal outcomes in valve-in-valve transcatheter versus redo surgical aortic valve replacement: A systematic review and meta-analysis. J Card Surg 2022; 37:3743-3753. [PMID: 36040611 PMCID: PMC9804591 DOI: 10.1111/jocs.16890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Postoperative acute kidney injury (AKI) and the requirement for renal replacement therapy (RRT) remain common and significant complications of both transcatheter valve-in-valve aortic valve replacement (ViV-TAVR) and redo surgical aortic valve replacement (SAVR). Nevertheless, the understanding of renal outcomes in the population undergoing either redo SAVR or ViV-TAVR remains controversial. METHODS A systematic database search with meta-analysis was conducted of comparative original articles of ViV-TAVR versus redo SAVR in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to September 2021. Primary outcomes were AKI and RRT. Secondary outcomes were stroke, major bleeding, pacemaker implantation rate, operative mortality, and 30-day mortality. RESULTS Our search yielded 5435 relevant studies. Eighteen studies met the inclusion criteria with a total of 11,198 patients. We found ViV-TAVR to be associated with lower rates of AKI, postoperative RRT, major bleeding, pacemaker implantation, operative mortality, and 30-day mortality. No significant difference was observed in terms of stroke rate. The mean incidence of AKI in ViV-TAVR was 6.95% (±6%) and in redo SAVR was 15.2% (±9.6%). For RRT, our data showed that VIV-TAVR to be 1.48% (±1.46%) and redo SAVR to be 8.54% (±8.06%). CONCLUSION Renoprotective strategies should be put into place to prevent and reduce AKI incidence regardless of the treatment modality. Patients undergoing re-intervention for the aortic valve constitute a high-risk and frail population in which ViV-TAVR demonstrated it might be a feasible option for carefully selected patients. Long-term follow-up data and randomized control trials will be needed to evaluate mortality and morbidity outcomes between these 2 treatments.
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Affiliation(s)
| | - Vinci Naruka
- Department of Cardiothoracic Surgery, Imperial College NHS TrustHammersmith HospitalLondonUK
| | - Robert Vardanyan
- Department of Medicine, Imperial College LondonFaculty of MedicineLondonUK
| | | | | | - Simon Kendall
- Department of Cardiothoracic SurgeryJames Cook University HospitalMiddlesboroughUK
| | - Roberto Casula
- Department of Cardiothoracic Surgery, Imperial College NHS TrustHammersmith HospitalLondonUK
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Imperial College NHS TrustHammersmith HospitalLondonUK,Department of Surgery and CancerImperial College LondonLondonUK
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15
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Majmundar M, Patel KN, Doshi R, Anantha-Narayanan M, Kumar A, Reed GW, Puri R, Kapadia SR, Jaradat ZA, Bhatt DL, Kalra A. Comparison of 6-Month Outcomes of Endovascular vs Surgical Revascularization for Patients With Critical Limb Ischemia. JAMA Netw Open 2022; 5:e2227746. [PMID: 35984655 PMCID: PMC9391961 DOI: 10.1001/jamanetworkopen.2022.27746] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE The Bypass Versus Angioplasty for Severe Ischemia of the Leg randomized controlled trial showed comparable outcomes between endovascular revascularization (ER) and surgical revascularization (SR) for patients with critical limb ischemia (CLI). However, several observational studies showed mixed results. Most of these studies were conducted before advanced endovascular technologies were available. OBJECTIVE To compare ER and SR treatment strategies for 6-month outcomes among patients with CLI. DESIGN, SETTING, AND PARTICIPANTS This retrospective, population-based cohort study used the Nationwide Readmissions Database to identify 66 277 patients with CLI who underwent ER or SR from January 1, 2016, to December 31, 2018. Data analyses were conducted from January 1, 2022, to February 8, 2022. A propensity score with 1:1 matching was applied. Patients with CLI who underwent ER or SR were identified, and those with missing information on the length of stay and/or younger than 18 years were excluded. EXPOSURES Endovascular or surgical revascularization. MAIN OUTCOMES AND MEASURES The primary outcome was a major amputation at 6 months. Significant secondary outcomes were in-hospital and 6-month mortality and an in-hospital safety composite of acute kidney injury, major bleeding, and vascular complication. Subgroup analysis was conducted for major amputation in high-volume centers. RESULTS A total of 66 277 patients were identified between 2016 and 2018 who underwent ER or SR for CLI. The Nationwide Readmissions Database does not provide racial and ethnic categories. The mean (SD) age of the cohort was 69.3 (12) years, and 62.5% of patients were male. A total of 54 546 patients (82.3%) underwent ER and 11 731 (17.7%) underwent SR. After propensity score matching, 11 106 matched pairs were found. Endovascular revascularization was associated with an 18% higher risk of major amputation compared with SR (997 of 10 090 [9.9%] vs 869 of 10 318 [8.4%]; hazard ratio, 1.18; 95% CI, 1.08-1.29; P = .001). However, no difference was observed in major amputation risk when both procedures were performed in high-volume centers. Endovascular revascularization and SR had similar mortality rates (517 of 11 106 [4.7%] vs 490 of 11 106 [4.4%]; hazard ratio, 1.06; 95% CI, 0.93-1.20; P = .39). However, the ER group had a 17% lower risk of in-hospital safety outcomes compared with the SR group (2584 of 11 106 [23.3%] vs 2979 of 11 106 [26.8%]; odds ratio, 0.83; 95% CI, 0.78-0.88; P < .001). CONCLUSIONS AND RELEVANCE The results of this study suggest that ER was safer, without any difference in mortality, but ER was associated with an increased risk of major amputation compared with SR. However, the risk of major amputation was similar when both procedures were performed at high-volume centers.
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Affiliation(s)
- Monil Majmundar
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City
| | - Kunal N. Patel
- Department of Internal Medicine, St Peter’s University Hospital, New Brunswick, New Jersey
| | - Rajkumar Doshi
- Department of Cardiology, St Joseph’s University Medical Center, Paterson, New Jersey
| | | | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio
| | - Grant W. Reed
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ziad A. Jaradat
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis
| | - Deepak L. Bhatt
- Brigham and Women’s Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Ankur Kalra
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis
- Cardiovascular Institute, Kalra Hospitals, New Delhi, India
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16
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Aurigemma C, Burzotta F, Vergallo R, Farina P, Romagnoli E, Cangemi S, Bianchini F, Nesta M, Bruno P, D'Amario D, Leone AM, Trani C. Transcatether Aortic Valve Implantation to Treat Degenerated Surgical Bioprosthesis: Focus on the Specific Procedural Challenges. Front Cardiovasc Med 2022; 9:895477. [PMID: 35711347 PMCID: PMC9194080 DOI: 10.3389/fcvm.2022.895477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Actually transcatheter aortic valve implantation within failed surgically bioprosthetic valves (VIV-TAVI) is an established procedure in patients at high risk for repeat surgical aortic valve intervention. Although less invasive than surgical reintervention, VIV-TAVI procedure offers potential challenges, such as higher rates of prosthesis-patient mismatch and coronary obstruction. Thus, optimal procedural planning plays an important role to minimize the risk of procedure complications. In this review, we describe the key points of a VIV-TAVI procedure to optimize outcomes and reduce the risk of procedure complications.
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Affiliation(s)
- Cristina Aurigemma
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rocco Vergallo
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Farina
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Cangemi
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Bianchini
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marialisa Nesta
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piergiorgio Bruno
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico D'Amario
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Maria Leone
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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17
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van Nieuwkerk AC, Santos RB, Fernandez-Nofrerias E, Tchétché D, de Brito FS, Barbanti M, Kornowski R, Latib A, D'Onofrio A, Ribichini F, Mainar V, Dumonteil N, Baan J, Abizaid A, Sartori S, D'Errigo P, Tarantini G, Lunardi M, Orvin K, Pagnesi M, Larraya GL, Ghattas A, Dangas G, Mehran R, Delewi R. Outcomes in Valve-in-Valve Transcatheter Aortic Valve Implantation. Am J Cardiol 2022; 172:81-89. [PMID: 35351288 DOI: 10.1016/j.amjcard.2022.02.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Abstract
The use of valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) is increasing, but studies evaluating clinical outcomes in these patients are scarce. Also, there are limited data to guide the choice of valve type in ViV-TAVI. Therefore, this CENTER-study evaluated clinical outcomes in patients with ViV-TAVI compared to patients with native valve TAVI (NV-TAVI). In addition, we compared outcomes in patients with ViV-TAVI treated with self-expandable versus balloon-expandable valves. A total of 256 patients with ViV-TAVI and 11333 patients with NV-TAVI were matched 1:2 using propensity score matching, resulting in 256 patients with ViV-TAVI and 512 patients with NV-TAVI. Mean age was 81±7 years, 58% were female, and the Society of Thoracic Surgeons Predicted Risk of Mortality was 6.3% (4.0% to 12.8%). Mortality rates were comparable between ViV-TAVI and NV-TAVI patients at 30 days (4.1% vs 5.9%, p = 0.30) and 1 year (14.2% vs 17.3%, p = 0.34). Stroke rates were also similar at 30 days (2.8% vs 1.8%, p = 0.38) and 1 year (4.9% vs 4.3%, p = 0.74). Permanent pacemakers were less frequently implanted in patients with ViV-TAVI (8.8% vs 15.0%, relative risk 0.59, 95% confidence interval [CI] 0.37 to 0.92, p = 0.02). Patients with ViV-TAVI were treated with self-expandable valves (n = 162) and balloon-expandable valves (n = 94). Thirty-day major bleeding was less frequent in patients with self-expandable valves (3% vs 13%, odds ratio 5.12, 95% CI 1.42 to 18.52, p = 0.01). Thirty-day mortality was numerically lower in patients with self-expandable valves (3% vs 7%, odds ratio 3.35, 95% CI 0.77 to 14.51, p = 0.11). In conclusion, ViV-TAVI seems a safe and effective treatment for failing bioprosthetic valves with low mortality and stroke rates comparable to NV-TAVI for both valve types.
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Affiliation(s)
- Astrid C van Nieuwkerk
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Netherlands
| | - Raquel B Santos
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Netherlands; Department of Cardiology, Centro Hospitalar Universitário do Porto, Serviço Cardiologia, Porto, Portugal
| | | | | | - Fabio S de Brito
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Marco Barbanti
- Division of Cardiology, Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, New York; Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | | | - Jan Baan
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Netherlands
| | - Alexandre Abizaid
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paola D'Errigo
- National Centre for Global Health - Istituto Superiore di Sanità, Rome, Italy
| | | | - Mattia Lunardi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Katia Orvin
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Matteo Pagnesi
- Department of Medical and Surgical specialties, Institute of Cardiology, ASST Spedali Civili, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | | | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ronak Delewi
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Netherlands.
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18
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Majmundar M, Kumar A, Doshi R, Shariff M, Krishnaswamy A, Reed GW, Brockett J, Lahorra JA, Svensson LG, Puri R, Kapadia SR, Kalra A. Early outcomes of transcatheter versus surgical aortic valve implantation in patients with bicuspid aortic valve stenosis. EUROINTERVENTION 2022; 18:23-32. [PMID: 35019840 PMCID: PMC9909453 DOI: 10.4244/eij-d-21-00757] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Limited information is available on outcomes in patients with bicuspid aortic valve (BAV) stenosis undergoing transcatheter aortic valve implantation (TAVI) compared with surgical aortic valve replacement (SAVR), as pivotal randomised trials excluded patients with BAV pathology due to anatomic complexity. AIMS The aim of the study was to compare early outcomes between TAVI and SAVR in patients with BAV stenosis. METHODS We queried the Nationwide Readmission Database (NRD) between 2016 and 2018 to identify adults who underwent TAVI or SAVR for BAV stenosis. The study's primary outcome was in-hospital mortality. Secondary outcomes were 30-day and six-month major adverse cardiovascular events (MACE). We matched both cohorts using propensity score matching, and applied logistic and Cox-proportional hazard regression to compute the odds ratio (OR), the hazard ratio (HR), and the 95% confidence interval (CI). RESULTS Out of 17,068 patients with BAV stenosis, 1,629 (9.5%) patients underwent TAVI and 15,439 (90.5%) underwent SAVR. After propensity score matching (PSM), we found 1,393 matched pairs. Of the matched pairs, 848 had complete six-month follow-ups. In the PSM cohort, TAVI was associated with reduced in-hospital mortality (0.7% vs 1.8%, OR: 0.35, 95% CI: 0.13-0.93; p=0.035), and a similar rate of MACE at 30 days (1% vs 1.5%, OR: 0.65, 95% CI: 0.27-1.58; p=0.343) and at six months (4.2% vs 4.9%, HR 0.86, 95% CI: 0.44-1.69; p=0.674), compared with SAVR. CONCLUSIONS In the propensity score-matched cohort, TAVI was associated with reduced odds of in-hospital mortality and a similar risk of 30-day and six-month MACE, supporting the feasibility of TAVI in BAV patients without a need for concurrent aortic root repair.
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Affiliation(s)
- Monil Majmundar
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA,Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA
| | - Ashish Kumar
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA,Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Rajkumar Doshi
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, NJ, USA
| | | | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Grant W. Reed
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James Brockett
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA,Department of Thoracic & Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph A. Lahorra
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA,Department of Thoracic & Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lars G. Svensson
- Department of Thoracic & Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 224 W Exchange St, Suite 225, Akron, Ohio 44302, USA
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Cuisset T, Jaussaud N, Morera P, Collart F, Deharo P. Letter: Reintervention for a failed surgical aortic bioprosthesis. Percutaneous or surgical treatment: should we look at the short- or long-term perspective? EUROINTERVENTION 2022; 17:e1455. [PMID: 35354548 PMCID: PMC9896387 DOI: 10.4244/eij-d-21-00812l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Thomas Cuisset
- Département de Cardiologie, CHU Timone, Marseille, France,Aix Marseille Université, INSERM, INRA, C2VN, Marseille, France,Aix-Marseille Université, Faculté de Médecine, Marseille, France
| | | | - Pierre Morera
- Service de Chirurgie Cardiologie, CHU Timone, Marseille, France
| | | | - Pierre Deharo
- Service de Cardiologie, CHU Timone, 264 Rue Saint-Pierre, 13005 Marseille, France
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Majmundar M, Doshi R, Kumar A, Kalra A. Reply: Reintervention for a failed surgical aortic bioprosthesis. Percutaneous or surgical treatment: should we look at the short- or long-term perspective? EUROINTERVENTION 2022; 17:e1456. [PMID: 35354549 PMCID: PMC9896382 DOI: 10.4244/eij-d-21-00812r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Monil Majmundar
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA,Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA
| | - Rajkumar Doshi
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Ashish Kumar
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA,Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Ankur Kalra
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, 1 Akron General Ave, Akron, OH 44307, USA
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Baldus S, Mauri V. Valve-in-valve TAVI: the new standard therapy for failing bioprosthetic valves? EUROINTERVENTION 2022; 17:1197-1198. [PMID: 35177380 PMCID: PMC9725087 DOI: 10.4244/eij-e-21-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Stephan Baldus
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Victor Mauri
- Heart Center, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
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