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Schaefer A, Bhadra OD, Conradi L, Westermann D, Kellner C, De Backer O, Bajoras V, Sondergaard L, Qureshi WT, Kakouros N, Aldrugh S, Amat-Santos I, Kaneko T, Harloff M, Teles R, Nolasco T, Neves JP, Abecasis M, Werner N, Lauterbach M, Sacha J, Krawczyk K, Trani C, Romagnoli E, Mangieri A, Condello F, Regueiro A, Brugaletta S, Biancari F, Niemelä M, Giannini F, Toselli M, Ruggiero R, Buono A, Maffeo D, Bruno F, Conrotto F, D'Ascenzo F, Savontaus M, Pykäri J, Ielasi A, Tespili M, Cimmino M, Albanese M, Biondi-Zoccai G, Corcione N, Morello A, Giordano A. Procedural success in transaxillary transcatheter aortic valve implantation according to type of transcatheter heart valve: results from the multicenter TAXI registry. Clin Res Cardiol 2024; 113:48-57. [PMID: 37138103 DOI: 10.1007/s00392-023-02216-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Transaxillary (TAx) transcatheter aortic valve implantation (TAVI) is a preferred alternative access in patients ineligible for transfemoral TAVI. AIMS This study used the Trans-AXillary Intervention (TAXI) registry to compare procedural success according to different types of transcatheter heart valves (THV). METHODS For the TAXI registry anonymized data of patients treated with TAx-TAVI were collected from 18 centers. Acute procedural, early and 1-month clinical outcomes were adjudicated in accordance with standardized VARC-3 definitions. RESULTS From 432 patients, 368 patients (85.3%, SE group) received self-expanding (SE) THV and 64 patients (14.8%, BE group) received balloon-expandable (BE) THV. Imaging revealed lower axillary artery diameters in the SE group (max/min diameter in mm: 8.4/6.6 vs 9.4/6.8 mm; p < 0.001/p = 0.04) but a higher proportion of axillary tortuosity in BE group (62/368, 23.6% vs 26/64, 42.6%; p = 0.004) with steeper aorta-left ventricle (LV) inflow (55° vs 51°; p = 0.002) and left ventricular outflow tract (LVOT)-LV inflow angles (40.0° vs 24.5°; 0.002). TAx-TAVI was more often conducted by right sided axillary artery in the BE group (33/368, 9.0% vs 17/64, 26.6%; p < 0.001). Device success was higher in the SE group (317/368, 86.1% vs 44/64, 68.8%, p = 0.0015). In logistic regression analysis, BE THV were a risk factor for vascular complications and axillary stent implantation. CONCLUSIONS Both, SE and BE THV can be safely used in TAx-TAVI. However, SE THV were more often used and were associated with a higher rate of device success. While SE THV were associated with lower rates of vascular complications, BE THV were more often used in cases with challenging anatomical circumstances.
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Affiliation(s)
- Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany.
| | - Oliver D Bhadra
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Dirk Westermann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Caroline Kellner
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Ole De Backer
- The Heart Center-Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vilhelmas Bajoras
- The Heart Center-Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Interventional Cardiology, Division of Cardiology and Vascular Diseases, Vilnius University, Hospital Santaros Clinics, Vilnius, Lithuania
| | - Lars Sondergaard
- The Heart Center-Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Waqas T Qureshi
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA, USA
| | - Nikolaos Kakouros
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA, USA
| | - Summer Aldrugh
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA, USA
| | - Ignacio Amat-Santos
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Morgan Harloff
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rui Teles
- Cardiothoracic Surgery Department, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Tiago Nolasco
- Cardiothoracic Surgery Department, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Jose Pedro Neves
- Cardiothoracic Surgery Department, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Miguel Abecasis
- Cardiothoracic Surgery Department, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Nikos Werner
- Department of Medicine 3, Barmherzige Brüder Hospital, Trier, Germany
| | | | - Jerzy Sacha
- Department of Cardiology, Institute of Medical Sciences, University Hospital, University of Opole, Opole, Poland
| | - Krzysztof Krawczyk
- Department of Cardiology, Institute of Medical Sciences, University Hospital, University of Opole, Opole, Poland
| | - Carlo Trani
- Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Enrico Romagnoli
- Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Francesco Condello
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Ander Regueiro
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Salvatore Brugaletta
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Matti Niemelä
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy
| | - Marco Toselli
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy
| | - Rossella Ruggiero
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy
| | - Andrea Buono
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Diego Maffeo
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Francesco Bruno
- Department of Medical Science, Division of Cardiology, Città Della Salute e della Scienza, Turin, Italy
| | - Federico Conrotto
- Department of Medical Science, Division of Cardiology, Città Della Salute e della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Department of Medical Science, Division of Cardiology, Città Della Salute e della Scienza, Turin, Italy
| | - Mikko Savontaus
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Jouni Pykäri
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | | | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Michele Cimmino
- Interventional Cardiology Unit, Santa Lucia Clinic, S. Giuseppe Vesuviano, Naples, Italy
| | - Michele Albanese
- Interventional Cardiology Unit, Santa Lucia Clinic, S. Giuseppe Vesuviano, Naples, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Nicola Corcione
- Interventional Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Alberto Morello
- Interventional Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Arturo Giordano
- Interventional Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Italy
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Pykäri J, Vasankari T, Ylitalo A, Porela P, Paana T, Malmberg M, Laurila S, Koskinen J, Koivisto T, Savontaus M. Impact of Intraprocedural Pressure Changes on Hemodynamic Outcome During Self-Expanding TAVR. Cardiol Ther 2023; 12:361-369. [PMID: 36899283 DOI: 10.1007/s40119-023-00307-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
INTRODUCTION During the transcatheter aortic valve replacement (TAVR) procedure, hemodynamic measurements can be used to evaluate transcatheter heart valve (THV) performance. We hypothesized that the occurrence of a significant decrease in invasive aortic pressure immediately after annular contact by a self-expanding THV indicates effective annular sealing. This phenomenon could thus be used as a marker for the occurrence of paravalvular leak (PVL). METHODS Thirty-eight patients undergoing TAVR procedure with a self-expandable Evolut R or Evolut Pro (Medtronic) valve prosthesis were included in the study. Drop in aortic pressure during valve expansion was defined as a decrease in systolic pressure of 30 mmHg immediately after annular contact. The primary endpoint was the occurrence of more than mild PVL immediately after valve implantation. RESULTS A pressure drop was seen in 60.5% (23/38) of patients. More than mild PVL requiring balloon post-dilatation (BPD) was significantly more frequent in patients who did not have a systolic pressure decrease > 30 mmHg during valve implantation (46.7% [7/15] vs. 13.0% [3/23], respectively; p = 0.03). Patients without a systolic pressure decrease > 30 mmHg also had a lower mean cover index on computed tomography analysis (16.2% vs. 13.3%; p = 0.016). The 30-day outcomes were similar between the two groups, and echocardiography at 30 days demonstrated more than none/trace PVL in 21.1% (8/38) of patients, with no difference between the two groups. CONCLUSION A decrease in aortic pressure after annular contact is associated with an increased probability of good hemodynamic outcome after self-expanding TAVR implantation. In addition to other methods, this parameter could be used as an additional marker for optimal valve positioning and hemodynamic outcome during the implantation procedure.
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Affiliation(s)
- Jouni Pykäri
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland
| | - Tuija Vasankari
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland
| | - Antti Ylitalo
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland
| | - Pekka Porela
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland
| | - Tuomas Paana
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland
| | - Markus Malmberg
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland
| | - Sanna Laurila
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland.,Satakunta Central Hospital, Sairalantie 3, Pori, Finland
| | - Juho Koskinen
- Department of Future Technologies, University of Turku, 20014, Turku, Finland
| | - Tero Koivisto
- Department of Future Technologies, University of Turku, 20014, Turku, Finland
| | - Mikko Savontaus
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland.
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3
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Giordano A, Schaefer A, Bhadra OD, Conradi L, Westermann D, DE Backer O, Bajoras V, Sondergaard L, Qureshi WT, Kakouros N, Aldrugh S, Amat-Santos I, Santos Martínez S, Kaneko T, Harloff M, Teles R, Nolasco T, Neves JP, Abecasis M, Werner N, Lauterbach M, Sacha J, Krawczyk K, Trani C, Romagnoli E, Mangieri A, Condello F, Regueiro A, Brugaletta S, Biancari F, Niemelä M, Giannini F, Toselli M, Ruggiero R, Buono A, Maffeo D, Bruno F, Conrotto F, D'Ascenzo F, Savontaus M, Pykäri J, Ielasi A, Tespili M, Corcione N, Ferraro P, Morello A, Albanese M, Biondi-Zoccai G. Percutaneous vs surgical axillary access for transcatheter aortic valve implantation: the TAXI registry. Panminerva Med 2022; 64:427-437. [PMID: 35638242 DOI: 10.23736/s0031-0808.22.04750-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is an established management strategy for severe aortic valve stenosis. Percutaneous axillary approach for TAVI holds the promise of improving safety without jeopardizing effectiveness in comparison to surgical access. We aimed at appraising the comparative effectiveness of percutaneous vs surgical axillary approaches for TAVI. METHODS We performed an international retrospective observational study using de-identified details on baseline, procedural, and 1-month follow-up features. Valve Academic Research Consortium (VARC)-3 criteria were applied throughout. Outcomes of interest were clinical events up to 1 month of follow-up, compared with unadjusted and propensity score-adjusted analyses. RESULTS A total of 432 patients were included, 189 (43.8%) receiving surgical access, and 243 (56.2%) undergoing percutaneous access. Primary hemostasis failure was more common in the percutaneous group (13.2% vs 4.2%, p<0.001), leading to more common use of covered stent implantation (13.2% vs 3.7%, p<0.001). Irrespectively, percutaneous access was associated with shorter hospital stay (-2.6 days [95% confidence interval: -5.0; -0.1], p=0.038), a lower risk of major adverse events (a composite of death, myocardial infarction, stroke, type 3 bleeding, and major access-site related complication; odds ratio=0.44 [0.21; 0.95], p=0.036), major access-site non-vascular complications (odds ratio=0.21 [0.06; 0.77], p=0.018), and brachial plexus impairment (odds ratio=0.16 [0.03; 0.76], p=0.021), and shorter hospital stay (-2.6 days [-5.0; -0.1], p=0.038). CONCLUSIONS Percutaneous axillary access provides similar or better results than surgical access in patients undergoing TAVI with absolute or relative contraindications to femoral access.
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Affiliation(s)
- Arturo Giordano
- Unit of Interventional Cardiology, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart and Vascular Center of Hamburg, Hamburg, Germany
| | - Oliver D Bhadra
- Department of Cardiovascular Surgery, University Heart and Vascular Center of Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center of Hamburg, Hamburg, Germany
| | - Dirk Westermann
- Department of Cardiology, University Heart and Vascular Center of Hamburg, Hamburg, Germany
| | - Ole DE Backer
- The Heart Center - Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Vilhelmas Bajoras
- The Heart Center - Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Lars Sondergaard
- The Heart Center - Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Waqas T Qureshi
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA, USA
| | - Nikolaos Kakouros
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA, USA
| | - Summer Aldrugh
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA, USA
| | - Ignacio Amat-Santos
- Department of Cardiology, CIBERCV, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Sandra Santos Martínez
- Department of Cardiology, CIBERCV, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Medical School of Harvard, Boston, MA, USA
| | - Morgan Harloff
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Medical School of Harvard, Boston, MA, USA
| | - Rui Teles
- Department of Cardiothoracic Surgery, Santa Cruz Hospital, Carnaxide, Lisbon, Portugal
| | - Tiago Nolasco
- Department of Cardiothoracic Surgery, Santa Cruz Hospital, Carnaxide, Lisbon, Portugal
| | - Jose P Neves
- Department of Cardiothoracic Surgery, Santa Cruz Hospital, Carnaxide, Lisbon, Portugal
| | - Miguel Abecasis
- Department of Cardiothoracic Surgery, Santa Cruz Hospital, Carnaxide, Lisbon, Portugal
| | - Nikos Werner
- Department of Medicine 3, Barmherzige Brüder Hospital, Trier, Germany
| | | | - Jerzy Sacha
- Department of Cardiology, Institute of Medical Sciences, University Hospital of Opole, Opole, Poland
| | - Krzysztof Krawczyk
- Department of Cardiology, Institute of Medical Sciences, University Hospital of Opole, Opole, Poland
| | - Carlo Trani
- Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Enrico Romagnoli
- Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan.,Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Francesco Condello
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan.,Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Ander Regueiro
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Salvatore Brugaletta
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy.,Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy.,Heart and Lung Center, University Hospital of Helsinki, Helsinki, Finland
| | - Matti Niemelä
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Francesco Giannini
- Heart and Lung Center, University Hospital of Helsinki, Helsinki, Finland
| | - Marco Toselli
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Rossella Ruggiero
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Andrea Buono
- Unit of Interventional Cardiology, Cardiovascular Department, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Diego Maffeo
- Unit of Interventional Cardiology, Cardiovascular Department, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Francesco Bruno
- Division of Cardiology, Department of Medical Science, Città Della Salute e della Scienza, Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Medical Science, Città Della Salute e della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Science, Città Della Salute e della Scienza, Turin, Italy
| | | | - Jouni Pykäri
- Heart Center, Turku University Hospital, Turku, Finland
| | - Alfonso Ielasi
- Unit of Clinical and Interventional Cardiology, Sant'Ambrogio Clinical Institute, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Maurizio Tespili
- Unit of Clinical and Interventional Cardiology, Sant'Ambrogio Clinical Institute, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Nicola Corcione
- Unit of Interventional Cardiology, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Paolo Ferraro
- Unit of Interventional Cardiology, Santa Lucia Clinic, S. Giuseppe Vesuviano, Naples, Italy
| | - Alberto Morello
- Unit of Interventional Cardiology, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Michele Albanese
- Unit of Interventional Cardiology, Santa Lucia Clinic, S. Giuseppe Vesuviano, Naples, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy - .,Mediterranea Cardiocentro, Naples, Italy
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4
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Biancari F, Pykäri J, Savontaus M, Laine M, Husso A, Virtanen M, Maaranen P, Niemelä M, Mäkikallio T, Tauriainen T, Eskola M, Raivio P, Valtola A, Juvonen T, Airaksinen J. Early and late pace-maker implantation after transcatheter and surgical aortic valve replacement. Catheter Cardiovasc Interv 2020; 97:E560-E568. [PMID: 32767643 DOI: 10.1002/ccd.29177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/06/2020] [Accepted: 07/19/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Conduction defects requiring permanent pacemaker (PPM) implantation are frequent complications occurring after surgical (SAVR) and transcatheter aortic valve replacement (TAVR). METHODS Patients who underwent TAVR or SAVR with a bioprosthesis from the nationwide FinnValve registry were the subjects of this study. Patients with prior PPM, who received a sutureless prosthesis, or required cardiac resynchronization therapy or implantable cardioverter defibrillator were excluded from this analysis. RESULTS Four thousand and ten patients underwent SAVR and 1,897 underwent TAVR. TAVR had an increased risk of PPM implantation at 30-day (10.1% vs. 3.5%, unadjusted OR 3.11, 95%CI 2.56-3.87) and 5-year (15.7% vs. 8.6%, unadjusted SHR, 2.12, 95%CI 1.81-2.48) compared to SAVR. PPM implantation within 30 days from the index procedure did not increase the risk of 5-year mortality after either SAVR or TAVR. Among 1,042 propensity score matched pairs, TAVR had an increased risk of PPM implantation at 30-day (9.9% vs. 4.7%, p < .0001) and 5-year (14.7% vs. 11.4%, p = .001), but late (>30 days) PPM implantation at 5-year (4.7% vs. 6.9% SHR 0.72, 95%CI 0.47-1.10) was comparable to SAVR. The types of prosthesis had an impact on 30-day PPM implantation after TAVR, but not on late (>30 days) PPM implantation. CONCLUSIONS Although the risk of 30-day PPM implantation is higher after TAVR compared to SAVR, late (>30 days) PPM implantation was comparable with these treatment methods. PPM implantation within 30 days did not affect late survival.
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Affiliation(s)
- Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Heart Center, Turku University Hospital, and University of Turku, Turku, Finland.,Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland
| | - Jouni Pykäri
- Heart Center, Turku University Hospital, and University of Turku, Turku, Finland
| | - Mikko Savontaus
- Heart Center, Turku University Hospital, and University of Turku, Turku, Finland
| | - Mika Laine
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | | | - Marko Virtanen
- Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pasi Maaranen
- Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Matti Niemelä
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Timo Mäkikallio
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Tuomas Tauriainen
- Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland
| | - Markku Eskola
- Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Peter Raivio
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Antti Valtola
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland
| | - Juhani Airaksinen
- Heart Center, Turku University Hospital, and University of Turku, Turku, Finland
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5
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Abstract
Background Epidemiology of myocarditis in childhood is largely unknown. Men are known to have a higher incidence of myocarditis than women in adults aged <50 years, but whether this is true by sex in pediatric age groups is unknown. We set out to study the occurrence and potential sex differences of myocarditis in a general pediatric population. Methods and Results Data of all hospital admissions with myocarditis in Finland occurring in patients aged ≤15 years from 2004 to 2014 were collected from a mandatory nationwide registry. All patients with myocarditis as a primary, secondary, or tertiary cause of admission were included. Total and age‐ and sex‐specific incidence rates were calculated using corresponding population data. There were 213 admissions with myocarditis in pediatric patients. Myocarditis was the primary cause of admission in 86%. The overall incidence rate of myocarditis was 1.95/100 000 person‐years. Of all patients, 77% were boys, but sex differences in incidence rates were age‐dependent. In children aged 0 to 5 years, there was no sex difference in the occurrence of myocarditis. Boys aged 6 to 10 years had a higher incidence rate compared with girls (72% boys; incidence rate ratio: 2.46; 95% confidence interval, 1.03–5.89; P=0.04). Sex difference further increased in children aged 11 to 15 years (80% boys; incidence rate ratio: 3.5; 95% confidence interval, 2.68–5.67; P<0.0001). Conclusions Myocarditis leading to hospital admission is relatively uncommon in children, but occurrence of myocarditis increases with age. There is no sex difference in the risk of myocarditis during the first 6 years of life, but boys have a significantly higher risk at ages 6 to 15 years.
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Affiliation(s)
- Anita Arola
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Essi Pikkarainen
- Heart Center, Turku University Hospital, Turku, Finland.,Department of Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Jussi Ot Sipilä
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.,Department of Neurology, North Karelia Central Hospital, Joensuu, Finland.,Department of Neurology, University of Turku, Finland
| | - Jouni Pykäri
- Heart Center, Turku University Hospital, Turku, Finland
| | - Päivi Rautava
- Clinical Research Center, Turku University Hospital, Turku, Finland.,Department of Public Health, University of Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
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