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Rudolph TK, Messika-Zeitoun D, Frey N, Lutz M, Krapf L, Passefort S, Fryearson J, Simpson H, Mortensen K, Rehse S, Tiroke A, Dodos F, Mies F, Deutsch C, Kurucova J, Thoenes M, Bramlage P, Steeds RP. Severe aortic stenosis management in heart valve centres compared with primary/secondary care centres. Heart 2023; 109:944-950. [PMID: 36657962 DOI: 10.1136/heartjnl-2022-321566] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/03/2023] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Current guidelines recommend use of heart valve centres (HVCs) to deliver optimal quality of care for patients with valve disease but there is no evidence to support this. The hypothesis of this study is that patient care with severe aortic stenosis (AS) will differ in HVCs compared with satellite centres. We aimed to compare the treatment of patients with AS at HVCs (tertiary care hospitals with full access to AS interventions) to satellites (hospitals without such access). METHODS IMPULSE enhanced is a European, observational, prospective registry enrolling consecutive patients with newly diagnosed severe AS at four HVCs and 10 satellites. Clinical characteristics, interventions performed and outcomes up to 1 year by site-type were examined. RESULTS Among 790 patients, 594 were recruited in HVCs and 196 in satellites. At baseline, patients in HVCs had more severe valve disease (higher peak aortic velocity (4.3 vs 4.1 m/s; p=0.008)) and greater comorbidity (coronary artery disease (CAD) (44% vs 27%; p<0.001) prior myocardial infarction (MI) (11% vs 5.1%; p=0.011) and chronic pulmonary disease (17% vs 8.9%; p=0.007)) than those presenting in satellites. An aortic valve replacement was performed more often by month 3 in HVCs than satellites in the overall population (52.6% of vs 31.3%; p<0.001) and in symptomatic patients (66.7% vs 43.2%, p<0.001). One-year survival rate was higher for patients in HVCs than satellites (HR2.19; 95% CI 1.28 to 3.73 total population and 2.89 (95%CI 1.64 to 5.11) for symptomatic patients. CONCLUSIONS Our data support the implementation of referral pathways that direct patients to HVCs performing both surgery and transcatheter interventions. TRIAL REGISTRATION NUMBER NCT03112629.
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Affiliation(s)
- Tanja K Rudolph
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - David Messika-Zeitoun
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Norbert Frey
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein-Campus Kiel, Kiel, Schleswig-Holstein, Germany.,Department of Cardiology, Angiology and Pneumology, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Matthias Lutz
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein-Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | - Laura Krapf
- Department of Cardiology, Hospital Max Fourestier, Nanterre, Île-de-France, France
| | - Stephanie Passefort
- Department of Cardiology, Hopital Andre Gregoire, Montreuil, Île-de-France, France
| | - John Fryearson
- Department of Cardiology, South Warwickshire NHS Foundation Trust, Warwick, Warwickshire, UK
| | - Helen Simpson
- Birmingham Heartlands Hospital, Birmingham, West Midlands, UK
| | - Kai Mortensen
- Kardiologische Gemeinschaftspraxis Kiel, Kiel, Germany
| | - Sebastian Rehse
- Departmet of Internal Medicine, Klinik Preetz, Preetz, Germany
| | | | - Fotini Dodos
- Praxis für Innere Medizin, Kardiologie, Pneumologie am Wiener Platz, Vienna, Austria
| | - Florian Mies
- Kardiologische Gemeinschaftspraxis Hohenlind, Cologne, Germany
| | - Cornelia Deutsch
- 1Institute for Pharmacology and Preventive Medicine, IPPMed, Cloppenburg, Germany
| | - Jana Kurucova
- Edwards Lifesciences AG Czech Republic Branch, Prague, Czech Republic
| | | | - Peter Bramlage
- 1Institute for Pharmacology and Preventive Medicine, IPPMed, Cloppenburg, Germany
| | - Richard Paul Steeds
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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2
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Bohmann K, Burgdorf C, Zeus T, Joner M, Alvarez H, Berning KL, Schikowski M, Kasel AM, van Mark G, Deutsch C, Kurucova J, Thoenes M, Frank D, Wundram S, Bramlage P, Miller B, Veulemans V. The COORDINATE Pilot Study: Impact of a Transcatheter Aortic Valve Coordinator Program on Hospital and Patient Outcomes. J Clin Med 2022; 11:jcm11051205. [PMID: 35268296 PMCID: PMC8910867 DOI: 10.3390/jcm11051205] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 12/03/2022] Open
Abstract
The transcatheter aortic valve implantation (TAVI) treatment pathway is complex, leading to procedure-related delays. Dedicated TAVI coordinators can improve pathway efficiency. COORDINATE was a pilot observational prospective registry at three German centers that enrolled consecutive elective patients with severe aortic stenosis undergoing TAVI to investigate the impact a TAVI coordinator program. Pathway parameters and clinical outcomes were assessed before (control group) and after TAVI coordinator program implementation (intervention phase). The number of repeated diagnostics remained unchanged after implementation. Patients with separate hospitalizations for screening and TAVI had long delays, which increased after implementation (65 days pre- vs. 103 days post-implementation); hospitalizations combining these were more efficient. The mean time between TAVI and hospital discharge remained constant. Nurse (p = 0.001) and medical technician (p = 0.008) working hours decreased. Patient satisfaction increased, and more consistent/intensive contact between patients and staff was reported. TAVI coordinators provided more post-TAVI support, including discharge management. No adverse effects on post-procedure or 30-day outcomes were seen. This pilot suggests that TAVI coordinator programs may improve aspects of the TAVI pathway, including post-TAVI care and patient satisfaction, without compromising safety. These findings will be further investigated in the BENCHMARK registry.
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Affiliation(s)
- Katja Bohmann
- Cardiothoracic Surgery Department, Heart and Vessel Center Bad Bevensen, 29549 Bad Bevensen, Germany; (K.B.); (M.S.)
| | - Christof Burgdorf
- Cardiology Department, Heart and Vessel Center Bad Bevensen, 29549 Bad Bevensen, Germany;
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Düsseldorf, Germany; (T.Z.); (K.L.B.); (V.V.)
| | - Michael Joner
- German Heart Center Munich, 80636 Munich, Germany; (M.J.); (H.A.); (A.M.K.)
| | - Héctor Alvarez
- German Heart Center Munich, 80636 Munich, Germany; (M.J.); (H.A.); (A.M.K.)
| | - Kira Lisanne Berning
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Düsseldorf, Germany; (T.Z.); (K.L.B.); (V.V.)
| | - Maren Schikowski
- Cardiothoracic Surgery Department, Heart and Vessel Center Bad Bevensen, 29549 Bad Bevensen, Germany; (K.B.); (M.S.)
| | - Albert Markus Kasel
- German Heart Center Munich, 80636 Munich, Germany; (M.J.); (H.A.); (A.M.K.)
- Cardiology Department, University Heart Centre, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Gesine van Mark
- Institute for Pharmacology and Preventive Medicine, 49661 Cloppenburg, Germany; (G.v.M.); (C.D.); (P.B.)
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, 49661 Cloppenburg, Germany; (G.v.M.); (C.D.); (P.B.)
| | | | | | - Derk Frank
- Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine) Department, UKSH University Clinical Center Schleswig-Holstein, 24105 Kiel, Germany;
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany
- Correspondence: ; Tel.: +49-431-5002-2801
| | - Steffen Wundram
- Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine) Department, UKSH University Clinical Center Schleswig-Holstein, 24105 Kiel, Germany;
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, 49661 Cloppenburg, Germany; (G.v.M.); (C.D.); (P.B.)
| | | | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Düsseldorf, Germany; (T.Z.); (K.L.B.); (V.V.)
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3
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Kennon S, Styra R, Bonaros N, Stastny L, Romano M, Lefèvre T, Di Mario C, Stefàno P, Ribichini FL, Himbert D, Urena-Alcazar M, Salgado-Fernandez J, Cuenca Castillo JJ, Garcia B, Deutsch C, Sykorova L, Kurucova J, Thoenes M, Lüske C, Bramlage P, Frank D. Quality of life after transcatheter or surgical aortic valve replacement using the Toronto Aortic Stenosis Quality of Life Questionnaire. Open Heart 2021; 8:openhrt-2021-001821. [PMID: 34810276 PMCID: PMC8609945 DOI: 10.1136/openhrt-2021-001821] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/03/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The Toronto Aortic Stenosis Quality of Life Questionnaire (TASQ) is a validated instrument for assessing quality of life (QoL) in patients with severe aortic stenosis (AS). In this study, we evaluated health status outcomes, based on the TASQ, in patients with severe AS undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). METHODS The TASQ registry was a prospective observational registry. Patients with severe AS from nine centres in Europe and one in Canada underwent either SAVR or transfemoral TAVR. Patients completed the TASQ, Kansas City Cardiomyopathy Questionnaire and Short Form-12 V.2 prior to the intervention, predischarge, and at 30-day and 3-month follow-ups. Primary end point was the TASQ score. RESULTS In both the TAVR (n=137) and SAVR (n=137) cohorts, significant increases were observed in all three scores. The overall TASQ score improved as did all but one of the individual domains at 3 months after the intervention (p<0.001). TASQ health expectations were the only domain which worsened (p<0.001). Across TASQ subscores, significant changes were evident from the time of discharge in the TAVR and 30-day follow-up in the SAVR cohort. In a categorical analysis of the TASQ, 39.7% of the TAVR group and 35.0% of the SAVR group had a substantially improved health status at 3 months compared with baseline. CONCLUSIONS The TASQ captured changes in QoL among patients with severe AS who were treated with TAVR or SAVR. QoL improved substantially after either intervention, as indicated by changes in the TASQ overall score at 3 months. TRIAL REGISTRATION NUMBER NCT03186339.
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Affiliation(s)
- Simon Kennon
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Rima Styra
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Lukas Stastny
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Mauro Romano
- Department of Thoracic and Cardiovascular Surgery, Hopital Prive Jacques Cartier, Massy, France
| | | | - Carlo Di Mario
- Department of Structural Interventional Cardiology, Department of Cardiac Surgery, Careggi University Hospital, Florence, Italy
| | - Pierluigi Stefàno
- Department of Structural Interventional Cardiology, Department of Cardiac Surgery, Careggi University Hospital, Florence, Italy
| | | | - Dominique Himbert
- Department of Cardiology, Bichat-Claude Bernard Hospital, Paris, France
| | | | - Jorge Salgado-Fernandez
- Department of Cardiology, Department of Cardiovascular Surgery, Hospital Juan Canalejo, Coruna, Spain
| | | | - Bruno Garcia
- Department of Cardiology, Hospital Vall d'Hebron, CIBER CV, Barcelona, Spain
| | - Cornelia Deutsch
- Clinical Studies and Registries, Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Lenka Sykorova
- Medical Affairs, Edwards Lifesciences, Prague, Czech Republic
| | - Jana Kurucova
- Medical Affairs, Edwards Lifesciences, Prague, Czech Republic
| | - Martin Thoenes
- Medical Affairs, Edwards Lifesciences, Nyon, Switzerland
| | - Claudia Lüske
- Clinical Studies and Registries, Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Clinical Studies and Registries, Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Derk Frank
- Department of Internal Medicine III (Cardiology, Angiology and Critical Care), Germany and DZHK (German Centre for Cardiovascular Research), Kiel, Germany
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4
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Steeds RP, Potter A, Mangat N, Fröhlich M, Deutsch C, Bramlage P, Thoenes M. Community-based aortic stenosis detection: clinical and echocardiographic screening during influenza vaccination. Open Heart 2021; 8:openhrt-2021-001640. [PMID: 34021069 PMCID: PMC8144056 DOI: 10.1136/openhrt-2021-001640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background Degenerative aortic stenosis (AS), the most common valvular heart disease in the Western world, is often diagnosed late when the mortality risk becomes substantial. We determined the feasibility of AS screening during influenza vaccination at general practitioner (GP) surgeries in the UK. Methods Consecutive subjects aged >65 years presenting to a GP for influenza vaccination underwent heart auscultation and 2D echocardiography (V-scan). Based on these findings, a patient management strategy was determined (referral to cardiologist, review within own practice or no follow-up measures) and status at 3 months was determined. Results 167 patients were enrolled with a mean age of 75 years. On auscultation, a heart murmur was detected in 30 of 167 (18%) patients (6 subjects with an AS-specific and 24 with a non-specific murmur). 75.2% of those with no murmur had a negative V-scan finding. Conversely, 16 of 30 (53%) patients with any murmur had an abnormal V-scan finding that was largely related to the aortic valve. Using clinical auscultation and V-scan screening, a decision not to pursue follow-up measures was taken in 147 (88%) cases, whereas 18 (10.8%) subjects were referred onward; with 5 of 18 (27.8%) and 3 of 18 (16.7%) being diagnosed with mild and moderate AS. Conclusions Our pilot study confirms feasibility of valvular heart disease screening in the elderly in a primary care setting. Using simple and inexpensive diagnostic measures and 7.3 million UK inhabitants undergoing influenza vaccination, nationwide screening could potentially identify 130 000 patients with moderate AS and a significant number of patients with severe AS.
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Affiliation(s)
- Richard Paul Steeds
- Queen Elizabeth Hospital & Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Maren Fröhlich
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Martin Thoenes
- Leman Research Institute, Schaffhausen, Switzerland.,Medical Department, Edwards Lifesciences, Nyon, Switzerland
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5
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Lauten A, Rudolph TK, Messika-Zeitoun D, Thambyrajah J, Serra A, Schulz E, Frey N, Maly J, Aiello M, Lloyd G, Bortone AS, Clerici A, Delle-Karth G, Rieber J, Indolfi C, Mancone M, Belle L, Arnold M, Bouma BJ, Lutz M, Deutsch C, Kurucova J, Thoenes M, Bramlage P, Steeds RP. Management of patients with severe aortic stenosis in the TAVI-era: how recent recommendations are translated into clinical practice. Open Heart 2021; 8:openhrt-2020-001485. [PMID: 33431618 PMCID: PMC7802661 DOI: 10.1136/openhrt-2020-001485] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/02/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022] Open
Abstract
Objective Approximately 3.4% of adults aged >75 years suffer from aortic stenosis (AS). Guideline indications for aortic valve replacement (AVR) distinguish between patients with symptomatic and asymptomatic severe AS. The present analysis aims to assess contemporary practice in the treatment of severe AS across Europe and identify characteristics associated with treatment decisions, namely denial of AVR in symptomatic patients and assignment of asymptomatic patients to AVR. Methods Participants of the prospective, multinational IMPULSE database of patients with severe AS were grouped according to AS symptoms, and stratified into subgroups based on assignment to/denial of AVR. Results Of 1608 symptomatic patients, 23.8% did not undergo AVR and underwent medical treatment. Denial was independently associated with multiple factors, including severe frailty (p=0.024); mitral (p=0.002) or tricuspid (p=0.004) regurgitation grade III/IV, and the presence of renal impairment (p=0.017). Of 392 asymptomatic patients, 86.5% had no prespecified indication for AVR. Regardless, 36.3% were assigned to valve replacement. Those with an indexed aortic valve area (AVA; p=0.045) or left ventricular ejection fraction (LVEF; p<0.001) below the study median; or with a left ventricular end systolic diameter above the study median (p=0.007) were more likely to be assigned to AVR. Conclusions There may be considerable discrepancies between guideline-based recommendations and clinical practice decision-making in the treatment of AS. It appears that guidelines may not fully capture the complete clinical spectrum of patients with AS. Thus, there is a need to find ways to increase their acceptance and the rate of adoption.
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Affiliation(s)
| | - Tanja K Rudolph
- Department of Cardiology, Hear and Diabetes Center Bad Oeynhausen, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | | | | | - Antonio Serra
- Interventional Cardiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalunya, Spain
| | - Eberhard Schulz
- Cardiology Department, AKH Celle, Celle, Niedersachsen, Germany
| | - Norbert Frey
- Department of Cardiology and Angiology, University of Kiel, Kiel, Schleswig-Holstein, Germany
| | - Jiri Maly
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marco Aiello
- Department of Cardiothoracic Surgery, Foundation IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Guy Lloyd
- St Bartholomew's Hospital, London, UK
| | | | | | | | - Johannes Rieber
- Herzkatheterlabor Nymphenburg and Department of Cardiology, University of Munich, Munich, Bayern, Germany
| | - Ciro Indolfi
- Division of Cardiology and URT CNR of IFC, University Magna Graecia, Catanzaro, Calabria, Italy
| | | | - Loic Belle
- Centre Hospital d'Annecy, Annecy, France
| | - Martin Arnold
- Department of Cardiology, University Hospital Erlangen, Erlangen, Bayern, Germany
| | | | - Matthias Lutz
- Department of Cardiology and Angiology, University of Kiel, Kiel, Schleswig-Holstein, Germany
| | - Cornelia Deutsch
- Institut für Pharmakologie und Präventive Medizin GmbH, Cloppenburg, Germany
| | | | | | - Peter Bramlage
- Institut für Pharmakologie und Präventive Medizin GmbH, Cloppenburg, Germany
| | - Richard Paul Steeds
- Queen Elizabeth Hospital & Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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6
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Steeds RP, Messika-Zeitoun D, Thambyrajah J, Serra A, Schulz E, Maly J, Aiello M, Rudolph TK, Lloyd G, Bortone AS, Clerici A, Delle-Karth G, Rieber J, Indolfi C, Mancone M, Belle L, Lauten A, Arnold M, Bouma BJ, Lutz M, Deutsch C, Kurucova J, Thoenes M, Bramlage P, Frey N. IMPULSE: the impact of gender on the presentation and management of aortic stenosis across Europe. Open Heart 2021; 8:openhrt-2020-001443. [PMID: 33419934 PMCID: PMC7798778 DOI: 10.1136/openhrt-2020-001443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/09/2020] [Accepted: 12/01/2020] [Indexed: 11/10/2022] Open
Abstract
Aims There is an increasing awareness of gender-related differences in patients with severe aortic stenosis and their outcomes after surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). Methods Data from the IMPULSE registry were analysed. Patients with severe aortic stenosis (AS) were enrolled between March 2015 and April 2017 and stratified by gender. A subgroup analysis was performed to assess the impact of age. Results Overall, 2171 patients were enrolled, and 48.0% were female. Women were characterised by a higher rate of renal impairment (31.7 vs 23.3%; p<0.001), were at higher surgical risk (EuroSCORE II: 4.5 vs 3.6%; p=0.001) and more often in a critical preoperative state (7.0vs 4.2%; p=0.003). Men had an increased rate of previous cardiac surgery (9.4 vs 4.7%; p<0.001) and a reduced left ventricular ejection fraction (4.9 vs 1.3%; p<0.001). Concomitant mitral and tricuspid valve disease was substantially more common among women. Symptoms were highly prevalent in both women and men (83.6 vs 77.3%; p<0.001). AVR was planned in 1379 cases. Women were more frequently scheduled to undergo TAVI (49.3 vs 41.0%; p<0.001) and less frequently for SAVR (20.3 vs 27.5%; p<0.001). Conclusions The present data show that female patients with severe AS have a distinct patient profile and are managed in a different way to males. Gender-based differences in the management of patients with severe AS need to be taken into account more systematically to improve outcomes, especially for women.
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Affiliation(s)
- Richard Paul Steeds
- Queen Elizabeth Hospital & Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Antonio Serra
- Interventional Cardiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Jiri Maly
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marco Aiello
- Department of Cardiothoracic Surgery, Foundation IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Tanja K Rudolph
- Department of Cardiology, Heart and Diabetes Center Bad Oeynhausen, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Guy Lloyd
- St Bartholomew's Hospital, London, UK
| | | | | | | | - Johannes Rieber
- Herzkatheterlabor Nymphenburg and Department of Cardiology, University of Munich, Munich, Germany
| | - Ciro Indolfi
- Division of Cardiology and URT CNR of IFC, University Magna Graecia, Catanzaro, Italy
| | | | - Loic Belle
- Centre Hospital d'Annecy, Annecy, France
| | - Alexander Lauten
- Department for Cardiology, Helios Erfurt Clinic, Erfurt, Germany
| | - Martin Arnold
- Department of Cardiology, University of Erlangen, Erlangen, Germany
| | | | - Matthias Lutz
- Department of Cardiology and Angiology, University of Kiel, Kiel, Germany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | | | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Norbert Frey
- Department of Cardiology and Angiology, University of Kiel, Kiel, Germany
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7
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Thoenes M, Agarwal A, Grundmann D, Ferrero C, McDonald A, Bramlage P, Steeds RP. Narrative review of the role of artificial intelligence to improve aortic valve disease management. J Thorac Dis 2021; 13:396-404. [PMID: 33569220 PMCID: PMC7867819 DOI: 10.21037/jtd-20-1837] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Valvular heart disease (VHD) is a chronic progressive condition with an increasing prevalence in the Western world due to aging populations. VHD is often diagnosed at a late stage when patients are symptomatic and the outcomes of therapy, including valve replacement, may be sub-optimal due the development of secondary complications, including left ventricular (LV) dysfunction. The clinical application of artificial intelligence (AI), including machine learning (ML), has promise in supporting not only early and more timely diagnosis, but also hastening patient referral and ensuring optimal treatment of VHD. As physician auscultation lacks accuracy in diagnosis of significant VHD, computer-aided auscultation (CAA) with the help of a commercially available digital stethoscopes improves the detection and classification of heart murmurs. Although used little in current clinical practice, CAA can screen large populations at low cost with high accuracy for VHD and faciliate appropriate patient referral. Echocardiography remains the next step in assessment and planning management and AI is delivering major changes in speeding training, improving image quality by pattern recognition and image sorting, as well as automated measurement of multiple variables, thereby improving accuracy. Furthermore, AI then has the potential to hasten patient disposal, by automated alerts for red-flag findings, as well as decision support in dealing with results. In management, there is great potential in ML-enabled tools to support comprehensive disease monitoring and individualized treatment decisions. Using data from multiple sources, including demographic and clinical risk data to image variables and electronic reports from electronic medical records, specific patient phenotypes may be identified that are associated with greater risk or modeled to the estimate trajectory of VHD progression. Finally, AI algorithms are of proven value in planning intervention, facilitating transcatheter valve replacement by automated measurements of anatomical dimensions derived from imaging data to improve valve selection, valve size and method of delivery.
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Affiliation(s)
- Martin Thoenes
- Léman Research Institute, Schaffhausen am Rheinfall, Switerzland
| | | | | | - Carmen Ferrero
- Departamento de Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Universidad de Sevilla, Spain
| | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Richard P Steeds
- Queen Elizabeth Hospital & Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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8
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Rudolph TK, Messika-Zeitoun D, Frey N, Thambyrajah J, Serra A, Schulz E, Maly J, Aiello M, Lloyd G, Bortone AS, Clerici A, Delle-Karth G, Rieber J, Indolfi C, Mancone M, Belle L, Lauten A, Arnold M, Bouma BJ, Lutz M, Deutsch C, Kurucova J, Thoenes M, Bramlage P, Steeds RP. Impact of selected comorbidities on the presentation and management of aortic stenosis. Open Heart 2020; 7:openhrt-2020-001271. [PMID: 32709699 PMCID: PMC7380845 DOI: 10.1136/openhrt-2020-001271] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/26/2020] [Accepted: 06/02/2020] [Indexed: 01/07/2023] Open
Abstract
Background Contemporary data regarding the impact of comorbidities on the clinical presentation and management of patients with severe aortic stenosis (AS) are scarce. Methods Prospective registry of severe patients with AS across 23 centres in nine European countries. Results Of the 2171 patients, chronic kidney disease (CKD 27.3%), left ventricular ejection fraction (LVEF) <50% (22.0%), atrial fibrillation (15.9%) and chronic obstructive pulmonary disease (11.4%) were the most prevalent comorbidities (49.3% none, 33.9% one and 16.8% ≥2 of these). The decision to perform aortic valve replacement (AVR) was taken in a comparable proportion (67%, 72% and 69%, in patients with 0, 1 and ≥2 comorbidities; p=0.186). However, the decision for TAVI was more common with more comorbidities (35.4%, 54.0% and 57.0% for no, 1 and ≥2; p<0.001), while the decision for surgical AVR (SAVR) was decreased with increasing comorbidity burden (31.9%, 17.4% and 12.3%; p<0.001). The proportion of patients with planned AVRs that were performed within 3 months was significantly higher in patients with 1 or ≥2 comorbidities than in those without (8.7%, 10.0% and 15.7%; p<0.001). Furthermore, the mean time to AVR was significantly shorter in patients with one (30.5 days) or ≥2 comorbidities (30.8 days) than in those without (35.7 days; p=0.012). Patients with reduced LVEF tended to be offered an AVR more frequently and with a shorter delay while patients with CKD were less frequently treated. Conclusions Comorbidities in severe patients with AS affect the presentation and management of patients with severe AS. TAVI was offered more often than SAVR and performed within a shorter time period.
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Affiliation(s)
- Tanja K Rudolph
- Department of Cardiology, Heart and Diabetes Center Bad Oeynhausen, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | | | - Norbert Frey
- Department of Cardiology and Angiology, University of Kiel, Kiel, Germany
| | | | - Antonio Serra
- Interventional Cardiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Jiri Maly
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marco Aiello
- Department of Cardiothoracic Surgery, Foundation IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Guy Lloyd
- St Bartholomew's Hospital, London, UK
| | | | | | | | - Johannes Rieber
- Herzkatheterlabor Nymphenburg and Department of Cardiology, University of Munich, Munich, Germany
| | - Ciro Indolfi
- Division of Cardiology and URT CNR of IFC, Magna Graecia University, Catanzaro, Italy
| | | | - Loic Belle
- Centre Hospital d'Annecy, Annecy, France
| | - Alexander Lauten
- German Centre for Cardiovascular Research (DZHK), University Heart Center & Charité, Berlin, Germany
| | - Martin Arnold
- Department of Cardiology, University of Erlangen, Erlangen, Germany
| | | | - Matthias Lutz
- Department of Cardiology and Angiology, University of Kiel, Kiel, Germany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | | | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Richard P Steeds
- Queen Elizabeth Hospital & Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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9
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Lutz M, Messika-Zeitoun D, Rudolph TK, Schulz E, Thambyrajah J, Lloyd G, Lauten A, Frey N, Kurucova J, Thoenes M, Deutsch C, Bramlage P, Steeds RP. Differences in the presentation and management of patients with severe aortic stenosis in different European centres. Open Heart 2020; 7:openhrt-2020-001345. [PMID: 32934015 PMCID: PMC7493097 DOI: 10.1136/openhrt-2020-001345] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/21/2020] [Accepted: 08/07/2020] [Indexed: 11/08/2022] Open
Abstract
Background An investigation into differences in the management and treatment of severe aortic stenosis (AS) between Germany, France and the UK may allow benchmarking of the different healthcare systems and identification of levers for improvement. Methods Patients with a diagnosis of severe AS under management at centres within the IMPULSE and IMPULSE enhanced registries were eligible. Results Data were collected from 2052 patients (795 Germany; 542 France; 715 UK). Patients in Germany were older (79.8 years), often symptomatic (89.5%) and female (49.8%) and had a lower EF (53.8%) than patients in France and UK. Comorbidities were more common and they had a higher mean Euroscore II. Aortic valve replacement (AVR) was planned within 3 months in 70.2%. This was higher (p<0.001) in Germany than France/ UK. Of those with planned AVR, 82.3% received it within 3 months with a gradual decline (Germany>France> UK; p<0.001). In 253 patients, AVR was not performed, despite planned. Germany had a strong transcatheter aortic valve implantation (TAVI) preference (83.2%) versus France/ UK (p<0.001). Waiting time for TAVI was shorter in Germany (24.9 days) and France (19.5 days) than UK (40.3 days). Symptomatic patients were scheduled for an AVR in 79.4% (Germany> France> UK; p<0.001) and performed in 83.6% with a TAVI preference (73.1%). 20.4% of the asymptomatic patients were intervened. Conclusion Patients in Germany had more advanced disease. The rate of intervention within 3 months after diagnosis was startlingly low in the UK. Asymptomatic patients without a formal indication often underwent an intervention in Germany and France.
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Affiliation(s)
- Matthias Lutz
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - David Messika-Zeitoun
- Department of Cardiology, University of Ottawa Heart Institue, Ottawa, Ontario, Canada
| | - Tanja K Rudolph
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | | | | | - Guy Lloyd
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - Alexander Lauten
- Department of Cardiology, HELIOS Klinikum Erfurt, Erfurt, Germany
| | - Norbert Frey
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | | | | | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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10
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Frank D, Kennon S, Bonaros N, Stastny L, Romano M, Lefèvre T, Di Mario C, Stefàno P, Ribichini F, Himbert D, Urena-Alcazar M, Salgado-Fernandez J, Castillo JJC, Garcia Del Blanco B, Deutsch C, Sykorova L, Kurucova J, Thoenes M, Lüske CM, Bramlage P, Styra R. Aortic valve replacement: validation of the Toronto Aortic Stenosis Quality of Life Questionnaire. ESC Heart Fail 2020; 8:270-279. [PMID: 33207035 PMCID: PMC7835556 DOI: 10.1002/ehf2.12961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/03/2020] [Accepted: 07/30/2020] [Indexed: 11/19/2022] Open
Abstract
Aims There is no quality of life tool specifically developed for patients with severe aortic stenosis (AS) to assess how this chronic condition and its treatment affect patients. The Toronto Aortic Stenosis Quality of Life Questionnaire (TASQ) has been developed to overcome this gap. The results of the validation of the TASQ in patients undergoing treatment for severe AS are presented. Methods and results Prospective study at 10 centres in Europe and Canada, which enrolled 274 patients with severe symptomatic AS undergoing surgical or transcatheter aortic valve replacement. Mean TASQ score at baseline was 71.2 points and increased to 88.9 three months after aortic valve implantation (P < 0.001). Increases were seen for the emotional impact (32.0 to 39.0; P < 0.001), physical limitations (14.8 to 22.0; P < 0.001), and physical symptoms (8.5 vs. 11.0; P < 0.001) domains. Internal consistency was good/excellent for overall TASQ score (α = 0.891) and for the physical limitation, emotional impact, and social limitation domains (α = 0.815–0.950). Test–retest reliability was excellent or strong for the overall TASQ (intraclass correlation coefficient of 0.883) and for the physical symptoms, physical limitation, emotional impact, and social limitation domains (intraclass correlation coefficient of 0.791–0.895). Responsiveness was medium overall (Cohen's d = 0.637) and medium/large for physical symptoms, emotional impact, and physical limitations (0.661–0.812). Sensitivity to change was significant for physical symptoms, physical limitations (both P < 0.001), emotional impact (P = 0.003), and social limitations (P = 0.038). Conclusions The TASQ is a new, brief, self‐administered, and clinically relevant health‐specific tool to measure changes in quality of life in patients with AS undergoing an intervention.
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Affiliation(s)
- Derk Frank
- Department of Internal Medicine III (Cardiology, Angiology and Critical Care), UKSH University Clinical Center Schleswig-Holstein, and DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Arnold-Heller Strasse 3, Kiel, 24105, Germany
| | - Simon Kennon
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Lukas Stastny
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Mauro Romano
- Department of Thoracic and Cardiovascular Surgery, Department of Interventional Cardiology, Hôpital Privé Jacques Cartier, Massy, France
| | - Thierry Lefèvre
- Department of Thoracic and Cardiovascular Surgery, Department of Interventional Cardiology, Hôpital Privé Jacques Cartier, Massy, France
| | - Carlo Di Mario
- Department of Structural Interventional Cardiology, Department of Cardiac Surgery, Careggi University Hospital, Florence, Italy
| | - Pierluigi Stefàno
- Department of Structural Interventional Cardiology, Department of Cardiac Surgery, Careggi University Hospital, Florence, Italy
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Dominique Himbert
- Department of Cardiology, Bichat-Claude Bernard Hospital, Paris, France
| | | | - Jorge Salgado-Fernandez
- Department of Cardiology, Department of Cardiovascular Surgery, Hospital Juan Canalejo, Coruña, Spain
| | | | | | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | | | | | | | - Claudia M Lüske
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Rima Styra
- Department of Psychiatry, University Health Network, Toronto, Canada
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11
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Prendergast BD, Baumgartner H, Delgado V, Gérard O, Haude M, Himmelmann A, Iung B, Leafstedt M, Lennartz J, Maisano F, Marinelli EA, Modine T, Mueller M, Redwood SR, Rörick O, Sahyoun C, Saillant E, Søndergaard L, Thoenes M, Thomitzek K, Tschernich M, Vahanian A, Wendler O, Zemke EJ, Bax JJ. Transcatheter heart valve interventions: where are we? Where are we going? Eur Heart J 2020; 40:422-440. [PMID: 30608523 DOI: 10.1093/eurheartj/ehy668] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 11/05/2018] [Indexed: 12/16/2022] Open
Abstract
Transcatheter heart valve interventions have transformed the outcomes of patients with valvular heart disease (VHD) who are unfavourable candidates for surgery. Technological advances have allowed extension of these interventions to younger or lower risk patients and those with other forms of VHD and may in the future permit earlier treatment of VHD in less symptomatic patients or those with moderate disease. The balance of risks and benefits is likely to differ between lower and higher risk patients, and more evidence is needed to evaluate the net benefit of transcatheter technology in these groups. As academic researchers, clinicians, industry, and patient stakeholders collaborate to research these broader indications for transcatheter valve interventions, it is essential to address (i) device durability and deliverability, (ii) specific anatomical needs (e.g. bicuspid aortic valves, aortic regurgitation, mitral and tricuspid valve disease), (iii) operator training, and (iv) the reinforced importance of the multidisciplinary Heart Team.
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Affiliation(s)
| | - Helmut Baumgartner
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, RC Leiden, The Netherlands
| | | | - Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Neuss, Germany
| | | | - Bernard Iung
- AP-HP, Cardiology Department, Bichat Hospital, Paris-Diderot University, Paris, France
| | | | | | - Francesco Maisano
- Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich, Zürich, Switzerland
| | | | - Thomas Modine
- Department of Cardiovascular Surgery, Hopital Cardiologique CHRU de Lille, Lille, France
| | | | - Simon R Redwood
- Department of Cardiology, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | | | | | | | - Lars Søndergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Alec Vahanian
- AP-HP, Cardiology Department, Bichat Hospital, Paris-Diderot University, Paris, France
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, RC Leiden, The Netherlands
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12
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Spence MS, Baan J, Iacovelli F, Martinelli GL, Muir DF, Saia F, Bortone AS, Densem CG, Owens CG, van der Kley F, Vis M, van Mourik MS, Costa G, Sykorova L, Lüske CM, Deutsch C, Kurucova J, Thoenes M, Bramlage P, Tamburino C, Barbanti M. Prespecified Risk Criteria Facilitate Adequate Discharge and Long-Term Outcomes After Transfemoral Transcatheter Aortic Valve Implantation. J Am Heart Assoc 2020; 9:e016990. [PMID: 32715844 PMCID: PMC7792272 DOI: 10.1161/jaha.120.016990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Despite the availability of guidelines for the performance of transcatheter aortic valve implantation (TAVI), current treatment pathways vary between countries and institutions, which impact on the mean duration of postprocedure hospitalization. Methods and Results This was a prospective, multicenter registry of 502 patients to validate the appropriateness of discharge timing after transfemoral TAVI, using prespecified risk criteria from FAST‐TAVI (Feasibility and Safety of Early Discharge After Transfemoral [TF] Transcatheter Aortic Valve Implantation), based on hospital events within 1‐year after discharge. The end point—a composite of all‐cause mortality, vascular access–related complications, permanent pacemaker implantation, stroke, cardiac rehospitalization, kidney failure, and major bleeding—was reached in 27.0% of patients (95% CI, 23.3–31.2) within 1 year after intervention; 7.5% (95% CI, 5.5–10.2) had in‐hospital complications before discharge and 19.6% (95% CI, 16.3–23.4) within 1 year after discharge. Overall mortality within 1 year after discharge was 7.3% and rates of cardiac rehospitalization 13.5%, permanent pacemaker implantation 4.2%, any stroke 1.8%, vascular‐access–related complications 0.7%, life‐threatening bleeding 0.7%, and kidney failure 0.4%. Composite events within 1 year after discharge were observed in 18.8% and 24.3% of patients with low risk of complications/early (≤3 days) discharge and high risk and discharged late (>3 days) (concordant discharge), respectively. Event rate in patients with discordant discharge was 14.3% with low risk but discharged late and increased to 50.0% in patients with high risk but discharged in ≤3 days. Conclusions The FAST‐TAVI risk assessment provides a tool for appropriate, risk‐based discharge that was validated with the 1‐year event rate after transfemoral TAVI. Registration URL: https://www.ClinicalTrials.gov; Unique identifier: NCT02404467.
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Affiliation(s)
- Mark S. Spence
- Cardiology DepartmentRoyal Victoria HospitalBelfastUnited Kingdom
| | - Jan Baan
- Department of CardiologyAmsterdam UMCUniversity of AmsterdamThe Netherlands
| | - Fortunato Iacovelli
- Cardiology DepartmentDepartment of Advanced Biomedical SciencesUniversity of NaplesItaly
- Cardiac Surgery DepartmentClinica San GaudenzioNovaraItaly
| | | | - Douglas F. Muir
- Cardiothoracic DivisionThe James Cook University HospitalMiddlesbroughUnited Kingdom
| | - Francesco Saia
- Cardiovascular and Thoracic DepartmentS. Orsola‐Malpighi University HospitalBolognaItaly
| | | | | | - Colum G. Owens
- Cardiology DepartmentRoyal Victoria HospitalBelfastUnited Kingdom
| | - Frank van der Kley
- Cardiology DepartmentLeiden University Medical CenterLeidenThe Netherlands
| | - Marije Vis
- Department of CardiologyAmsterdam UMCUniversity of AmsterdamThe Netherlands
| | | | - Giuliano Costa
- Catania Division of CardiologyPoliclinico‐Vittorio Emanuele HospitalUniversity of CataniaItaly
| | | | - Claudia M. Lüske
- Institute for Pharmacology and Preventive MedicineCloppenburgGermany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive MedicineCloppenburgGermany
| | | | | | - Peter Bramlage
- Institute for Pharmacology and Preventive MedicineCloppenburgGermany
| | - Corrado Tamburino
- Catania Division of CardiologyPoliclinico‐Vittorio Emanuele HospitalUniversity of CataniaItaly
| | - Marco Barbanti
- Catania Division of CardiologyPoliclinico‐Vittorio Emanuele HospitalUniversity of CataniaItaly
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13
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Caponcello MG, Banderas LM, Ferrero C, Bramlage C, Thoenes M, Bramlage P. Gender differences in aortic valve replacement: is surgical aortic valve replacement riskier and transcatheter aortic valve replacement safer in women than in men? J Thorac Dis 2020; 12:3737-3746. [PMID: 32802453 PMCID: PMC7399394 DOI: 10.21037/jtd-20-700] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Aortic stenosis (AS) is a progressive and degenerative disease that necessitates valve replacement through either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Various studies have shown that, unlike for TAVR, SAVR is associated with an elevated risk for women as compared to men. The aim of this review is to better understand the risks and their possible causes, associated with the use of both TAVR and SAVR in female patients. Our systematic review included studies published between 2012 and 2020, identified through specific searches of PubMed. Compatibility of publications, determined by the use of pre-defined inclusion/exclusion criteria, resulted in 15 articles being used in our review. Overall, more men than women undergo SAVR, but our findings confirmed that SAVR is associated with worse outcomes in women in the short-term. Reasons for a higher 30-day mortality post-SAVR in women include an increased age, higher in-hospital mortality and, possibly baseline comorbidities and anatomical differences. There was no difference observed in 30-day mortality between men and women undergoing TAVR. Female patients appear to have a better longer-term survival post-TAVR than their male counterparts. Understanding the reasons why women have worse outcomes post-SAVR is essential for ensuring appropriate treatment selection for patients with AS, as well as for achieving the best possible long-term and safety outcomes for these patients.
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Affiliation(s)
- Maria Giulia Caponcello
- Departamento Farmacia y Tecnología Farmacéutica, Universidad de Sevilla, Sevilla, Spain.,Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Lucia M Banderas
- Departamento Farmacia y Tecnología Farmacéutica, Universidad de Sevilla, Sevilla, Spain
| | - Carmen Ferrero
- Departamento Farmacia y Tecnología Farmacéutica, Universidad de Sevilla, Sevilla, Spain
| | - Carsten Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Martin Thoenes
- Departamento Farmacia y Tecnología Farmacéutica, Universidad de Sevilla, Sevilla, Spain.,Leman Research Institute, Switzerland
| | - Peter Bramlage
- Departamento Farmacia y Tecnología Farmacéutica, Universidad de Sevilla, Sevilla, Spain.,Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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14
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Laule M, Mattig I, Schöbel C, Knebel F, Lauten A, Lembcke A, Thoenes M, Grubitzsch H, Stangl K, Dreger H. Inferior Caval Valve Implantation Versus Optimal Medical Therapy for Severe Tricuspid Regurgitation. J Am Coll Cardiol 2020; 74:473-475. [PMID: 31319922 DOI: 10.1016/j.jacc.2019.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/13/2019] [Accepted: 05/21/2019] [Indexed: 11/15/2022]
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15
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Dreger H, Mattig I, Hewing B, Knebel F, Lauten A, Lembcke A, Thoenes M, Roehle R, Stangl V, Landmesser U, Grubitzsch H, Stangl K, Laule M. Treatment of Severe TRIcuspid Regurgitation in Patients with Advanced Heart Failure with CAval Vein Implantation of the Edwards Sapien XT VALve (TRICAVAL): a randomised controlled trial. EUROINTERVENTION 2020; 15:1506-1513. [PMID: 31929100 DOI: 10.4244/eij-d-19-00901] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of our study was to compare the impact of implantation of a balloon-expandable transcatheter valve into the inferior vena cava (CAVI) on exercise capacity with optimal medical therapy (OMT) in patients with severe tricuspid regurgitation (TR) and high surgical risk. METHODS AND RESULTS Twenty-eight patients were randomised to OMT (n=14) or CAVI (n=14). The primary endpoint was maximal oxygen uptake at the three-month follow-up. Secondary endpoints included six-minute walk test, NYHA class, NT-proBNP levels, right heart function, unscheduled heart failure hospitalisation, and quality of life as assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Patients underwent follow-up examinations one, three, six, and twelve months after randomisation. Maximal oxygen uptake did not change significantly in either group after three months and there was no difference between the OMT and CAVI groups (-0.1±1.8 ml∙kg-1∙min-1 vs -1.0±1.6 ml∙kg-1∙min-1, p=0.4995). Compared to baseline, CAVI improved NYHA class, dyspnoea, and quality of life after three months. However, there were no statistically significant differences in the secondary endpoints between the groups. Four periprocedural complications occurred after CAVI, resulting in open heart surgery. Four patients in the OMT group and eight patients (including four after conversion to surgery) in the CAVI group died from right heart failure, sepsis or haemorrhage. CONCLUSIONS CAVI did not result in a superior functional outcome compared to OMT. Due to an unexpectedly high rate of valve dislocations, the study was stopped for safety reasons.
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Affiliation(s)
- Henryk Dreger
- Medizinische Klinik für Kardiologie und Angiologie, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
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16
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Schymik G, Rudolph T, Jacobshagen C, Rothe J, Treede H, Kerber S, Frank D, Sykorova L, Okamoto M, Thoenes M, Deutsch C, Bramlage P, Butter C. Balloon-expandable transfemoral transcatheter aortic valve implantation with or without predilation: findings from the prospective EASE-IT TF multicentre registry. Open Heart 2019; 6:e001082. [PMID: 31673387 PMCID: PMC6803005 DOI: 10.1136/openhrt-2019-001082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/16/2019] [Accepted: 09/12/2019] [Indexed: 11/05/2022] Open
Abstract
Background Predilation of the native valve has long been deemed necessary in transfemoral transcatheter aortic valve implantation (TF-TAVI), despite little trial evidence to support its clinical use. As most evidence is derived from retrospective analyses of observational studies, we conducted a two-armed, prospective multicentre registry. Methods Patients undergoing TF-TAVI with the Edwards SAPIEN 3 valve, with or without balloon aortic valvuloplasty (BAV), were included and their procedural characteristics, short-term safety and short-term efficacy outcomes compared. We hypothesised that BAV may be safely omitted in many patients and omission could be associated with procedural benefits. Results Overall, 196 consecutive patients underwent TF-TAVI, 56 with BAV and 140 without. The mean age was 81.2±6.2 years, and the mean logistic EuroSCORE I was 17.1±13.6. Device success according to Valve Academic Research Consortium-2 (VARC-2) was achieved in 96.4%. The median procedural duration was shorter without BAV (56 min vs 90 min; p=0.001), as was fluoroscopy time (10 min vs 13 min; p=0.001). The need for balloon postdilation was less frequent in patients without BAV (15.7% vs 30.4%, p=0.029). There was no difference in the proportion of patients meeting the VARC-2 defined composite safety endpoint at 30 days (9.3% without vs 8.9% with BAV; adjusted OR (adjOR) 2.55; 95% CI 0.56 to 18.84) and at 6 months (15.2% without vs 16.4% with BAV; adjOR 1.66; 95% CI 0.49 to 6.55). Conclusions In the majority of patients, BAV can be safely omitted from the TAVI procedure without adverse effects. The omission of BAV is associated with shorter procedural duration and could be advantageous for the majority of patients. Trial registration number NCT02760771.
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Affiliation(s)
- Gerhard Schymik
- Medical Clinic IV, Department of Cardiology, Municipal Hospital Karlsruhe, Karlsruhe, Baden-Württemberg, Germany
| | - Tanja Rudolph
- Heart Center, University of Cologne, Cologne, Germany
| | | | - Jürgen Rothe
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Hendrik Treede
- Universitätsklinik und Poliklinik für Herzchirurgie, Universitätsklinikum Halle, Halle, Germany
| | | | - Derk Frank
- Department of Internal Medicine III (Cardiology and Angiology), University Hospital Schleswig-Holstein,Campus Kiel, Kiel, Schleswig-Holstein, Germany.,ZHK (German Centre for Cardiovascular Research), Partner Site Kiel/Hamburg/Lübeck, Hamburg, Germany
| | | | - Maki Okamoto
- Department of Cardiology, Immanuel Clinic Bernau, Heart Center Brandenburg & Medical School Brandenburg Bernau, Bernau, Germany
| | | | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Christian Butter
- Department of Cardiology, Immanuel Clinic Bernau, Heart Center Brandenburg & Medical School Brandenburg Bernau, Bernau, Germany
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Steeds RP, Lutz M, Thambyrajah J, Serra A, Schulz E, Maly J, Aiello M, Rudolph TK, Lloyd G, Bortone AS, Hauptmann KE, Clerici A, Delle-Karth G, Rieber J, Indolfi C, Mancone M, Belle L, Lauten A, Arnold M, Bouma BJ, Deutsch C, Kurucova J, Thoenes M, Bramlage P, Frey N, Messika-Zeitoun D. Facilitated Data Relay and Effects on Treatment of Severe Aortic Stenosis in Europe. J Am Heart Assoc 2019; 8:e013160. [PMID: 31549578 PMCID: PMC6806053 DOI: 10.1161/jaha.119.013160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Many patients with severe aortic stenosis are referred late with advanced symptoms or inappropriately denied intervention. The objective was to investigate whether a structured communication to referring physicians (facilitated data relay) might improve the rate and timeliness of intervention. Methods and Results A prospective registry of consecutive patients with severe aortic stenosis at 23 centers in 9 European countries with transcatheter as well as surgical aortic valve replacement being available was performed. The study included a 3‐month documentation of the status quo (phase A), a 6‐month intervention phase (implementing facilitated data relay), and a 3‐month documentation of a legacy effect (phase‐B). Two thousand one hundred seventy‐one patients with severe aortic stenoses were enrolled (phase A: 759; intervention: 905; phase‐B: 507). Mean age was 77.9±10.0 years, and 80% were symptomatic, including 52% with severe symptoms. During phase A, intervention was planned in 464/696 (67%), 138 (20%) were assigned to watchful waiting, 8 (1%) to balloon aortic valvuloplasty, 60 (9%) were listed as not for active treatment, and in 26 (4%), no decision was made. Three hundred sixty‐three of 464 (78%) patients received the planned intervention within 3 months. Timeliness of the intervention improved as shown by the higher number of aortic valve replacements performed within 3 months (59% versus 51%, P=0.002) and a significant decrease in the time to intervention (36±38 versus 30±33 days, P=0.002). Conclusions A simple, low‐cost, facilitated data relay improves timeliness of treatment for patients diagnosed with severe aortic stenosis, resulting in a shorter time to transcatheter aortic valve replacement. This effect was mainly driven by a significant improvement in timeliness of intervention in transcatheter aortic valve replacement but not surgical aortic valve replacement. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02241447.
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Affiliation(s)
- Richard P Steeds
- Queen Elizabeth Hospital & Institute of Cardiovascular Sciences University of Birmingham UK
| | - Matthias Lutz
- Department of Cardiology and Angiology University of Kiel Germany
| | | | - Antonio Serra
- Interventional Cardiology Unit, Hospital de la Santa Creu i Sant Pau Barcelona Spain
| | | | - Jiri Maly
- Department of Cardiovascular Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic.,Department of Cardiovascular Surgery Second Faculty of Medicine Charles University Prague Czech Republic
| | - Marco Aiello
- Department of Cardiothoracic Surgery Foundation IRCCS Policlinico S.Matteo Pavia Italy
| | - Tanja K Rudolph
- Department of Cardiology University of Cologne Heart Center Cologne Germany
| | | | | | | | | | | | - Johannes Rieber
- Herzkatheterlabor Nymphenburg and Department of Cardiology University of Munich Germany
| | - Ciro Indolfi
- Division of Cardiology and URT CNR of IFC University Magna Graecia Catanzaro Italy
| | | | | | - Alexander Lauten
- German Centre for Cardiovascular Research (DZHK) University Heart Center & Charité Berlin Germany
| | - Martin Arnold
- Department of Cardiology University Hospital Erlangen Germany
| | | | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine Cloppenburg Germany
| | | | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine Cloppenburg Germany
| | - Norbert Frey
- Department of Cardiology and Angiology University of Kiel Germany
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Hengstenberg C, Thoenes M, Bramlage P, Siller-Matula J, Mascherbauer J. Aortic valve stenosis awareness in Austria-results of a nationwide survey in 1001 subjects. Wien Med Wochenschr 2019; 170:141-149. [PMID: 31541366 PMCID: PMC7098927 DOI: 10.1007/s10354-019-00708-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/16/2019] [Indexed: 12/05/2022]
Abstract
Despite the prognostic significance of severe aortic valve stenosis, knowledge is limited in the general population. To document the status quo for Austria, knowledge about valvular heart disease/aortic valve stenosis was documented in 1001 participants >60 years of age. 6.7% of respondents were knowledgeable of aortic valve stenosis, with 1.6% being concerned about the condition (24.1% cancer, 18.8% Alzheimer’s disease, 15.1% stroke). 29.5% were familiar with valvular heart disease (76.7% heart attack, 36.9% stroke). Only 1/3 reported auscultation by their general practitioner (GP) at least every third visit. Typical symptoms of aortic valve stenosis were likely to be reported by 50%. After exposure to further information on aortic valve stenosis, only 20% reported to be more concerned and ready to obtain more disease-related information. Awareness of surgical and catheter-based treatment options was claimed by 77% of respondents. Awareness campaigns on valvular heart disease are warranted to improve patient care in Austria.
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Affiliation(s)
- Christian Hengstenberg
- Department of Internal Medicine, Division of Cardiology, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Jolanta Siller-Matula
- Department of Internal Medicine, Division of Cardiology, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Julia Mascherbauer
- Department of Internal Medicine, Division of Cardiology, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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19
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Rudolph TK, Messika-Zeitoun D, Frey N, Lutz M, Krapf L, Passefort S, Fryearson J, Simpson H, Mortensen K, Rehse S, Tiroke A, Dodos F, Mies F, Pohlmann C, Kurucova J, Thoenes M, Bramlage P, Steeds RP. Caseload management and outcome of patients with aortic stenosis in primary/secondary versus tertiary care settings-design of the IMPULSE enhanced registry. Open Heart 2019; 6:e001019. [PMID: 31413844 PMCID: PMC6667938 DOI: 10.1136/openhrt-2019-001019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/31/2019] [Accepted: 06/13/2019] [Indexed: 01/14/2023] Open
Abstract
Background Severe aortic stenosis (AS) is one of the most common and most serious valve diseases. Without timely intervention with surgical aortic valve replacement or transcatheter aortic valve replacement, patients have an estimated survival of 2–3 years. Guidelines for the treatment of AS have been developed, but studies suggest that as many as 42% of patients with AS are not treated according to these recommendations. The aims of this registry are to delineate the caseload of patients with AS, outline the management of these patients and determine appropriateness of treatments in participating centres with and without onsite access to surgery and percutaneous treatments. Methods/design The IMPULSE enhanced registry is an international, multicentre, prospective, observational cohort registry conducted at four central full access centres (tertiary care hospitals) and at least two satellite centres per hub (primary/secondary care hospitals). An estimated 800 patients will be enrolled in the registry and patient follow-up will last for 12 months. Discussion In addition to the primary aims determining the caseload management and outcome of patients with AS in primary, secondary and tertiary care settings, the registry will also determine a time course for the transition from asymptomatic to symptomatic status and the diagnostic steps, treatment decisions and the identification of decision-makers in tertiary versus primary/secondary care hospitals. The last patient will be enrolled in the registry in 2018 and results of the registry are anticipated in 2019. Registration number NCT03112629.
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Affiliation(s)
- Tanja K Rudolph
- Department of Cardiology, University of Cologne Heart Center, Cologne, Germany
| | - David Messika-Zeitoun
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Norbert Frey
- Department of Cardiology and Angiology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Matthias Lutz
- Department of Cardiology and Angiology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Laura Krapf
- Department of Cardiology, Hopital Max Fourestier, Nanterre, France
| | | | - John Fryearson
- Department of Cardiology, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Helen Simpson
- Department of Cardiology, Birmingham Heartlands Hospital, Birmingham, UK
| | | | - Sebastian Rehse
- Department of Internal Medicine, Hospital Preetz, Preetz, Germany
| | | | - Fotini Dodos
- Practice for Internal Medicine, Cardiology, Pneumology / Practice for Cardiology Hohenlind, Cologne, Germany
| | - Florian Mies
- Practice for Internal Medicine, Cardiology, Pneumology / Practice for Cardiology Hohenlind, Cologne, Germany
| | | | | | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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20
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Ashauer JO, Bonaros N, Kofler M, Schymik G, Butter C, Romano M, Bapat V, Strauch J, Schröfel H, Busjahn A, Deutsch C, Bramlage P, Kurucova J, Thoenes M, Baldus S, Rudolph TK. Balloon-expandable transcatheter aortic valve implantation with or without pre-dilation - results of a meta-analysis of 3 multicenter registries. BMC Cardiovasc Disord 2019; 19:172. [PMID: 31324150 PMCID: PMC6642534 DOI: 10.1186/s12872-019-1151-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/05/2019] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the outcomes of transcatheter aortic valve implantation (TAVI) without balloon aortic valvuloplasty (BAV) in a real-world setting through a patient-level meta-analysis. Methods The meta-analysis included patients of three European multicenter, prospective, observational registry studies that compared outcomes after Edwards SAPIEN 3 or XT TAVI with (n = 339) or without (n = 355) BAV. Unadjusted and adjusted pooled odds ratios (with 95% confidence intervals) were calculated for procedural and 30-day outcomes. Results Median procedural time was shorter in the non-BAV group than in the BAV group (73 versus 93 min, p = 0.001), as was median fluoroscopy time (7 versus 11 min, p = 0.001). Post-delivery balloon dilation (15.5% versus 22.4%, p = 0.02) and catecholamine use (9.0% vs. 17.9%; p = 0.016) was required less often in the non-BAV group than in the BAV group with the difference becoming insignificant after multiple adjustment. There was a reduced risk for periprocedural atrioventricular block during the intervention (1.4% versus 4.1%, p = 0.035) which was non-significant after adjustment. The rate of moderate/severe paravalvular regurgitation post-TAVI was 0.6% in the no-BAV group versus 2.7% in the BAV group. There were no between-group differences in the risk of death, stroke or other adverse clinical outcomes at day 30. Conclusions This patient-level meta-analysis of real-world data indicates that TAVI performed without BAV is advantageous as it has an adequate device success rate, reduced procedure time and no adverse effects on short-term clinical outcomes.
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Affiliation(s)
- Jannik Ole Ashauer
- Department of Cardiology, University of Cologne Heart Center, Cologne, Germany
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Markus Kofler
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Gerhard Schymik
- Medical Clinic IV, Department of Cardiology, Municipal Hospital, Karlsruhe, Germany
| | - Christian Butter
- Department of Cardiology, Immanuel Clinic Bernau, Heart Center Brandenburg, Bernau, Germany
| | - Mauro Romano
- Institut Hospitalier Jacques Cartier, Massy, France
| | - Vinayak Bapat
- Columbia University Medical Center / New York-Presbyterian Hospital, New York, NY, USA
| | - Justus Strauch
- Clinic for Cardiosurgery and Thoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - Holger Schröfel
- Department Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany
| | | | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Bahnhofstrasse 20, 49661, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Bahnhofstrasse 20, 49661, Cloppenburg, Germany.
| | - Jana Kurucova
- Edwards Lifesciences, Medical Affairs/Professional Education, Prague, Czech Republic
| | - Martin Thoenes
- Edwards Lifesciences, Medical Affairs/Professional Education, Nyon, Switzerland
| | - Stephan Baldus
- Department of Cardiology, University of Cologne Heart Center, Cologne, Germany
| | - Tanja K Rudolph
- Department of Cardiology, University of Cologne Heart Center, Cologne, Germany.,Department of Cardiology, Heart and Diabetes Center Bad Oeynhausen, Ruhr-University of Bochum, Bad Oeynhausen, Germany
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21
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Frey N, Steeds RP, Rudolph TK, Thambyrajah J, Serra A, Schulz E, Maly J, Aiello M, Lloyd G, Bortone AS, Hauptmann KE, Clerici A, Delle Karth G, Rieber J, Indorfi C, Mancone M, Belle L, Lauten A, Arnold M, Bouma BJ, Lutz M, Pohlmann C, Kurucova J, Thoenes M, Bramlage P, Messika-Zeitoun D. Symptoms, disease severity and treatment of adults with a new diagnosis of severe aortic stenosis. Heart 2019; 105:1709-1716. [PMID: 31302639 DOI: 10.1136/heartjnl-2019-314940] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/18/2019] [Accepted: 06/21/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Contemporary data on patients with previously undiagnosed severe aortic stenosis (AS) are scarce. We aimed to address this gap by gathering data from consecutive patients diagnosed with severe AS on echocardiography. METHODS This was a prospective, multicentre, multinational, registry in 23 tertiary care hospitals across 9 European countries. Patients with a diagnosis of severe AS were included using echocardiography (aortic valve area (AVA) <1 cm2, indexed AVA <0.6 cm2/m2, maximum jet-velocity (Vmax) >4 m/s and/or mean transvalvular gradient >40 mm Hg). RESULTS The 2171 participants had a mean age of 77.9 years and 48.0% were female. The mean AVA was 0.73 cm2, Vmax4.3 m/s and mean gradient 47.1 mm Hg; 62.1% had left ventricular hypertrophy and 27.3% an ejection fraction (EF) <50%. 1743 patients (80.3%) were symptomatic (shortness-of-breath 91.0%; dizziness 30.2%, chest pain 28.9%). Patients had a EuroSCORE II of 4.0; 25.3% had a creatinine clearance <50 mL/min, and 3.2% had an EF <30%. Symptomatic patients were older and had more comorbidities than asymptomatic patients. Despite European Society of Cardiology 2017 valvular heart disease guideline class I recommendation, in only 76.2% a decision was made for an intervention (transcatheter 50.4%, surgical aortic valve replacement 25.8%). In asymptomatic patients, 57.7% with a class I/IIa indication were scheduled for a procedure, while 36.3% patients without an indication had their valve replaced. CONCLUSIONS The majority of patients with severe AS presented at an advanced disease stage. Management of severe AS remained suboptimal in a significant proportion of contemporary patients with severe AS. TRIAL REGISTRATION NUMBER NCT02241447;Results.
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Affiliation(s)
- Norbert Frey
- Department of Cardiology and Angiology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | | | | | - Antonio Serra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eberhard Schulz
- Kardiologie I, Universitätsmedizin der Johannes Gutenberg Universität Mainz, Mainz, Germany
| | - Jiri Maly
- Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marco Aiello
- Cardiothoracic Surgery, Pavia University School of Medicine, Foundation IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Guy Lloyd
- Cardiology/Cardiac Imaging, St Bartholomews Hospital, London, UK
| | | | - Karl Eugen Hauptmann
- Abteilung für Innere Medizin 3, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - Alberto Clerici
- Department of Cardiac Surgery, University of Turin, Turin, Italy
| | - Georg Delle Karth
- Department of Internal Medicine/Cardiology, Hietzing Hospital, Vienna, Austria
| | - Johannes Rieber
- Department of Cardiology and Intensive Care Medicine, Heart Center Bogenhausen, Munich, Germany
| | - Ciro Indorfi
- Department of Cardiology, Magna Graecia University, Catanzaro, Italy
| | - Massimo Mancone
- Department of Cardiovascular and Respiratory Disease, University of Rome La Sapienza, Rome, Italy
| | - Loic Belle
- Department of Cardiology, Annecy Hospital, Annecy, France
| | - Alexander Lauten
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany
| | - Martin Arnold
- Cardiology Department, University of Erlangen, Erlangen, Germany
| | - Berto J Bouma
- AMC Heart Center, Academical Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthias Lutz
- Department of Cardiology and Angiology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | | | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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22
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Frank D, Kennon S, Bonaros N, Romano M, Lefèvre T, Di Mario C, Stefàno P, Ribichini FL, Himbert D, Urena-Alcazar M, Salgado-Fernandez J, Cuenca Castillo JJ, Garcia B, Kurucova J, Thoenes M, Lüske C, Bramlage P, Styra R. Trial protocol for the validation of the 'Toronto Aortic Stenosis Quality of Life (TASQ) Questionnaire' in patients undergoing surgical aortic valve replacement (SAVR) or transfemoral (TF) transcatheter aortic valve implantation (TAVI): the TASQ registry. Open Heart 2019; 6:e001008. [PMID: 31218003 PMCID: PMC6546188 DOI: 10.1136/openhrt-2019-001008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/05/2019] [Accepted: 04/14/2019] [Indexed: 12/11/2022] Open
Abstract
Background Patients with severe aortic stenosis (AS) have a reduced life expectancy and quality of life (QoL), owing to advanced age and the presence of multiple comorbidities. Currently, there is no AS-specific QoL measurement tool, which prevents an accurate assessment of how this chronic condition and its treatment affect patients. The Toronto Aortic Stenosis Quality of Life Questionnaire (TASQ) was developed in order to address this deficiency. Methods The present trial protocol was designed to enable validation of the TASQ, which has been produced in five languages (English, French, German, Italian and Spanish) to increase usability. Patients with severe AS who are undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) will be asked to complete the TASQ and, for comparative purposes, the Kansas City Cardiomyopathy Questionnaire and the general health-related QoL Short Form-12 questionnaire. The questionnaires will be completed prior to the intervention, at discharge, as well as at 30 days and 3 months follow-up. A total of 290 patients will be recruited across one Canadian and nine European centres. Overall, the protocol validation aims to include 120 patients undergoing transfemoral TAVI (TF-TAVI), 120 undergoing SAVR and up to 50 being treated medically. The primary objective of the registry is to validate the TASQ in five different languages. The secondary objective is to assess the utility of the TASQ for assessing differences in QoL outcome between patients undergoing TF-TAVI, SAVR or medical management for their AS. Discussion Validation and roll-out of the TASQ will enable clinicians to capture an accurate assessment of how AS and its management affects the QoL of patients and will help them to determine the most appropriate treatment strategy for individual patients. Trial registration number NCT03186339.
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Affiliation(s)
- Derk Frank
- Departmentof Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine), UKSH University Clinical Center Schleswig-Holstein, Kiel, Germany and DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Simon Kennon
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital London, London, UK
| | - Nikolaos Bonaros
- Departmentof Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Mauro Romano
- Departmentof Thoracic and Cardiovascular Surgery, Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Massy, France
| | - Thierry Lefèvre
- Departmentof Thoracic and Cardiovascular Surgery, Department of Interventional Cardiology, Hopital Privé Jacques Cartier, Massy, France
| | - Carlo Di Mario
- Department of Structural Interventional Cardiology, Department of Cardiac Surgery, Careggi University Hospital, Florence, Italy
| | - Pierluigi Stefàno
- Department of Structural Interventional Cardiology, Department of Cardiac Surgery, Careggi University Hospital, Florence, Italy
| | | | - Dominique Himbert
- Department of Cardiology, Bichat-Claude Bernard Hospital, Paris, France
| | | | - Jorge Salgado-Fernandez
- Department of Cardiology, Department of Cardiovascular Surgery, Hospital Juan Canalejo, Coruña, Spain
| | | | - Bruno Garcia
- Department of Cardiology, Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - Claudia Lüske
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Rima Styra
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
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23
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Butter C, Okamoto M, Schymik G, Jacobshagen C, Rothe J, Treede H, Kerber S, Frank D, Bramlage P, Sykorova L, Thoenes M, Rudolph TK. Degree of valve calcification in patients undergoing transfemoral transcatheter aortic valve implantation with and without balloon aortic valvuloplasty: Findings from the multicenter EASE-IT TF registry. Catheter Cardiovasc Interv 2019; 94:469-478. [PMID: 30866154 DOI: 10.1002/ccd.28164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/20/2018] [Accepted: 02/09/2019] [Indexed: 12/17/2022]
Abstract
AIMS We aimed to assess whether the level of aortic root calcification is associated with BAV performance/omission during transcatheter aortic valve implantation (TAVI), and to explore related outcomes. METHODS AND RESULTS EASE-IT TF was a prospective, observational, multicenter registry of patients undergoing TF-TAVI with the Edwards SAPIEN 3, with or without BAV predilation. Valvular calcification was quantified from pre-procedural multi-slice computed tomography images and compared between BAV and no BAV patients. Data for 178 patients (55 BAV; 123 no BAV) were analyzed. There were no significant differences between groups in terms of regional/leaflet sector calcification volumes, maximum asymmetry between the different leaflet sectors, or total calcification scores. Overall, a greater-than-average leaflet calcification volume was independently predictive of ≥mild PVL (OR: 5.116; 95% CI: 1.042-38.35) and the need for post-dilation (OR: 3.592; 95% CI: 1.173-12.14). The latter effect was abated in patients with BAV (OR: 1.837; 95% CI: 0.223-18.00) and intensified in those without BAV (OR: 5.575; 95% CI: 1.114-38.74). No other BAV-dependent effects of calcification on outcomes were observed. CONCLUSIONS In the majority of transfemoral valve implantations, calcification does not appear to be the main driving factor in the decision to perform/omit BAV. Predilation may be valuable for reducing post-dilation requirements in patients only with a greater degree of leaflet calcification.
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Affiliation(s)
- Christian Butter
- Department of Cardiology, Immanuel Clinic Bernau, Heart Center Brandenburg and Brandenburg Medical School (MHB), Bernau bei Berlin, Germany
| | - Maki Okamoto
- Department of Cardiology, Immanuel Clinic Bernau, Heart Center Brandenburg and Brandenburg Medical School (MHB), Bernau bei Berlin, Germany
| | - Gerhard Schymik
- Medical Clinic IV, Department of Cardiology, Municipal Hospital, Karlsruhe, Germany
| | | | - Jürgen Rothe
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Hendrik Treede
- Universitätsklinik und Poliklinik für Herzchirurgie, Universitätsklinikum Halle, Halle, Germany
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Center, Bad Neustadt, Germany
| | - Derk Frank
- ZHK (German Centre for Cardiovascular Research), Hamburg, Germany.,Department of Internal Medicine III (Cardiology and Angiology), University Hospital Schleswig-Holstein, Kiel, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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Hascoët S, Dallapozza R, Bentham J, Petit J, Tahhan N, Carere R, Kantzis M, Ewert P, Biernacka E, Kretschmar O, Deutsch C, Thoenes M, Bramlage P, Haas N. Early outcomes of percutaneous pulmonary valve implantation using the Edwards SAPIEN 3 transcatheter heart valve system. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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25
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Hascoet S, Dalla Pozza R, Bentham J, Carere RG, Kanaan M, Ewert P, Biernacka EK, Kretschmar O, Deutsch C, Lecerf F, Lehner A, Kantzis M, Kurucova J, Thoenes M, Bramlage P, Haas NA. Early outcomes of percutaneous pulmonary valve implantation using the Edwards SAPIEN 3 transcatheter heart valve system. EUROINTERVENTION 2019; 14:1378-1385. [DOI: 10.4244/eij-d-18-01035] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cocchieri R, Petzina R, Romano M, Jagielak D, Bonaros N, Aiello M, Lapeze J, Laine M, Chocron S, Muir D, Eichinger W, Thielmann M, Labrousse L, Rein KA, Verhoye JP, Gerosa G, Bapat V, Baumbach H, Sims H, Deutsch C, Bramlage P, Kurucova J, Thoenes M, Frank D. Outcomes after transaortic transcatheter aortic valve implantation: long-term findings from the European ROUTE†. Eur J Cardiothorac Surg 2018; 55:737-743. [DOI: 10.1093/ejcts/ezy333] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/30/2018] [Accepted: 09/06/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Riccardo Cocchieri
- Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Rainer Petzina
- Department of Internal Medicine III (Cardiology and Angiology) UKSH, Campus Kiel, Kiel, Germany
| | - Mauro Romano
- Department of Thoracic and Cardiovascular Surgery, Institut Hospitalier Jacques Cartier, Massy, France
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Marco Aiello
- Department of Cardiothoracic Surgery, Foundation IRCCS Policlinico S. Matteo, Pavia University School of Medicine, Pavia, Italy
| | - Joel Lapeze
- Department of Cardiovascular Surgery, Hospital Louis Pradel, Lyon, France
| | - Mika Laine
- Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Sidney Chocron
- Department of Cardiac Surgery, Hospital Jean Minjoz, University Hospital of Besancon, Besancon, France
| | - Douglas Muir
- Department of Cardiothoracic Surgery, James Cook Hospital, Middlesbrough, UK
| | - Walter Eichinger
- Department of Cardiothoracic Surgery, Klinikum Bogenhausen, Munich, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University Hospital Essen, Essen, Germany
| | - Louis Labrousse
- Department of Cardiovascular Surgery, CHU Hospital of Bordeaux, Bordeaux, France
| | - Kjell Arne Rein
- Department of Cardiothoracic Surgery, Rikshospital Oslo, Oslo, Norway
| | | | - Gino Gerosa
- Department of Cardiac Surgery, University of Padova, Padova, Italy
| | - Vinayak Bapat
- Department of Cardiac Surgery, St. Thomas‘Hospital, London, UK
| | - Hardy Baumbach
- Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Germany
| | - Helen Sims
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Jana Kurucova
- Edwards Lifesciences, Medical Affairs/Professional Education, Nyon, Switzerland
| | - Martin Thoenes
- Edwards Lifesciences, Medical Affairs/Professional Education, Nyon, Switzerland
| | - Derk Frank
- Department of Internal Medicine III (Cardiology and Angiology) UKSH, Campus Kiel, Kiel, Germany
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Frey N, Steeds R, Rudolph T, Kurucova J, Thoenes M, Bramlage P, Messika-Zeitoun D. CONTEMPORARY PRESENTATION OF PATIENTS WITH SEVERE AORTIC STENOSIS - A LARGE PROSPECTIVE MULTICENTER REGISTRY FROM 23 CENTERS ACROSS 9 EUROPEAN COUNTRIES (THE IMPULSE REGISTRY). Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Thoenes M, Bramlage P, Zamorano P, Messika-Zeitoun D, Wendt D, Kasel M, Kurucova J, Steeds RP. Patient screening for early detection of aortic stenosis (AS)-review of current practice and future perspectives. J Thorac Dis 2018; 10:5584-5594. [PMID: 30416809 DOI: 10.21037/jtd.2018.09.02] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In Europe, approximately one million people over 75 years suffer from severe aortic stenosis (AS), one of the most serious and most common valve diseases, and this disease burden is increasing with the aging population. A diagnosis of severe symptomatic AS is associated with an average life expectancy of 2-3 years and necessitates a timely valve intervention. Guidelines for valve replacement therapy have been established but only a proportion of patients with symptomatic AS actually receive this life-saving treatment. The decision for valve intervention in asymptomatic patients with severe AS is often more challenging and likely results in fewer patients receiving treatment in comparison to their symptomatic counterparts. This article reviews the epidemiology and clinical manifestations of AS, the associated economic burden of AS to the healthcare system, the diagnosis of AS and the possible mechanisms for the introduction of routine screening in elderly patients. Elderly patients typically visit healthcare providers more frequently than younger patients, thereby providing increased opportunities for ad hoc AS screening and this, along with raising patient awareness of the symptoms of AS, has the potential to result in the earlier diagnosis and treatment of AS and increased patient survival.
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Affiliation(s)
- Martin Thoenes
- Léman Research Institute, Schaffhausen am Rheinfall, Switzerland.,Edwards Lifesciences, Nyon, Switzerland
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | | | | | - Daniel Wendt
- Klinik für Thorax- und Kardiovaskuläre Chirurgie, Westdeutsches Herzzentrum Essen, Universitätsklinikum Essen, Essen, Germany
| | | | | | - Richard P Steeds
- Queen Elizabeth Hospital & Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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Hascoet S, Pozza RD, Bentham J, Petit J, Tahhan N, Carere RG, Kantzis M, Ewert P, Biernacka EK, Kretschmar O, Deutsch C, Thoenes M, Bramlage P, Haas NA. Early outcomes of percutaneous pulmonary valve implantation using the Edwards SAPIEN 3 transcatheter heart valve system. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2018.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Salizzoni S, Mancuso S, Steeds R, Lutz M, Rudolph T, Thoenes M, Bramlage P, Frey N, Clerici A, Messika-Zeitoun D. TCT-363 Impact of the heart team in decision making in patients with severe aortic stenosis – data from the IMPULSE registry. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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31
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Puri R, Webb JG, Al Qoofi F, Welsh RC, Brown C, Masson JB, Natarajan MK, Peniston C, Cheema AN, Radhakrishnan S, Généreux P, Thoenes M, Côté M, Rodés-Cabau J. Evolution of Procedural and Clinical Outcomes After Balloon-Expanding Transcatheter Aortic Valve Implantation In Canada (from the Early Canadian Experience and SOURCE XT Registries). Am J Cardiol 2018; 122:461-467. [PMID: 29980274 DOI: 10.1016/j.amjcard.2018.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 12/27/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has evolved globally, yet its evolution and performance across the Canadian landscape have yet to be formally assessed. Patients captured within the early Canadian TAVI experience with a balloon-expanding valve (n = 339; 2005 to 2009) and those enrolled in the Canadian SOURCE XT registry (n = 415; 2012 to 2015) were systematically compared with respect to baseline clinical, echocardiographic, and procedural characteristics. Valve-related and clinical outcomes were compared across the 2 time periods according to standardized definitions. Notable baseline between-group differences were noted across time, with Society of Thoracic Surgeons Predicted Risk of Mortality score being lower in the SOURCE XT cohort compared with the earlier Canadian cohort (7.4 ± 6.6% vs 9.8 ± 6.4%, p <0.001). The SOURCE XT cohort underwent TAVI through the transfemoral approach more frequently than their earlier Canadian counterparts (75% vs 48%), at the expense of transapical access, with major access site vascular complications (2.7% vs 13%), and ≥mild residual aortic regurgitation (39% vs 69%) being significantly less frequent (p <0.001 for all). At 30-days, there were no significant differences in rates of stroke (1.9% vs 2.4%) or new pacemakers (5.8% vs 5.0%); however, 30-day and 1-year mortality rates were significantly lower in the SOURCE XT cohort (3.6% vs 10.4%; 13.0% vs 24.2%, respectively, p<0.001 for both). In conclusion, TAVIs evolution in Canada with a balloon-expanding valve coincided with more optimized patient selection and increasing use of transfemoral access, which along with increasing operator experience, contributed to improved procedural and longer term clinical outcomes.
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Affiliation(s)
- Rishi Puri
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Robert C Welsh
- University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Craig Brown
- Saint John's Regional Hospital, Saint John, New Brunswick, Canada
| | | | | | | | | | | | | | | | - Mélanie Côté
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
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Laule M, Mattig I, Hewing B, Schoebel C, Knebel F, Lauten A, Lembcke A, Thoenes M, Baumann G, Stangl V, Landmesser U, Stangl K, Dreger H. P1488Treatment of severe tricuspid regurgitation in patients with advanced heart failure with caval vein implantation of the edwards sapien XT valve (TRICAVAL): a controlled prospective randomized trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Laule
- Charité - Universitätsmedizin Berlin, Medizinische Klinik für Kardiologie und Angiologie, Campus Charité Mitte, Berlin, Germany
| | - I Mattig
- Charité - Universitätsmedizin Berlin, Medizinische Klinik für Kardiologie und Angiologie, Campus Charité Mitte, Berlin, Germany
| | - B Hewing
- Charité - Universitätsmedizin Berlin, Medizinische Klinik für Kardiologie und Angiologie, Campus Charité Mitte, Berlin, Germany
| | - C Schoebel
- Charité - Universitätsmedizin Berlin, Medizinische Klinik für Kardiologie und Angiologie, Campus Charité Mitte, Berlin, Germany
| | - F Knebel
- Charité - Universitätsmedizin Berlin, Medizinische Klinik für Kardiologie und Angiologie, Campus Charité Mitte, Berlin, Germany
| | - A Lauten
- Charité - Universitätsmedizin Berlin, Medizinische Klinik für Kardiologie, Campus Benjamin Franklin, Berlin, Germany
| | - A Lembcke
- Charité - Universitätsmedizin Berlin, Institut für Radiologie, Berlin, Germany
| | - M Thoenes
- Edwards Lifesciences, Nyon, Switzerland
| | - G Baumann
- Charité - Universitätsmedizin Berlin, Medizinische Klinik für Kardiologie und Angiologie, Campus Charité Mitte, Berlin, Germany
| | - V Stangl
- Charité - Universitätsmedizin Berlin, Medizinische Klinik für Kardiologie und Angiologie, Campus Charité Mitte, Berlin, Germany
| | - U Landmesser
- Charité - Universitätsmedizin Berlin, Medizinische Klinik für Kardiologie, Campus Benjamin Franklin, Berlin, Germany
| | - K Stangl
- Charité - Universitätsmedizin Berlin, Medizinische Klinik für Kardiologie und Angiologie, Campus Charité Mitte, Berlin, Germany
| | - H Dreger
- Charité - Universitätsmedizin Berlin, Medizinische Klinik für Kardiologie und Angiologie, Campus Charité Mitte, Berlin, Germany
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Shehada SE, Wendt D, Peters D, Mourad F, Marx P, Thielmann M, Kahlert P, Lind A, Janosi RA, Rassaf T, Rath PM, Thoenes M, Jakob H, El Gabry M. Infections after transcatheter versus surgical aortic valve replacement: mid-term results of 200 consecutive patients. J Thorac Dis 2018; 10:4342-4352. [PMID: 30174882 DOI: 10.21037/jtd.2018.06.54] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Transcatheter aortic valve implantation (TAVI) is the standard therapy for high-risk patients with aortic stenosis (AS). TAVI-outcomes are widely investigated in comparison to surgical aortic valve replacement (SAVR), but less is known about infectious complications after TAVI. We aimed to compare early and mid-term infectious outcomes of patients undergoing TAVI or SAVR. Methods The present study is a prospective single-centre study including 200 consecutive patients between 06/2014-03/2015 undergoing TAVI (either transfemoral or transapical and transaortic, n=47+53=100) or SAVR (either isolated or concomitant with CABG, n=52+48=100). The mean age and log. EuroSCORE were significantly different between both groups (81±6 versus 69±11 years, P<0.001 and 23.1%±13.8% versus 8.7%±9.5%, P<0.001). Primary endpoints included wound healing disorders, respiratory and urinary tract infections and incidence of endocarditis or sepsis within hospital stay. Secondary endpoints included infectious parameters, infectious related rehospitalisation and 2-year mortality. Results Primary endpoints showed no difference in overall TAVI- versus SAVR-groups regarding respiratory- (14% versus 19%, P=0.45), urinary-tract (7% versus 4%, P=0.54) infections, sepsis (5% versus 6%, P=1.0), endocarditis (0% versus 1%, P=1.0) or 30-day mortality (10% versus 4%, P=0.09), except for wound disorders, which were significantly lower in the TAVI-group (1% versus 8%, P=0.035), respectively. Secondary endpoints reported no difference regarding infectious related rehospitalisation (4% versus 4%, P=1.0), but significantly higher 2-year mortality (28% versus 16%, P=0.048) in the TAVI-group. Conclusions So far, little has been studied about infectious complications after TAVI. This study reports no difference between the overall TAVI and SAVR groups regarding infectious complications. However, SAVR group show more wound healing disorders but less mortality than TAVI group.
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Affiliation(s)
- Sharaf-Eldin Shehada
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Davina Peters
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Fanar Mourad
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Philipp Marx
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Philipp Kahlert
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Alexander Lind
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Rolf-Alexander Janosi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Peter-Michael Rath
- Institute for Medical Microbiology, University Hospital Essen, Essen, Germany
| | | | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Mohamed El Gabry
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
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Ungar A, Mannarino G, van der Velde N, Baan J, Thibodeau MP, Masson JB, Santoro G, van Mourik M, Jansen S, Deutsch C, Bramlage P, Kurucova J, Thoenes M, Maggi S, Schoenenberger AW. Comprehensive geriatric assessment in patients undergoing transcatheter aortic valve implantation - results from the CGA-TAVI multicentre registry. BMC Cardiovasc Disord 2018; 18:1. [PMID: 29301486 PMCID: PMC5755352 DOI: 10.1186/s12872-017-0740-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/14/2017] [Indexed: 01/06/2023] Open
Abstract
Background In older patients with aortic stenosis (AS) undergoing TAVI, the potential role of prior CGA is not well established. To explore the value of comprehensive geriatric assessment (CGA) for predicting mortality and/or hospitalisation within the first 3 months after transcatheter aortic valve implantation (TAVI). Methods An international, multi-centre, prospective registry (CGA-TAVI) was established to gather data on CGA results and medium-term outcomes in geriatric patients undergoing TAVI. Logistic regression was used to evaluate the predictive value of a multidimensional prognostic index (MPI); a short physical performance battery (SPPB); and the Silver Code, which was based on administrative data, for predicting death and/or hospitalisation in the first 3 months after TAVI (primary endpoint). Results A total of 71 TAVI patients (mean age 85.4 years; mean log EuroSCORE I 22.5%) were enrolled. Device success according to VARC criteria was 100%. After adjustment for selected baseline characteristics, a higher (poorer) MPI score (OR: 3.34; 95% CI: 1.39–8.02; p = 0.0068) and a lower (poorer) SPPB score (OR: 1.15; 95% CI: 1.01–1.54; p = 0.0380) were found to be associated with an increased likelihood of the primary endpoint. The Silver Code did not show any predictive ability in this population. Conclusions Several aspects of the CGA have shown promise for being of use to physicians when predicting TAVI outcomes. While the MPI may be useful in clinical practice, the SPPB may be of particular value, being simple and quick to perform. Validation of these findings in a larger sample is warranted. Trial registration The trial was registered in ClinicalTrials.gov on November 7, 2013 (NCT01991444).
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Affiliation(s)
- Andrea Ungar
- Geriatric Intensive Care Unit, Department of Geriatrics and Medicine, Careggi Hospital and University of Florence, Florence, Italy.
| | - Giulio Mannarino
- Geriatric Intensive Care Unit, Department of Geriatrics and Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Nathalie van der Velde
- Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, Netherlands
| | - Jan Baan
- Cardiology, Academic Medical Center, Amsterdam, Netherlands
| | | | | | - Gennaro Santoro
- Geriatric Intensive Care Unit, Department of Geriatrics and Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | | | - Sofie Jansen
- Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, Netherlands
| | - Cornelia Deutsch
- Institute for Pharmacology und Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology und Preventive Medicine, Cloppenburg, Germany
| | | | | | - Stefania Maggi
- CNR-Institute of Neuroscience, Aging Branch, Padua, Italy
| | - Andreas W Schoenenberger
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Strauch J, Wendt D, Diegeler A, Heimeshoff M, Hofmann S, Holzhey D, Oertel F, Wahlers T, Kurucova J, Thoenes M, Deutsch C, Bramlage P, Schröfel H. Balloon-expandable transapical transcatheter aortic valve implantation with or without predilation of the aortic valve: results of a multicentre registry†. Eur J Cardiothorac Surg 2017; 53:771-777. [DOI: 10.1093/ejcts/ezx397] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/22/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Justus Strauch
- Clinic for Cardiosurgery and Thoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center, Essen, Germany
| | - Anno Diegeler
- Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| | | | - Steffen Hofmann
- Schuechtermann-Klinik, Cardiac Centre Osnabrück-Bad Rothenfelde, Rothenfelde, Germany
| | - David Holzhey
- Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | | | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | | | | | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Holger Schröfel
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany
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Auffret V, Becerra Munoz V, Loirat A, Dumont E, Le Breton H, Paradis JM, Doyle D, De Larochellière R, Mohammadi S, Verhoye JP, Dagenais F, Bedossa M, Boulmier D, Leurent G, Asmarats L, Regueiro A, Chamandi C, Rodriguez-Gabella T, Voisine E, Moisan AS, Thoenes M, Côté M, Puri R, Voisine P, Rodés-Cabau J. Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Lower-Surgical-Risk Patients With Chronic Obstructive Pulmonary Disease. Am J Cardiol 2017; 120:1863-1868. [PMID: 28886850 DOI: 10.1016/j.amjcard.2017.07.097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/17/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
Respiratory complications are a major factor contributing to postoperative morbidity and mortality, especially in patients with chronic obstructive pulmonary disease (COPD). Our objective was to compare the rate of respiratory complications in patients with COPD with severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR). Low-to-intermediate surgical-risk patients with moderate or severe COPD who underwent TAVI or SAVR at 2 tertiary centers were included in this study. COPD was defined by the Global Initiative for Chronic Lung Disease classification. The primary end point was the 30-day composite of respiratory mortality, prolonged ventilation (>24 hours), the need for reintubation for respiratory causes, tracheostomy, acute respiratory distress syndrome, pneumonia, or pneumothorax. The inverse probability of treatment weighting was determined to reduce baseline imbalance between the 2 groups. A total of 321 patients (mean age 72.4 ± 9.3 years old, 74.5% male, mean Society of Thoracic Surgeons predicted risk of mortality 3.8 ± 1.9%, mean forced expiratory volume 1: 59 ± 13%) were included in the analysis. TAVI was performed in 122 patients, whereas 199 underwent SAVR. There were no differences between the 2 groups regarding the composite respiratory primary end point (SAVR 10.6%, TAVR 7.4%, adjusted odds ratio 0.57, 95% confidence interval 0.20 to 1.65, p = 0.30). Transfemoral TAVI without general anesthesia (28 patients) was associated with the lowest rate of respiratory complications (3.6%). Among patients with moderate or severe COPD at low-to-intermediate surgical risk, TAVI patients had a similar rate of 30-day major pulmonary complications compared with SAVR patients despite a higher baseline risk profile. Future studies should further investigate whether TAVI is associated with reduced respiratory complications, comparing transfemoral TAVI recipients treated with local anesthesia with their SAVR counterparts.
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Bapat V, Frank D, Cocchieri R, Jagielak D, Bonaros N, Aiello M, Lapeze J, Laine M, Chocron S, Muir D, Eichinger W, Thielmann M, Labrousse L, Rein KA, Verhoye JP, Gerosa G, Baumbach H, Bramlage P, Deutsch C, Thoenes M, Romano M. Transcatheter Aortic Valve Replacement Using Transaortic Access: Experience From the Multicenter, Multinational, Prospective ROUTE Registry. JACC Cardiovasc Interv 2017; 9:1815-22. [PMID: 27609256 DOI: 10.1016/j.jcin.2016.06.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 03/24/2016] [Revised: 06/08/2016] [Accepted: 06/20/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The Registry of the Utilization of the TAo-TAVR approach using the Edwards SAPIEN Valve (ROUTE) was established to assess the effectiveness and safety of the use of transaortic (TAo) access for transcatheter aortic valve replacement (TAVR) procedures (NCT01991431). BACKGROUND TAVR represents an alternative to surgical valve replacement in high-risk patients. Whereas the transfemoral access route is used commonly as the first-line approach, transapical access is an option for patients not suitable for transfemoral treatment mainly due to anatomic conditions. TAo-TAVR has been shown to be a viable alternative surgical access route; however, only limited data on its effectiveness and safety has been published. METHODS ROUTE is a multicenter, international, prospective, observational registry; data were collected from 18 centers across Europe starting in February 2013. Patients having severe calcific aortic stenosis were documented if they were scheduled to undergo TAo-TAVR using an Edwards SAPIEN XT or a SAPIEN 3 valve. The primary endpoint was 30-day mortality. Secondary endpoints were intraprocedural or in hospital and 30-day complication rates. RESULTS A total of 301 patients with a mean age of 81.7 ± 5.9 years and an Society of Thoracic Surgeons score of 9.0 ± 7.6% were included. Valve success was documented in 96.7%. The 30-day mortality was 6.1% (18/293) (procedure-related mortality: 3.1%; 9 of 293). The Valve Academic Research Consortium-2 defined complications included myocardial infarction (1.0%), stroke (1.0%), transient ischemic attack (0.3%), major vascular complications (3.4%), life-threatening bleeding (3.4%), and acute kidney injury (9.5%). In 3.3% of patients, paravalvular regurgitation was classified as moderate or severe (10 of 300). Twenty-six patients (8.8%) required permanent pacemaker implantation. CONCLUSIONS TAo access for TAVR seems to be a safe alternative to the transapical procedure.
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Affiliation(s)
| | - Derk Frank
- Department of Internal Medicine III (Cardiology and Angiology) UKSH, Campus Kiel, Germany
| | - Ricardo Cocchieri
- Heart Center, Academic Medical Center, University of Amsterdam, Netherlands
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Poland
| | - Nikolaos Bonaros
- University Hospital for Cardiac Surgery, Medical University Innsbruck, Austria
| | - Marco Aiello
- Department of Cardiothoracic Surgery, Foundation IRCCS Policlinico S. Matteo, Pavia University School of Medicine, Pavia, Italy
| | - Joel Lapeze
- Department of Cardiovascular Surgery, Hospital Louis Pradel, Lyon, France
| | - Mika Laine
- Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Sidney Chocron
- Cardiothoracic Surgery, Hospital Jean Minjoz, University Hospital of Besancon, France
| | - Douglas Muir
- Cardiothoracic Division, James Cook Hospital, Middlesbrough, United Kingdom
| | - Walter Eichinger
- Department of Cardiothoracic Surgery, Klinikum Bogenhausen, Munich, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University Hospital Essen, Germany
| | - Louis Labrousse
- Department of Cardiovascular Surgery, CHU Hospital of Bordeaux, France
| | - Kjell Arne Rein
- Department of Cardiothoracic Surgery, Rikshospital Oslo, Norway
| | | | - Gino Gerosa
- Department of Cardiac Surgery, University of Padova, Italy
| | - Hardy Baumbach
- Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus Stuttgart, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Martin Thoenes
- Edwards Lifesciences, Medical Affairs/Professional Education, Nyon, Switzerland
| | - Mauro Romano
- Institut Hospitalier Jacques Cartier, Massy, France
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Rodés-Cabau J, Masson JB, Welsh RC, Garcia del Blanco B, Pelletier M, Webb JG, Al-Qoofi F, Généreux P, Maluenda G, Thoenes M, Paradis JM, Chamandi C, Serra V, Dumont E, Côté M. Reply. JACC Cardiovasc Interv 2017; 10:1599-1600. [DOI: 10.1016/j.jcin.2017.06.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 06/27/2017] [Indexed: 11/24/2022]
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Rodés-Cabau J, Masson JB, Welsh RC, Garcia del Blanco B, Pelletier M, Webb JG, Al-Qoofi F, Généreux P, Maluenda G, Thoenes M, Paradis JM, Chamandi C, Serra V, Dumont E, Côté M. Aspirin Versus Aspirin Plus Clopidogrel as Antithrombotic Treatment Following Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve. JACC Cardiovasc Interv 2017; 10:1357-1365. [DOI: 10.1016/j.jcin.2017.04.014] [Citation(s) in RCA: 227] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 11/29/2022]
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Bramlage P, Swift SL, Thoenes M, Minguet J, Ferrero C, Schmieder RE. Non-steroidal mineralocorticoid receptor antagonism for the treatment of cardiovascular and renal disease. Eur J Heart Fail 2017; 19:811. [PMID: 28586538 DOI: 10.1002/ejhf.888] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Romano M, Frank D, Cocchieri R, Jagielak D, Bonaros N, Aiello M, Lapeze J, Laine M, Chocron S, Muir D, Eichinger W, Thielmann M, Labrousse L, Arne Rein K, Verhoye JP, Gerosa G, Baumbach H, Deutsch C, Bramlage P, Thoenes M, Bapat V. Transaortic transcatheter aortic valve implantation using SAPIEN XT or SAPIEN 3 valves in the ROUTE registry†. Interact Cardiovasc Thorac Surg 2017; 25:757-764. [DOI: 10.1093/icvts/ivx159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 04/14/2017] [Indexed: 11/12/2022] Open
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Bonaros N, Petzina R, Cocchieri R, Jagielak D, Aiello M, Lapeze J, Laine M, Chocron S, Muir D, Eichinger W, Thielmann M, Labrousse L, Bapat V, Arne Rein K, Verhoye JP, Gerosa G, Baumbach H, Kofler M, Bramlage P, Deutsch C, Thoenes M, Frank D, Romano M. Transaortic transcatheter aortic valve implantation as a first-line choice or as a last resort? An analysis based on the ROUTE registry†. Eur J Cardiothorac Surg 2017; 51:919-926. [DOI: 10.1093/ejcts/ezw406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/17/2016] [Indexed: 11/13/2022] Open
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Kofler M, Dumfarth J, Frank D, Cocchieri R, Jagielak D, Aiello M, Lapeze J, Laine M, Chocron S, Muir D, Eichinger W, Thielmann M, Labrousse L, Bapat V, Arne K, Verhoye J, Gerosa G, Baumbach H, Bamlage P, Deutsch C, Thoenes M, Romano M, Bonaros N. Balloon Expandable Transaortic Transcatheter Valve Implantation with or without Predilation of the Aortic Valve: Results from a Multicenter, Multinational Prospective Registry (ROUTE). Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Kofler
- Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - J. Dumfarth
- Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - D. Frank
- Department of Internal Medicine III, Universitätsklinikum Schleswig Holstein Kiel, Kiel, Germany
| | - R. Cocchieri
- Medical University of Amsterdam, Heart Center Academic medical Center, Amsterdam, The Netherlands
| | - D. Jagielak
- Medical University of Gdansk, Gdansk, Poland
| | - M. Aiello
- Pavia University School of Medicine, Pavia, Italy
| | | | - M. Laine
- Helsinki University Central Hospital, Helsinki, Finland
| | - S. Chocron
- University Hospital of Coimbra Besancon, Besancon, France
| | - D. Muir
- James Cook Hospital, Middlesbrough, United Kingdom
| | | | | | | | - V. Bapat
- St. Thomas Hospital, London, United Kingdom
| | - K. Arne
- Oslo University Hospital, Oslo, Norway
| | | | | | - H. Baumbach
- Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - P. Bamlage
- Institute of Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - C. Deutsch
- Institute of Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - M. Thoenes
- Edwards Lifesciences Medical Affairs, Nyon, Switzerland
| | - M. Romano
- Hôpital privé Jacques Cartier, Massy, France
| | - N. Bonaros
- Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Shivaraju A, Thilo C, Ott I, Mayr PN, Schunkert H, von Scheidt W, Thoenes M, Byrne R, Kastrati A, Kasel AM. Tools and Techniques - Clinical: Fluoroscopic balloon sizing of the aortic annulus before transcatheter aortic valve replacement (TAVR) - follow the "right cusp rule". EUROINTERVENTION 2016; 11:840-2. [PMID: 26603992 DOI: 10.4244/eijv11i7a170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Anupama Shivaraju
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Cowie MR, Blomster JI, Curtis LH, Duclaux S, Ford I, Fritz F, Goldman S, Janmohamed S, Kreuzer J, Leenay M, Michel A, Ong S, Pell JP, Southworth MR, Stough WG, Thoenes M, Zannad F, Zalewski A. Electronic health records to facilitate clinical research. Clin Res Cardiol 2016; 106:1-9. [PMID: 27557678 PMCID: PMC5226988 DOI: 10.1007/s00392-016-1025-6] [Citation(s) in RCA: 278] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/05/2016] [Indexed: 02/07/2023]
Abstract
Electronic health records (EHRs) provide opportunities to enhance patient care, embed performance measures in clinical practice, and facilitate clinical research. Concerns have been raised about the increasing recruitment challenges in trials, burdensome and obtrusive data collection, and uncertain generalizability of the results. Leveraging electronic health records to counterbalance these trends is an area of intense interest. The initial applications of electronic health records, as the primary data source is envisioned for observational studies, embedded pragmatic or post-marketing registry-based randomized studies, or comparative effectiveness studies. Advancing this approach to randomized clinical trials, electronic health records may potentially be used to assess study feasibility, to facilitate patient recruitment, and streamline data collection at baseline and follow-up. Ensuring data security and privacy, overcoming the challenges associated with linking diverse systems and maintaining infrastructure for repeat use of high quality data, are some of the challenges associated with using electronic health records in clinical research. Collaboration between academia, industry, regulatory bodies, policy makers, patients, and electronic health record vendors is critical for the greater use of electronic health records in clinical research. This manuscript identifies the key steps required to advance the role of electronic health records in cardiovascular clinical research.
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Affiliation(s)
- Martin R Cowie
- National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, SW3 6HP, UK.
| | - Juuso I Blomster
- Astra Zeneca R&D, Molndal, Sweden
- University of Turku, Turku, Finland
| | | | | | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | | | | | - Jörg Kreuzer
- Boehringer-Ingelheim, Pharma GmbH & Co KG, Ingelheim, Germany
| | | | | | | | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Wendy Gattis Stough
- Campbell University College of Pharmacy and Health Sciences, Campbell, NC, USA
| | | | - Faiez Zannad
- INSERM, Centre d'Investigation Clinique 9501 and Unité 961, Centre Hospitalier Universitaire, Nancy, France
- Department of Cardiology, Nancy University, Université de Lorraine, Nancy, France
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Puri R, Byrne J, Muller R, Baumbach H, Eltchaninoff H, Redwood S, Cheema A, Dubois C, Ihlberg L, Wijeysundera HC, Cerillo A, Götberg M, Klaaborg KE, Pelletier M, Blanco-Mata R, Edwards R, Gandolfo C, Muir D, Meucci F, Sinning JM, Stella P, Veulemans V, Virtanen M, Regueiro A, Thoenes M, Pibarot P, Pelletier-Beaumont E, Rodés-Cabau J. Transcatheter aortic valve implantation in patients with small aortic annuli using a 20 mm balloon-expanding valve. Heart 2016; 103:148-153. [PMID: 27534978 DOI: 10.1136/heartjnl-2016-309707] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/09/2016] [Accepted: 07/13/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND While transcatheter aortic valve implantation (TAVI) is established for treating high-operative risk surgical aortic valve replacement candidates, until recently the smallest transcatheter heart valve (THV) measured 23 mm, posing greater risk for annular rupture and THV failure in patients with aortic stenosis (AS) with small aortic annuli (≤20 mm). OBJECTIVES In the setting of a multicentre registry, we report on the safety, efficacy and early clinical outcomes of the SAPIEN XT 20 mm balloon-expanding THV. RESULTS Among TAVI 55 recipients (n=30 for native AS, n=25 for a valve-in-valve procedure (V-in-V)), median age and Society of Thoracic Surgeons score were 85 (81 to 87) years and 7.8 (4.7 to 12.4)%, respectively. Mean and minimum annular diameters were 19±1 and 17±2 mm, respectively, in native patients with AS, and 17±1 mm (internal diameter) in V-in-V recipients. Successful device implantation rate was 96%, with no procedural-related death. Overall in-hospital-30-day death, stroke and major bleeding rates were 5%, 2% and 9%, respectively. In native AS TAVI recipients, mean transaortic gradient decreased from 54±20 to 12±5 mm Hg (p<0.001), and from 45±17 to 24±8 mm Hg (p<0.001) in V-in-V recipients. Severe prosthesis-patient mismatch (PPM) rates were 10% and 48% in native AS and V-in-V TAVI recipients, respectively (p=0.03). Post-TAVI, the rate of moderate aortic regurgitation was 7% and 0% in native AS and V-in-V TAVI recipients, respectively. CONCLUSIONS TAVI with the 20 mm SAPIEN XT THV appears safe and technically feasible, with acceptable short-term clinical outcomes and low rates of severe PPM in those with native AS.
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Affiliation(s)
- Rishi Puri
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | | | | | | | - Asim Cheema
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Christophe Dubois
- Universitaire Ziekenhuizen and Katholieke Universiteit Leuven, Leuven, Belgium
| | - Leo Ihlberg
- Helsinki University Hospital, Helsinki, Finland
| | | | | | | | | | - Marc Pelletier
- New Brunswick Heart Centre, Saint John, New Brunswick, Canada
| | | | | | | | - Douglas Muir
- The James Cook University Hospital, Middlesbrough, UK
| | - Francesco Meucci
- Azienda Ospedaliero Universitaria Careggi Largo Brambilla, Florence, Italy
| | | | - Pieter Stella
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Ander Regueiro
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Martin Thoenes
- Edwards LifeSciences, Nyon, Switzerland.,Léman Research Institute, Switzerland
| | - Philippe Pibarot
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
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Bramlage P, Swift SL, Thoenes M, Minguet J, Ferrero C, Schmieder RE. Non-steroidal mineralocorticoid receptor antagonism for the treatment of cardiovascular and renal disease. Eur J Heart Fail 2015; 18:28-37. [DOI: 10.1002/ejhf.444] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/13/2015] [Accepted: 09/21/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Peter Bramlage
- Institute for Pharmacology and Preventive Medicine; Mahlow Germany
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy; University of Sevilla; Spain
| | | | | | - Joan Minguet
- Institute for Pharmacology and Preventive Medicine; Mahlow Germany
| | - Carmen Ferrero
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy; University of Sevilla; Spain
| | - Roland E. Schmieder
- Department of Nephrology and Hypertension; University Hospital of the University Erlangen-Nürnberg; Erlangen Germany
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Puri R, Baumbach H, Wijeysundera HC, Cheema A, Mueller R, Redwood S, Byrne J, Eltchaninoff H, Klaaborg KE, Pelletier M, Dubois C, Ruel M, Virtanen MP, Veulemans V, Sinning JM, Cerillo AG, Meucci F, Gandolfo C, Stella PR, Blanco R, Gotberg M, Muir DF, Herzog JP, Thoenes M, Pibarot P, Beaumont EP, Rodes-Cabau J. TCT-637 Transcatheter Aortic Valve Implantation in Patients with Small Aortic Annuli Using the Edwards SAPIEN XT 20mm Balloon-Expanding Heart Valve: Early Clinical Results from A Multi-Center Registry. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wendt D, Stühle S, Marx P, Benedik J, Wendt H, Stühle T, Thoenes M, Thielmann M, Jakob H, Kowalczyk W. The investigation of systolic and diastolic leaflet kinematics of bioprostheses with a new in-vitro test method. MINIM INVASIV THER 2015; 24:274-81. [PMID: 26358833 DOI: 10.3109/13645706.2015.1078818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We aimed to investigate leaflet kinematics of bioprostheses with a novel high-speed imaging method. MATERIAL AND METHODS High-speed-imaging (1000 Hz) was used to evaluate leaflet kinematics of the Carpentier-Edwards Perimount Magna (PM) and Magna Ease (PME) aortic bioprostheses. Both prostheses (diameter 23 mm) were placed inside a model aorta under pulsatile flow conditions. Frequencies (F) and different stroke volumes (S) were simulated. Maximum aortic valve area (AVA), total ejection time (TET), rapid valve opening time (RVOT) and rapid valve closing time (RVCT) as well as opening (OS) and closing (CS) speeds were evaluated. RESULTS Both bioprostheses showed different results dependent on flow conditions. The test setup was capable of identifying small AVA-differences between both valves (235 vs. 202 mm², F60/S60; 272 vs. 207 mm²; F70/S80), as well as differences in OS and CS (2.36 vs. 1.62 mm²/ms; 2.97 vs. 2.44 mm²/ms, F80/S60). TET was comparable (638 vs. 645 ms F60/S60; 341 vs. 343 ms, F90/S60), while results for RVOT and RVCT were equal, and dependent on frequency and stroke volume. CONCLUSIONS The novel evaluation method is sensitive to detect differences between valves, although differences were found to be small. PM has a larger visible AVA associated with higher opening and closing speeds in contrast to PME.
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Affiliation(s)
- Daniel Wendt
- a 1 Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen , Essen, Germany
| | - Sebastian Stühle
- a 1 Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen , Essen, Germany
| | - Philipp Marx
- a 1 Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen , Essen, Germany
| | - Jaroslav Benedik
- a 1 Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen , Essen, Germany
| | - Hermann Wendt
- a 1 Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen , Essen, Germany
| | - Thomas Stühle
- b 2 Institute of Geoinformatics, University Münster , Münster, Germany
| | | | - Matthias Thielmann
- a 1 Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen , Essen, Germany
| | - Heinz Jakob
- a 1 Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen , Essen, Germany
| | - Wojciech Kowalczyk
- d 4 Chair of Mechanics and Robotics, University Duisburg-Essen , Campus Duisburg, Duisburg, Germany
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