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Bleiziffer S, Appleby C, Delgado V, Eltchaninoff H, Gebhard C, Hengstenberg C, Wojakowski W, Petersen N, Kurucova J, Bramlage P, Rudolph TK. Patterns of aortic valve replacement in Europe and adoption by sex. Int J Cardiol 2024; 406:131996. [PMID: 38555056 DOI: 10.1016/j.ijcard.2024.131996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/20/2024] [Accepted: 03/27/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE Management of patients with severe aortic stenosis (AS) may differ according to the patient sex. This study aimed to describe patterns of aortic valve replacement (AVR) for severe AS across Europe, including stratification by sex. METHODS Procedure volume data for surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) for six years (2015-2020) were extracted from national databases for Austria, Czech Republic, Denmark, England, Finland, France, Germany, Norway, Poland, Spain, Sweden, and Switzerland and stratified by sex. Patients per million population (PPM) undergoing AVR per year were calculated using population estimates from Eurostat. RESULTS Between 2015 and 2019, AVR procedures grew at an average annual rate of 3.9%. In 2020, the average total PPM undergoing AVR across all countries was 339, with 51% of procedures being TAVI and 49% SAVR. AVR PPM varied widely between countries, with the highest and lowest in Germany and Poland, respectively. The average total PPM was higher for men than women (423 vs. 258), but a higher proportion of women (62%) than men (44%) received TAVI. The proportion of TAVI among total AVR procedures increased with age, with an overall average of 96% of men and 98% of women aged ≥85 years receiving TAVI; however, adoption of TAVI varied by country. CONCLUSIONS The analysis of temporal trends in the adoption of TAVI vs. SAVR across Europe showed significant variations. Despite the higher use of TAVI vs. SAVR in women, overall rates of AV intervention in women were lower compared to men.
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Affiliation(s)
- Sabine Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine-Westphalia, University Hospital, Ruhr-University Bochum, Bad Oeynhausen, Germany.
| | - Clare Appleby
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Dr, Liverpool L14 3PE, UK.
| | - Victoria Delgado
- Heart Institute, Department of Cardiology, Hospital University Germans Trias i Pujol Barcelona, Spain.
| | - Helene Eltchaninoff
- Department of Cardiology, Normandie Univ, UNIROUEN, U1096, CHU Rouen, F-76000 Rouen, France.
| | - Catherine Gebhard
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
| | - Christian Hengstenberg
- Division of Cardiology, Department of Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Wojtek Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziolowa 45/47, Katowice 40-635, Poland.
| | | | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.
| | - Tanja K Rudolph
- General and Interventional Cardiology/Angiology, Heart and Diabetes Centre, North Rhine-Westphalia, Bad Oeynhausen, Ruhr-University, Germany.
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Batchelor WB, Sanchez CE, Sorajja P, Harvey JE, Galper BZ, Kini A, Keegan P, Grubb KJ, Eisenberg R, Rogers T. Temporal Trends, Outcomes, and Predictors of Next-Day Discharge and Readmission Following Uncomplicated Evolut Transcatheter Aortic Valve Replacement: A Propensity Score-Matched Analysis. J Am Heart Assoc 2024; 13:e033846. [PMID: 38639328 DOI: 10.1161/jaha.123.033846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/23/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Next-day discharge (NDD) outcomes following uncomplicated self-expanding transcatheter aortic valve replacement have not been studied. Here, we compare readmission rates and clinical outcomes in NDD versus non-NDD transcatheter aortic valve replacement with Evolut. METHODS AND RESULTS Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry patients (n=29 597) undergoing elective transcatheter aortic valve replacement with self-expanding supra-annular valves (Evolut R, PRO, and PRO+) from July 2019 to June 2021 were stratified by postprocedure length of stay: ≤1 day (NDD) versus >1 day (non-NDD). Propensity score matching was used to compare risk adjusted 30-day readmission rates and 1-year outcomes in NDD versus non-NDD, and multivariable regression to determine predictors of NDD and readmission. Between the first and last calendar quarter, the rate of NDD increased from 45.4% to 62.1% and median length of stay decreased from 2 days to 1. Propensity score matching produced relatively well-matched NDD and non-NDD cohorts (n=10 549 each). After matching, NDD was associated with lower 30-day readmission rates (6.3% versus 8.4%; P<0.001) and 1-year adverse outcomes (death, 7.0% versus 9.3%; life threatening/major bleeding, 1.6% versus 3.4%; new permanent pacemaker implantation/implantable cardioverter-defibrillator, 3.6 versus 11.0%; [all P<0.001]). Predictors of NDD included non-Hispanic ethnicity, preexisting permanent pacemaker implantation/implantable cardioverter-defibrillator, and previous surgical aortic valve replacement. CONCLUSIONS Most patients undergoing uncomplicated self-expanding Evolut transcatheter aortic valve replacement are discharged the next day. This study found that NDD can be predicted from baseline patient characteristics and was associated with favorable 30-day and 1-year outcomes, including low rates of permanent pacemaker implantation and readmission.
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Affiliation(s)
| | | | - Paul Sorajja
- Valve Science Center Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital Minneapolis MN USA
| | - James E Harvey
- Structural Heart Program, Wellspan York Hospital York PA USA
| | | | - Anapoorna Kini
- Division of Cardiology Mount Sinai Medical Center New York NY USA
| | - Patricia Keegan
- Division of Cardiology, Emory Structural Heart and Valve Center Emory University Hospital Midtown Atlanta GA USA
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory Structural Heart and Valve Center Emory University Hospital Midtown Atlanta GA USA
| | | | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center Washington DC USA
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Roque A, Pizzi MN. 18F-FDG PET/CT and cardiac CTA in transcatheter aortic valve implanted endocarditis: Still at the beginning of a long road. J Nucl Cardiol 2021; 28:2083-2085. [PMID: 31975331 DOI: 10.1007/s12350-020-02035-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 12/22/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Albert Roque
- Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- IDI (Institut de Diagnòstic per la Imatge), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - María Nazarena Pizzi
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Barcelona, Spain.
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
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Mentias A, Sarrazin MV, Desai M, Kapadia S, Cram P, Girotra S. Expansion of transcatheter aortic valve replacement in the United States. Am Heart J 2021; 234:23-30. [PMID: 33388288 PMCID: PMC7954961 DOI: 10.1016/j.ahj.2020.12.018] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/25/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patterns of diffusion of TAVR in the United States (U.S.) and its relation to racial disparities in TAVR utilization remain unknown. METHODS We identified TAVR hospitals in the continental U.S. from 2012-2017 using Medicare database and mapped them to Hospital Referral Regions (HRR). We calculated driving distance from each residential ZIP code to the nearest TAVR hospital and calculated the proportion of the U.S. population, in general and by race, that lived <100 miles driving distance from the nearest TAVR center. Using a discrete time hazard logistic regression model, we examined the association of hospital and HRR variables with the opening of a TAVR program. RESULTS The number of TAVR hospitals increased from 230 in 2012 to 540 in 2017. The proportion of the U.S. population living <100 miles from nearest TAVR hospital increased from 89.3% in 2012 to 94.5% in 2017. Geographic access improved for all racial and ethnic subgroups: Whites (84.1%-93.6%), Blacks (90.0%- 97.4%), and Hispanics (84.9%-93.7%). Within a HRR, the odds of opening a new TAVR program were higher among teaching hospitals (OR 1.48, 95% CI 1.16-1.88) and hospital bed size (OR 1.44, 95% CI 1.37-1.52). Market-level factors associated with new TAVR programs were proportion of Black (per 1%, OR 0.78, 95% CI 0.69-0.89) and Hispanic (per 1%, OR 0.82, 95% CI 0.75-0.90) residents, the proportion of hospitals within the HRR that already had a TAVR program (per 10%, OR 1.07, 95% CI 1.03-1.11), P <.01 for all. CONCLUSION The expansion of TAVR programs in the U.S. has been accompanied by an increase in geographic coverage for all racial subgroups. Further study is needed to determine reasons for TAVR underutilization in Blacks and Hispanics.
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Affiliation(s)
- Amgad Mentias
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
| | - Mary Vaughan Sarrazin
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa City, IA
| | - Milind Desai
- Heart and Vascular institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Samir Kapadia
- Heart and Vascular institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Peter Cram
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Saket Girotra
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa City, IA
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Albassam O, Henning KA, Qiu F, Cram P, Sheth TN, Ko DT, Woodward G, Austin PC, Wijeysundera HC. Increasing Wait-Time Mortality for Severe Aortic Stenosis: A Population-Level Study of the Transition in Practice From Surgical Aortic Valve Replacement to Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2020; 13:e009297. [PMID: 33167700 DOI: 10.1161/circinterventions.120.009297] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has emerged as a reasonable alternative to surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis (AS). There is limited data on temporal trends in wait-times and access to care for patients with AS, irrespective of treatment modality. We sought to investigate the trends in wait-times for the treatment (either SAVR or TAVR) of AS in Ontario, Canada, and to understand the drivers of wait-list mortality and hospitalization due to heart failure. METHODS In this population-level retrospective cohort study, we identified patients from April 1, 2012, to March 31, 2018, who were referred for treatment of symptomatic severe AS awaiting either SAVR or TAVR. The primary outcome was the median total wait-time from referral date to either SAVR or TAVR procedure. Primary clinical outcomes were all-cause mortality and heart failure-related hospitalizations while on the wait-list. RESULTS The referral cohort consisted of a total of 22 876 referrals for aortic valve replacement, with (N=8098) TAVR and (N=14 778) SAVR referrals. The mean and median wait times for the overall AVR cohort were 87 and 59 days, respectively. The TAVR subcohort had longer wait-times (median 84 days) compared with the SAVR subcohort (median 50 days). Year over year, there was a statistically significant an increase in wait-times (P<0.001) for the overall AS cohort as well as each of the TAVR (P<0.0001) and SAVR (P<0.0001) subgroups. Wait-time mortality was 2.5% (TAVR 5.2% and SAVR 1.05%), while the cumulative probability of heart failure hospitalization was 3.6% (TAVR 7.7% and SAVR 1.3%). CONCLUSIONS In patients with severe symptomatic AS awaiting aortic valve replacement, there has been a trend of increasing wait times for both SAVR and TAVR. This was associated with increasing mortality and hospitalizations related to heart failure while on the wait-list.
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Affiliation(s)
- Omar Albassam
- Schulich Heart Program, Sunnybrook Health Sciences Center (O.A., D.T.K., H.C.W.), University of Toronto, Canada
| | - Kayley A Henning
- ICES, Toronto, ON, Canada (K.A.H., F.Q., P.C., D.T.K., P.C.A., H.C.W.)
| | - Feng Qiu
- ICES, Toronto, ON, Canada (K.A.H., F.Q., P.C., D.T.K., P.C.A., H.C.W.)
| | - Peter Cram
- Department of Medicine (P.C., D.T.K., H.C.W.), University of Toronto, Canada
- ICES, Toronto, ON, Canada (K.A.H., F.Q., P.C., D.T.K., P.C.A., H.C.W.)
- Division of General Medicine, and Geriatrics, Sinai Health System and University Health Network, Toronto, ON, Canada (P.C.)
| | - Tej N Sheth
- Hamilton Health Sciences and Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada (T.N.S.)
| | - Dennis T Ko
- Schulich Heart Program, Sunnybrook Health Sciences Center (O.A., D.T.K., H.C.W.), University of Toronto, Canada
- Department of Medicine (P.C., D.T.K., H.C.W.), University of Toronto, Canada
- Institute for Health Policy Management and Evaluation (D.T.K., H.C.W.), University of Toronto, Canada
- ICES, Toronto, ON, Canada (K.A.H., F.Q., P.C., D.T.K., P.C.A., H.C.W.)
| | | | - Peter C Austin
- ICES, Toronto, ON, Canada (K.A.H., F.Q., P.C., D.T.K., P.C.A., H.C.W.)
| | - Harindra C Wijeysundera
- Schulich Heart Program, Sunnybrook Health Sciences Center (O.A., D.T.K., H.C.W.), University of Toronto, Canada
- Department of Medicine (P.C., D.T.K., H.C.W.), University of Toronto, Canada
- Institute for Health Policy Management and Evaluation (D.T.K., H.C.W.), University of Toronto, Canada
- ICES, Toronto, ON, Canada (K.A.H., F.Q., P.C., D.T.K., P.C.A., H.C.W.)
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Al-Khadra Y, Darmoch F, Moussa Pacha H, Soud M, Kaki A, Alraies MC, Kapadia S. Temporal Trends of 30-Day Readmission for Patients Undergoing Transcatheter or Surgical Aortic Valve Replacement: A Nationwide Cohort Study. JACC Cardiovasc Interv 2020; 13:270-272. [PMID: 31973804 DOI: 10.1016/j.jcin.2019.07.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/23/2019] [Accepted: 07/30/2019] [Indexed: 11/27/2022]
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Akintoye E, Ando T, Sandio A, Adegbala O, Salih M, Zubairu J, Oseni A, Sistla P, Alqasrawi M, Egbe A, Mentias A, Afonso L, Briasoulis A, Panaich S, Desai MY. Aortic Valve Replacement for Severe Aortic Stenosis Before and During the Era of Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 126:73-81. [PMID: 32336533 DOI: 10.1016/j.amjcard.2020.03.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/19/2020] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 12/20/2022]
Abstract
Recent positive results of transcatheter aortic valve replacement (TAVI) in clinical trials have sparked debate on whether TAVI should be first line for all patients with aortic stenosis. However, limited evidence exists on the clinical impact of TAVI on a national level. Using the national inpatient sample (NIS) of hospital discharges in the United States from 2001 to 2016, we evaluated the rate of AVR and associated in-hospital outcomes in pre-TAVI and TAVI era. Hierarchical mixed effect modeling was used to assess for trend and calculate risk adjusted estimates. Annual volume of AVR increased from 49,357 in 2001 to 100,050 in 2016 (103% increase). Compared with the pre-TAVI era, mean annual change in volume of AVR was higher in the TAVI era (+2.9% vs +9.4%, respectively, p <0.001). In contrast, rate of in-hospital mortality decreased from 5.4% in 2001 to 2.7% in 2016 (50% decrease). Compared with the pre-TAVI era, magnitude of mean annual change in mortality was higher in TAVI era (-4.0% vs -6.7%, respectively, p = 0.04). Unlike SAVR for which risk-adjusted rate for most outcomes seems to have plateaued, TAVI demonstrated significant improvement from 2012 to 2016 for mortality (4.6% to 1.8%), acute kidney injury (15.1% to 2.6%) and nonroutine home discharge (63.6% to 44.6%). However, no significant change in the rate of stroke (2.4% to 2.1%) and pacemaker implantation remained high (8.1% to 9.4%). Lastly, median length of stay was shorter for TAVI compared with isolated SAVR (3 vs 8 days, respectively). In conclusion, the adoption of TAVI has led to increase in volume of AVR for severe aortic stenosis in the United States with favorable short-term outcome.
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Affiliation(s)
- Emmanuel Akintoye
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa.
| | - Tomo Ando
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Aubin Sandio
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Oluwole Adegbala
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Mohamed Salih
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Josiah Zubairu
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Abdullahi Oseni
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Phanicharan Sistla
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Musab Alqasrawi
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Alexander Egbe
- Division of Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Amgad Mentias
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Luis Afonso
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Sidakpal Panaich
- Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Milind Y Desai
- Center for Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Khan JM, Rogers T, Greenbaum AB, Babaliaros VC, Yildirim DK, Bruce CG, Herzka DA, Schenke WH, Ratnayaka K, Lederman RJ. Transcatheter Electrosurgery: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 75:1455-1470. [PMID: 32216915 PMCID: PMC7184929 DOI: 10.1016/j.jacc.2020.01.035] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 01/28/2023]
Abstract
Transcatheter electrosurgery refers to a family of procedures using radiofrequency energy to vaporize and traverse or lacerate tissue despite flowing blood. The authors review theory, simulations, and benchtop demonstrations of how guidewires, insulation, adjunctive catheters, and dielectric medium interact. For tissue traversal, all but the tip of traversing guidewires is insulated to concentrate current. For leaflet laceration, the "Flying V" configuration concentrates current at the inner lacerating surface of a kinked guidewire. Flooding the field with non-ionic dextrose eliminates alternative current paths. Clinical applications include traversing occlusions (pulmonary atresia, arterial and venous occlusion, and iatrogenic graft occlusion), traversing tissue planes (atrial and ventricular septal puncture, radiofrequency valve repair, transcaval access, Potts and Glenn shunts), and leaflet laceration (BASILICA, LAMPOON, ELASTA-Clip, and others). Tips are provided for optimizing these techniques. Transcatheter electrosurgery already enables a range of novel therapeutic procedures for structural heart disease, and represents a promising advance toward transcatheter surgery.
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Affiliation(s)
- Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Medstar Washington Hospital Center, Washington, DC
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Medstar Washington Hospital Center, Washington, DC
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia
| | | | - Dursun Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Daniel A Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - William H Schenke
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Kanishka Ratnayaka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; UCSD Rady Children's Hospital, San Diego, California
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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Abstract
New developments in transcatheter valve technologies including aortic valve replacement and mitral valve and tricuspid valve interventions are described. Recent studies evaluating the success rate, patient outcomes, and anesthesiologic management of the procedures are discussed.
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Affiliation(s)
- Michael A Ackermann
- Department of Anesthesiology and Intensive Care Medicine, Heart Centre Leipzig, Struempellstr 39, Leipzig 04289, Germany
| | - Jörg K Ender
- Department of Anesthesiology and Intensive Care Medicine, Heart Centre Leipzig, Struempellstr 39, Leipzig 04289, Germany.
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10
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Vendrik J, van Mourik MS, Houterman S, Vis MM, Baan J. [Transcatheter aortic valve implantation: an overview]. Ned Tijdschr Geneeskd 2019; 163:D4011. [PMID: 31682089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In recent years, transcatheter aortic valve implantation (TAVI) has evolved from a treatment for patients who are inoperable or at high risk of surgical complications, to an equivalent alternative to surgical valve replacement for almost all patients with symptomatic, severe aortic valve stenosis. In the Netherlands, the number of patients who undergo TAVI gradually increases, while outcomes after TAVI improve and complication rates decrease. Before TAVI can be considered as the preferred treatment for aortic valve stenosis, however, additional insight is needed in valve durability, selection criteria for patients who benefit most from TAVI, and treatment outcomes regarding quality of life.
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Affiliation(s)
- Jeroen Vendrik
- Amsterdam UMC, locatie AMC, Hartcentrum, Amsterdam
- Contact: J. Vendrik
| | | | | | - M M Vis
- Amsterdam UMC, locatie AMC, Hartcentrum, Amsterdam
| | - Jan Baan
- Amsterdam UMC, locatie AMC, Hartcentrum, Amsterdam
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11
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Kibler M, Marchandot B, Messas N, Labreuche J, Vincent F, Grunebaum L, Hoang VA, Reydel A, Crimizade U, Kindo M, Hoang MT, Zeyons F, Trinh A, Petit-Eisenmann H, De Poli F, Leddet P, Duhamel A, Jesel L, Ohana M, Susen S, Ohlmann P, Van Belle E, Morel O. Primary Hemostatic Disorders and Late Major Bleeding After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2019; 72:2139-2148. [PMID: 30360823 DOI: 10.1016/j.jacc.2018.08.2143] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 04/19/2018] [Revised: 07/13/2018] [Accepted: 08/06/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Periprocedural and late (>30 days) bleedings represent major complications after transcatheter aortic valve replacement and have been identified as potential areas for improved patient care. OBJECTIVES The authors sought to evaluate the impact of ongoing primary hemostasis disorders on late major/life-threatening bleeding complications (MLBCs). METHODS Bleedings were assessed according to the VARC-2 (Valve Academic Research Consortium-2) criteria. Closure time of adenosine diphosphate (CT-ADP), a surrogate marker of high molecular weight von Willebrand multimers proteolysis was assessed 24 h after the procedure. Ongoing primary hemostasis disorder was defined by a CT-ADP >180 s. RESULTS Among 372 patients who survived at 30 days, MLBCs occurred in 42 patients (11.3%) at a median follow-up of 383 days (interquartile range: 188 to 574 days). MLBCs were mainly of gastrointestinal origin (42.8%) and were associated with increased overall mortality (hazard ratio [HR]: 5.66; 95% confidence interval [CI]: 3.10 to 10.31; p < 0.001) and cardiac mortality (HR: 11.62; 95% CI: 4.59 to 29.37; p < 0.001). A 2.5-fold elevation of MLBCs could be evidenced in patients with a CT-ADP > 180 s (27.4% vs. 11.5%; p < 0.001). Multivariate regression analysis identified paravalvular leak (PVL) (HR: 6.31; 95% CI: 3.43 to 11.60; p < 0.0001) and CT-ADP > 180 s (HR: 3.08; 95% CI: 1.62 to 5.81; p = 0.0005) as predictor of MLBCs. CONCLUSIONS MLBCs after transcatheter aortic valve replacement are frequent and associated with an increased morbidity and mortality. PVL and CT-ADP >180 s were identified as strong predictors for MLBCs. These findings strongly suggest that persistent HMW defects contribute to enhanced bleeding risk in patients with residual PVL.
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Affiliation(s)
- Marion Kibler
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Nathan Messas
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Julien Labreuche
- Department of Biostatistics, Centre Hospitalier Universitaire, Lille, France
| | - Flavien Vincent
- CHU Lille, Institut Coeur-Poumon, Cardiology, Lille, France; University of Lille, INSERM U1011 - EGID, Institut Pasteur de Lille, Lille, France
| | - Lelia Grunebaum
- Department of Haemostasis, Centre Hospitalier Universitaire, Strasbourg, France
| | - Viet Anh Hoang
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Antje Reydel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Ulun Crimizade
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Michel Kindo
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Minh Tam Hoang
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Floriane Zeyons
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Annie Trinh
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Hélène Petit-Eisenmann
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Fabien De Poli
- Department of Cardiology, Centre Hospitalier de Haguenau, Haguenau, France
| | - Pierre Leddet
- Department of Cardiology, Centre Hospitalier de Haguenau, Haguenau, France
| | - Alain Duhamel
- Department of Biostatistics, Centre Hospitalier Universitaire, Lille, France
| | - Laurence Jesel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France; UMR 1260 INSERM Nanomédecine Régénérative, Université de Strasbourg, Strasbourg, France
| | - Mickael Ohana
- Department of Radiology, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Sophie Susen
- University of Lille, INSERM U1011 - EGID, Institut Pasteur de Lille, Lille, France; CHU Lille, Hematology Transfusion, Lille, France
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Eric Van Belle
- CHU Lille, Institut Coeur-Poumon, Cardiology, Lille, France; University of Lille, INSERM U1011 - EGID, Institut Pasteur de Lille, Lille, France. https://twitter.com/Eric_Van_Belle
| | - Olivier Morel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France; UMR 1260 INSERM Nanomédecine Régénérative, Université de Strasbourg, Strasbourg, France.
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12
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Laricchia A, Mangieri A, Latib A, Montorfano M, Tzanis G, Gallone G, Alfieri O, Colombo A, Giannini F. Temporal trends in procedural death and need for urgent open surgery during transcatheter aortic valve replacement: A single, high-volume center 10-year experience. Int J Cardiol 2019; 293:80-83. [PMID: 31281048 DOI: 10.1016/j.ijcard.2019.06.060] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/14/2019] [Accepted: 06/21/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite advancements in the safety of transcatheter aortic valve replacement (TAVR) resulting in progressively wider indications, adverse periprocedural outcomes still raise concern. Real-world outcome data are thus of primary importance to evaluate the procedural risk-benefit trade-off in the continuously changing populations undergoing TAVR. METHODS We retrospectively assessed 1348 consecutive patients undergoing TAVR between 2007 and 2017. The primary endpoint was a composite of procedural mortality and need for conversion to emergent surgery, as defined by the Valve Academic Research Consortium-2 criteria. Temporal trends in baseline characteristics and outcomes were evaluated. The independent outcomes predictors were assessed through multivariate regression analysis. RESULTS A total of 56 (4.1%) patients experienced the primary endpoint. 47 (3.5%) patients died during hospital stay, 19 (1.4%) within 72 h from the procedure. 17 patients (1.2%) needed an emergent conversion to open surgery, of whom 7 (41.2%) did not survive. Significant temporal trends of increasing mean age (from 79.4 ± 7.4 to 81 ± 7.5, p = 0.007) and decreasing surgical risk (mean STS: from 9 ± 9.5 to 7.1 ± 9.8, p = 0.010) were observed. When dichotomized at the median procedural date (year 2014), a significant reduction in the occurrence of the primary endpoint in more recent years was observed (3.0% vs 5.2%, p = 0.041). This was the single primary endpoint independent predictor at multivariate analysis. CONCLUSION The high-volume 10-year experience in TAVR procedures at our center shows encouraging trends in procedural mortality reduction, which anyhow still occurs at a non-negligible rate, calling for further research to detect and to blunt the determinant of early procedural events.
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Affiliation(s)
- Alessandra Laricchia
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy.
| | - Antonio Mangieri
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Department of Cardiology, Montefiore Medical Centre, New York, USA
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Georgios Tzanis
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Guglielmo Gallone
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio Alfieri
- Cardiac Surgery Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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Michel M, Didier R, Bouleti C, Gilard M. Transcatheter aortic valve implantation in patients with severe aortic stenosis: Does lower-risk profile mean a young patient? Arch Cardiovasc Dis 2019; 112:293-295. [PMID: 31006625 DOI: 10.1016/j.acvd.2019.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Morgane Michel
- Robert Debré Hospital, AP-HP, 75019 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, ECEVE, UMR 1123, 75010 Paris, France; Inserm, ECEVE, U1123, 75010 Paris, France
| | - Romain Didier
- University hospital of Brest, Department of cardiology, 29200 Brest, France
| | - Claire Bouleti
- Inserm U1148, Department of Cardiology, hôpital Bichat, AP-HP, 6, rue Henri-Huchard, 75018 Paris, France
| | - Martine Gilard
- University hospital of Brest, Department of cardiology, 29200 Brest, France.
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Aldalati O, Kaura A, Khan H, Dworakowski R, Byrne J, Eskandari M, Deshpande R, Monaghan M, Wendler O, MacCarthy P. Bioprosthetic structural valve deterioration: How do TAVR and SAVR prostheses compare? Int J Cardiol 2019; 268:170-175. [PMID: 30041783 DOI: 10.1016/j.ijcard.2018.04.091] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 03/31/2018] [Accepted: 04/20/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The durability of TAVR prostheses has come under major scrutiny since the move towards lower risk patients. We sought to compare the rate of structural valve deterioration (SVD) over time between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). METHODS We included all TAVR and SAVR patients (age ≥ 75 years) that were performed in our centre from 2005 until 2015. Applying the internationally "agreed on" definitions of SVD, we surveyed all available serial echocardiographic follow-ups. RESULTS We included 269 TAVR and 174 SAVR cases. Post-intervention, TAVR patients had lower mean and peak gradients but higher rate of mild aortic regurgitation. SAVR patients had longer follow-up (in months, SAVR: 53 (30, 85) Vs TAVR: 33.4 (23, 52)). SVD as per Valve Academic Research Consortium-2 (VARC-2) was similar between the two groups (TAVR 28% Vs SAVR 31%; P = 0.593) but moderate haemodynamic SVD (European Association of Percutaneous Cardiovascular Intervention (EAPCI) criteria) was more common among SAVR cases (TAVR 11.5% Vs SAVR 20.7%; P = 0.007). Using Kaplan-Meier estimates, the rate of SVD over time was not different between the two groups as per VARC-2 criteria but different when moderate haemodynamic SVD criteria were applied (Log Rank P = 0.022) in favour of TAVR. The mean gradient rose steadily over time but more so post-SAVR (β = 0.52 ± 0.24 in comparison to TAVR at every given time point; P = 0.032). CONCLUSION Structural valve deterioration is common on long-term follow-up post-TAVR. The rate is similar to post-SAVR cases according to VARC-2 criteria but less according to the moderate haemodynamic SVD criteria.
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Affiliation(s)
- Omar Aldalati
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Amit Kaura
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Habib Khan
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Rafal Dworakowski
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Jonathan Byrne
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Mehdi Eskandari
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Ranjit Deshpande
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Mark Monaghan
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Olaf Wendler
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom.
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Martins A, Castro ML, Fragata I. [Initial Experience of a TAVI Program: Analysis of the Anesthetic Decision and its Evolution]. ACTA MEDICA PORT 2019; 32:126-132. [PMID: 30896393 DOI: 10.20344/amp.10982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/17/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Transcatheter aortic valve implantation is a less invasive option for aortic valve replacement. The number of transcatheter aortic valve implantations under local anesthesia with sedation has been increasing as the team's experience increases and less invasive accesses are used. The aim of this study is to describe the evolution of the anesthetic technique in patients undergoing transcatheter aortic valve implantation at our center over the years, as which was compared. MATERIAL AND METHODS Retrospective study in 149 consecutive patients undergoing transcatheter aortic valve implantation in Hospital Santa Marta (January 2010 to December 2016). Data was collected from the periprocedural records of patients. Patients were stratified according to anesthetic technique. RESULTS From our patients' sample, 57.0% were female, with median age 82 [58 - 95] years. Most patients underwent general anesthesia (68.5%). In the local anesthesia with sedation group there was a shorter duration of the procedure (120; [60 - 285] vs 155 [30 - 360]) and a lower number of patients requiring administration of vasopressors (61.8% vs 28.3%) - p < 0.05. There were no differences regarding length of hospital stay (9 [4 - 59] vs 10 [3 - 87]), periprocedural complications (66.0% vs 72.5%), readmission rate (4.3% vs 3.9%) or 30-days (2.1% vs 4.9%) and 1-year mortality (6.4% vs 7.8%) - p < 0.05. There was an increasing number of transcatheter aortic valve implantations performed under local anesthesia with sedation over the years. DISCUSSION The choice of anesthetic technique depends on the patient's characteristics, experience and preference of the team. CONCLUSION Local anesthesia with sedation seems to be associated with similar results as general anesthesia. The increase in the number of transcatheter aortic valve implantations under local anesthesia with sedation seems to follow the trend of lower invasiveness of the procedure.
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Affiliation(s)
- Ana Martins
- Serviço de Anestesiologia. Hospital de Santa Marta. Centro Hospitalar de Lisboa Central. Lisboa
| | - Maria Lurdes Castro
- Serviço de Anestesiologia. Hospital de Santa Marta. Centro Hospitalar de Lisboa Central. Lisboa. Portugal
| | - Isabel Fragata
- Serviço de Anestesiologia. Hospital de Santa Marta. Centro Hospitalar de Lisboa Central. Lisboa. Portugal
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Weltert L, De Paulis R, Salatino T, Tomai F. Latest Advances in Transcatheter Cardiac Valvular Treatment. Surg Technol Int 2018; 33:219-237. [PMID: 30204929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
When the original monograph on valvular prostheses was published in Surgical Technology International, back in 1993, transcatheter technology had not yet been invented. These techniques have been gradually revealed in subsequent issues. When we first considered writing a paper that described both surgical and transcatheter prosthesis, we realized that such a combined paper would be impractically large. Therefore, we decided to split our survey into more than one paper. This paper seeks to address the paucity of information available regarding transcatheter aortic valve implantation (TAVI) and similar devices. This publication may serve as a reference point for critically organizing information on an evolving topic. The following article deals with the large number of transcatheter devices related to valvular and ventricular pathologies: TAVI for the aortic and mitral valves, with a focus on indications, techniques and complications, as well as specific aortic devices, and devices to treat mitral regurgitation with non-conventional access. Every effort has been made to make the content relevant and up-to-date, which proved to be particularly challenging due to the continuous technological evolution which characterizes this field.
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Affiliation(s)
- Luca Weltert
- Heart Surgery Division, European Hospital, Rome, Italy
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Shekelle PG, Goldman DP. Development of a Group Judgment Process for Forecasts of Health Care Innovations. JAMA Netw Open 2018; 1:e185108. [PMID: 30646380 PMCID: PMC6324356 DOI: 10.1001/jamanetworkopen.2018.5108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
IMPORTANCE Health care costs have increased substantially over the past few decades, in part owing to the development and diffusion of new medical treatments. Forecasting potential future technologic innovations can allow for more informed planning. OBJECTIVE To assess the predictive validity of a structured formal method for forecasting future technologic innovations in health care. DESIGN, SETTING, AND PARTICIPANTS This pilot study combined an untested, unvalidated combination of a consensus process and group judgment process to evaluate forecasts made in 2001 for technologic innovations by 2021 in Alzheimer disease (AD) and cardiovascular disease (CVD). Six experts in AD and 7 experts in CVD composed the judgment group. The study was conducted in 2017-2018. MAIN OUTCOMES AND MEASURES Year 2001 forecasts for 2021 that were judged by experts as being close to correct, directionally correct, or not correct, as well as innovations that occurred since 2001 that were not predicted. RESULTS Four forecasts of innovations in AD, each considered to be between 30% and 40% likely to be achieved by 2021, were judged to be close to correct. One forecast was considered to be directionally correct, with a likelihood of occurrence of 40%, in that it was overoptimistic. One innovation that occurred was missed: new imaging techniques (amyloid β plaque and tau tangle positron emission tomographic imaging). Five forecasts of CVD innovations were considered to be at least 50% likely to occur by 2021, and of these, 2 were judged to be close to correct, 1 was judged as being directionally correct, and 2 were judged as being not correct (although in one of these forecasts, the overarching innovation has been achieved but with a different noninvasive imaging modality). Of 7 additional forecasts considered to be less likely to be achieved by 2021, 4 were judged to be close to correct and 3 were judged as being directionally correct. Two innovations occurred but were missed: transcatheter aortic valve replacement and cardiac resynchronization therapy. Across both conditions, 15 of 17 innovations forecasted were judged to be close to correct or directionally correct, 2 were judged to be incorrect, and there were 3 missed innovations. CONCLUSIONS AND RELEVANCE Expert elicitation provided a useful, but not fully accurate, lens into future innovation.
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Affiliation(s)
- Paul G. Shekelle
- Southern California Evidence-Based Practice Center Site at the RAND Corporation, Santa Monica, California
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California
| | - Dana P. Goldman
- Public Policy, Pharmacy, and Economics, University of Southern California, Los Angeles
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Abstract
During the last 15 years, transcatheter aortic valve implantation (TAVI) has gained wide acceptance with good reproducible clinical and safety outcomes. Today, TAVI has not only overtaken conventional surgery as the standard of care for the treatment of patients with symptomatic aortic stenosis at high surgical risk, but can also be considered in selected intermediate-risk patients. This follows technological improvements, better patient assessment and increased operator experience leading to a significant reduction in most procedure-related complications and long-term mortality. In this review, we provide internists, on the one hand with current data in the TAVI field including clinical outcomes from the most recent, major trials and on the other hand, highlight the remaining pitfalls of this treatment and the gaps in evidence that need to be addressed in order to further improve clinical practice and expand its indication.
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Affiliation(s)
- Nils Perrin
- Structural Cardiology Unit, Division of Cardiology, Department of Medical Specialties at the University Hospital of Geneva, Switzerland
| | - Angela Frei
- Structural Cardiology Unit, Division of Cardiology, Department of Medical Specialties at the University Hospital of Geneva, Switzerland
| | - Stephane Noble
- Structural Cardiology Unit, Division of Cardiology, Department of Medical Specialties at the University Hospital of Geneva, Switzerland.
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Abstract
This study uses National Inpatient Sample data to characterize trends in transcatheter aortic valve replacement (TAVR) in age groups 55 years and older in the United States from 2012 to 2015.
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Affiliation(s)
- Art Sedrakyan
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Sanket S. Dhruva
- Robert Wood Johnson Foundation Clinical Scholars Program, Veterans Affairs Connecticut Healthcare System, New Haven
| | - Tianyi Sun
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Jialin Mao
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Mario F. L. Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Rita F. Redberg
- Division of Cardiology, University of California, San Francisco School of Medicine, San Francisco
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Baeßler B, Mauri V, Bunck AC, Pinto Dos Santos D, Friedrichs K, Maintz D, Rudolph T. Software-automated multidetector computed tomography-based prosthesis-sizing in transcatheter aortic valve replacement: Inter-vendor comparison and relation to patient outcome. Int J Cardiol 2018; 272:267-272. [PMID: 30017520 DOI: 10.1016/j.ijcard.2018.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/25/2018] [Accepted: 07/02/2018] [Indexed: 01/24/2023]
Affiliation(s)
- Bettina Baeßler
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Victor Mauri
- Department III of Internal Medicine, Heart Centre, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Alexander C Bunck
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Daniel Pinto Dos Santos
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Kai Friedrichs
- Department III of Internal Medicine, Heart Centre, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - David Maintz
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Tanja Rudolph
- Department III of Internal Medicine, Heart Centre, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
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De Sciscio P, Brubert J, De Sciscio M, Serrani M, Stasiak J, Moggridge GD. Quantifying the Shift Toward Transcatheter Aortic Valve Replacement in Low-Risk Patients: A Meta-Analysis. Circ Cardiovasc Qual Outcomes 2018; 10:CIRCOUTCOMES.116.003287. [PMID: 28600455 DOI: 10.1161/circoutcomes.116.003287] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 04/12/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND In recent years, use of transcatheter aortic valve replacement has expanded to include patients at intermediate- and low-risk cohorts. We sought to determine disease prevalence and treatment distribution including transcatheter aortic valve replacement eligibility in low-risk patients across 37 advanced economies. METHODS AND RESULTS Four systematic searches were conducted across MEDLINE, EMBASE, and the Cochrane database for studies evaluating disease prevalence, severity, decision making, and survival in patients with aortic stenosis. Estimates of disease prevalence and treatment eligibility were calculated using stochastic simulation and population data for the 37 countries comprising the International Monetary Fund's advanced economies index. Fifty-six studies comprising 42 965 patients were included across 5 domains: prevalence, severity, symptom status, treatment modality, and outcome. The pooled prevalence in the general population aged 60 to 74 years and >75 years was 2.8% (95% confidence interval [CI], 1.4%-4.1%) and 13.1% (95% CI, 8.2%-17.9%), respectively-corresponding to an estimated 16.1 million (95% CI, 12.2-20.3) people in 37 advanced economies. Of these, an estimated 3.2 million (95% CI, 2.2-4.4) patients have severe aortic stenosis with 1.9 million (95% CI, 1.3-2.6) eligible for surgical aortic valve replacement. There are ≈485 230 (95% CI, 284 550-66 7350) high-risk/inoperable patients, 152 690 (95% CI, 73 410-263 000) intermediate-risk patients, and 378 890 (95% CI, 205 130-610 210) low-risk patients eligible for transcatheter aortic valve replacement. CONCLUSIONS With a prevalence of 4.5%, an estimated 16.1 million people aged ≥60 years across 37 advanced economies have aortic stenosis. Of these, there are ≈1.9 million patients eligible for surgical aortic valve replacement and 1.0 million patients eligible for transcatheter aortic valve replacement.
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Affiliation(s)
- Paolo De Sciscio
- From the Departments of Engineering (P.D.S.) and Chemical Engineering and Biotechnology (P.D.S., J.B., M.S., J.S., G.M.), University of Cambridge, United Kingdom; and Department of General Medicine, Royal Adelaide Hospital, Internal Medicine Service, Royal Adelaide Hospital, Adelaide, Australia (M.D.S.).
| | - Jacob Brubert
- From the Departments of Engineering (P.D.S.) and Chemical Engineering and Biotechnology (P.D.S., J.B., M.S., J.S., G.M.), University of Cambridge, United Kingdom; and Department of General Medicine, Royal Adelaide Hospital, Internal Medicine Service, Royal Adelaide Hospital, Adelaide, Australia (M.D.S.)
| | - Michele De Sciscio
- From the Departments of Engineering (P.D.S.) and Chemical Engineering and Biotechnology (P.D.S., J.B., M.S., J.S., G.M.), University of Cambridge, United Kingdom; and Department of General Medicine, Royal Adelaide Hospital, Internal Medicine Service, Royal Adelaide Hospital, Adelaide, Australia (M.D.S.)
| | - Marta Serrani
- From the Departments of Engineering (P.D.S.) and Chemical Engineering and Biotechnology (P.D.S., J.B., M.S., J.S., G.M.), University of Cambridge, United Kingdom; and Department of General Medicine, Royal Adelaide Hospital, Internal Medicine Service, Royal Adelaide Hospital, Adelaide, Australia (M.D.S.)
| | - Joanna Stasiak
- From the Departments of Engineering (P.D.S.) and Chemical Engineering and Biotechnology (P.D.S., J.B., M.S., J.S., G.M.), University of Cambridge, United Kingdom; and Department of General Medicine, Royal Adelaide Hospital, Internal Medicine Service, Royal Adelaide Hospital, Adelaide, Australia (M.D.S.)
| | - Geoff D Moggridge
- From the Departments of Engineering (P.D.S.) and Chemical Engineering and Biotechnology (P.D.S., J.B., M.S., J.S., G.M.), University of Cambridge, United Kingdom; and Department of General Medicine, Royal Adelaide Hospital, Internal Medicine Service, Royal Adelaide Hospital, Adelaide, Australia (M.D.S.)
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Reinöhl J, Kaier K, Reinecke H, Frankenstein L, Zirlik A, Zehender M, von Zur Mühlen C, Bode C, Stachon P. Transcatheter Aortic Valve Replacement: The New Standard in Patients With Previous Coronary Bypass Grafting? JACC Cardiovasc Interv 2017; 9:2137-2143. [PMID: 27765308 DOI: 10.1016/j.jcin.2016.07.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 04/12/2016] [Revised: 07/14/2016] [Accepted: 07/28/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to assess how the introduction of transcatheter aortic valve replacement (TAVR) has changed clinical practice and outcome in patients who have previously undergone coronary artery bypass grafting (CABG). BACKGROUND A significant proportion of patients admitted for aortic valve replacement have previously undergone CABG and are therefore at increased operative risk in case of redo surgery. METHODS In-hospital outcome data were analyzed from patients with or without previous CABG undergoing isolated surgical aortic valve replacement or TAVR in Germany from 2007 to 2013. RESULTS In total, 32,581 TAVR and 55,992 surgical aortic valve replacement procedures were performed in patients with (n = 6,221) or without (n = 82,352) previous CABG. TAVR increased markedly in patients with previous CABG, from 18 procedures in 2007 to 1,191 in 2013, while surgical aortic valve replacement decreased in these patients from 471 to 179 procedures. In 2013, TAVR was the preferred therapy in almost 90% of patients with previous CABG. In-hospital mortality was increased in patients with previous CABG compared with those without (7.6% vs. 6.3% for TAVR and 7.2% vs. 2.6% for surgical aortic valve replacement). Bleeding and stroke rates were also increased with redo surgical aortic valve replacement procedures (with vs. without previous CABG: stroke, 3.2% vs. 1.8%; relevant bleeding, 29.6% vs. 13.4%; acute kidney injury, 4.2% vs. 2.9%), whereas this was not the case with TAVR (stroke, 2.1% vs. 2.6%; relevant bleeding, 7.3% vs. 8.3%; acute kidney injury, 6.3% vs. 5.4% respectively). A similar influence was seen in resource utilization (discharge destination home: TAVR after CABG, 51%; surgical aortic valve replacement after CABG, 31%). CONCLUSIONS Since its introduction in 2007, TAVR has been increasingly used in Germany in patients with previous CABG, and in-hospital outcome data support the trend away from redo surgery.
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Affiliation(s)
- Jochen Reinöhl
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany.
| | - Klaus Kaier
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany; Center for Medical Biometry and Medical Informatics - University of Freiburg, Freiburg, Germany
| | - Holger Reinecke
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Lutz Frankenstein
- Department of Cardiology, Angiology, and Pulmonology, University of Heidelberg, Heidelberg, Germany
| | - Andreas Zirlik
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany
| | - Manfred Zehender
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany
| | | | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany
| | - Peter Stachon
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany
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Hawkins RB, Downs EA, Johnston LE, Mehaffey JH, Fonner CE, Ghanta RK, Speir AM, Rich JB, Quader MA, Yarboro LT, Ailawadi G. Impact of Transcatheter Technology on Surgical Aortic Valve Replacement Volume, Outcomes, and Cost. Ann Thorac Surg 2017; 103:1815-1823. [PMID: 28450137 PMCID: PMC5596915 DOI: 10.1016/j.athoracsur.2017.02.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/16/2017] [Accepted: 02/13/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) represents a disruptive technology that is rapidly expanding in use. We evaluated the effect on surgical aortic valve replacement (SAVR) patient selection, outcomes, volume, and cost. METHODS A total of 11,565 patients who underwent SAVR, with or without coronary artery bypass grafting (2002 to 2015), were evaluated from the Virginia Cardiac Services Quality Initiative database. Patients were stratified by surgical era: pre-TAVR era (2002 to 2008, n = 5,113), early-TAVR era (2009 to 2011, n = 2,709), and commercial-TAVR era (2012 to 2015, n = 3,743). Patient characteristics, outcomes, and resource utilization were analyzed by univariate analyses. RESULTS Throughout the study period, statewide SAVR volumes increased with median volumes of pre-TAVR: 722 cases/year, early-TAVR: 892 cases/year, and commercial-TAVR: 940 cases/year (p = 0.005). Implementation of TAVR was associated with declining Society of Thoracic Surgeons predicted risk of mortality among SAVR patients (3.7%, 2.6%, and 2.4%; p < 0.0001), despite increasing rates of comorbid disease. The mortality rate was lowest in the current commercial-TAVR era (3.9%, 4.3%, and 3.2%; p = 0.05), and major morbidity decreased throughout the time period (21.2%, 20.5%, and 15.2%; p < 0.0001). The lowest observed-to-expected ratios for both occurred in the commercial-TAVR era (0.9 and 0.9, respectively). Resource utilization increased generally, including total cost increases from $42,835 to $51,923 to $54,710 (p < 0.0001). CONCLUSIONS At present, SAVR volumes have not been affected by the introduction of TAVR. The outcomes for SAVR continue to improve, potentially due to availability of transcatheter options for high-risk patients. Despite rising costs for SAVR, open approaches still provide a significant cost advantage over TAVR.
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Affiliation(s)
- Robert B Hawkins
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Emily A Downs
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Lily E Johnston
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Clifford E Fonner
- Virginia Cardiac Services Quality Initiative, Falls Church, Virginia
| | - Ravi K Ghanta
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Alan M Speir
- INOVA Heart and Vascular Institute, Falls Church, Virginia
| | - Jeffrey B Rich
- Virginia Cardiac Services Quality Initiative, Falls Church, Virginia
| | - Mohammed A Quader
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Leora T Yarboro
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
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Nijenhuis VJ, Huitema MP, Vorselaars VMM, Swaans MJ, de Kroon T, van der Heyden JAS, Rensing BJWM, Heijmen R, Ten Berg JM, Post MC. Echocardiographic pulmonary hypertension probability is associated with clinical outcomes after transcatheter aortic valve implantation. Int J Cardiol 2016; 225:218-225. [PMID: 27732925 DOI: 10.1016/j.ijcard.2016.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 06/22/2016] [Revised: 10/01/2016] [Accepted: 10/04/2016] [Indexed: 11/17/2022]
Abstract
AIMS Pulmonary hypertension (PH) is associated with mortality after transcatheter aortic valve implantation (TAVI). However, diagnosis based on tricuspid regurgitant velocity (TRV) is often inaccurate and unreliable. The updated PH guidelines introduced a PH probability grading implementing additional PH signs on transthoracic echocardiography (TTE), from which we aimed to analyse its effects on clinical outcomes in patients undergoing TAVI. METHODS AND RESULTS We included 591 consecutive patients (mean age 80.2±8.4years, 58.0% female, mean STS risk score 6.2±3.8%) undergoing TAVI. Patients were divided into "low" (n=270; TRV ≤2.8m/s without additional PH signs), "intermediate" (n=131; TRV ≤2.8m/s with additional PH signs, or TRV 2.9-3.4m/s without additional PH signs), and "high" PH probability (n=190; TRV 2.9-3.4m/s with additional PH signs, or TRV >3.4m/s). The overall 30-day and 2-year mortality rates were 10.2% and 33.8%, respectively. "High" PH probability was an independent predictor of mortality at 30days (HR 3.68, 95% CI 2.03 to 6.67, p<0.01) and 2years (HR 2.19, 95% CI 1.57 to 3.04, p<0.01), compared to "low" PH probability. The "intermediate" group did not show an increased risk. The presence of additional PH signs resulted in a significantly higher mortality at 30days (19.6% vs. 5.1%, p<0.01) and two years (54.2% vs. 22.5%, p<0.01). CONCLUSIONS The updated echocardiographic PH probability model incorporating additional PH signs independently predicts early and late mortality after TAVI. Additional PH signs are of great value in assessing one's risks since its presence is strongly associated with early and late mortality.
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Affiliation(s)
- V J Nijenhuis
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - M P Huitema
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - V M M Vorselaars
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - T de Kroon
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - B J W M Rensing
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - R Heijmen
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M C Post
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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Zamorano J, Gonçalves A, Lancellotti P, Andersen KA, González-Gómez A, Monaghan M, Brochet E, Wunderlich N, Gafoor S, Gillam LD, La Canna G. The use of imaging in new transcatheter interventions: an EACVI review paper. Eur Heart J Cardiovasc Imaging 2016; 17:835-835af. [PMID: 27311822 DOI: 10.1093/ehjci/jew043] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 02/15/2016] [Indexed: 01/28/2023] Open
Abstract
Transcatheter therapies for the treatment of valve heart diseases have expanded dramatically over the last years. The new developments and improvements in devices and techniques, along with the increasing expertise of operators, have turned the catheter-based approaches for valvular disease into an established treatment option. Various imaging techniques are used during these procedures, but echocardiography plays an essential role during patient selection, intra-procedural monitoring, and post-procedure follow-up. The echocardiographic assessment of patients undergoing transcatheter interventions places demands on echocardiographers that differ from those of the routine evaluation of patients with valve disease, and there is a need for specific expertise for those working in the cath lab. In the context of the current rapid developments and growing use of transcatheter valve therapies, this document intends to update the previous recommendations and address new advancements in imaging, particularly for those involved in any stage of the treatment of patients with valvular heart diseases.
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Ullah S, Faraz A, Dharamshi HA. TAVR - The future of aortic stenosis management. J PAK MED ASSOC 2016; 66:485-486. [PMID: 27122285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - Ahmad Faraz
- MBBS, Karachi Medical and Dental College, Karachi
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Barbanti M, Tamburino C, D'Errigo P, Ranucci M, Onorati F, Covello RD, Santini F, Rosato S, Santoro G, Fusco D, Grossi C, Seccareccia F. Reply: TAVI in Lower Risk Patients: Revolution or Nonsense? Keep Calm and Select Patients. J Am Coll Cardiol 2016; 67:1381-2. [PMID: 26988964 DOI: 10.1016/j.jacc.2016.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/22/2015] [Accepted: 01/05/2016] [Indexed: 11/17/2022]
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Vahanian A. CardioPulse: Valvular interventions from the Europeanperspective. Eur Heart J 2016; 37:796-7. [PMID: 26951576 DOI: 10.1093/eurheartj/ehw009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Waksman R, Rogers T. CardioPulse: Transcatheter aortic valve replacement.The American perspective on transcatheter aortic valve replacement. Eur Heart J 2016; 37:797-799. [PMID: 27458634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
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Balan P, Anderson HV, Helmy T. How to Build a Better TAVR. J Invasive Cardiol 2016; 28:71-72. [PMID: 26841441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - H Vernon Anderson
- University of Texas - Houston, 6431 Fannin, Suite 1.246, Houston, TX 77030 USA.
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Mayor S. Transcatheter aortic valve replacement enables higher risk patients to be treated, study shows. BMJ 2015; 351:h6909. [PMID: 26692460 DOI: 10.1136/bmj.h6909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Reinöhl J, Kaier K, Reinecke H, Schmoor C, Frankenstein L, Vach W, Cribier A, Beyersdorf F, Bode C, Zehender M. Effect of Availability of Transcatheter Aortic-Valve Replacement on Clinical Practice. N Engl J Med 2015; 373:2438-47. [PMID: 26672846 DOI: 10.1056/nejmoa1500893] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [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] [Indexed: 11/19/2022]
Abstract
BACKGROUND Since the adoption of transcatheter aortic-valve replacement (TAVR), questions have been raised about its effect on clinical practice in comparison with the effect of surgical aortic-valve replacement, which is considered the current standard of care. Complete nationwide data are useful in examining how the introduction of a new technique influences previous clinical standards. METHODS We analyzed data on characteristics of patients and in-hospital outcomes for all isolated TAVR and surgical aortic-valve replacement procedures performed in Germany from 2007 to 2013. RESULTS In total, 32,581 TAVR and 55,992 surgical aortic-valve replacement procedures were performed. The number of TAVR procedures increased from 144 in 2007 to 9147 in 2013, whereas the number of surgical aortic-valve replacement procedures decreased slightly, from 8622 to 7048. Patients undergoing TAVR were older than those undergoing surgical aortic-valve replacement (mean [±SD] age, 81.0±6.1 years vs. 70.2±10.0 years) and at higher preoperative risk (estimated logistic EuroSCORE [European System for Cardiac Operative Risk Evaluation], 22.4% vs. 6.3%, on a scale of 0 to 100%, with higher scores indicating greater risk and a score of more than 20% indicating high surgical risk). In-hospital mortality decreased in both groups between 2007 and 2013 (from 13.2% to 5.4% with TAVR and from 3.8% to 2.2% with surgical aortic-valve replacement). The incidences of stroke, bleeding, and pacemaker implantation (but not acute kidney injury) also declined. CONCLUSIONS The use of TAVR increased markedly in Germany between 2007 and 2013; the concomitant reduction in the use of surgical aortic-valve replacement was moderate. Patients undergoing TAVR were older and at higher procedural risk than those undergoing surgical aortic-valve replacement. In-hospital mortality decreased in both groups but to a greater extent among patients undergoing TAVR. (Funded by the Heart Center, Freiburg University.).
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Affiliation(s)
- Jochen Reinöhl
- From the Departments of Cardiology and Angiology I ( J.R., K.K., C.B., M.Z.) and Cardiovascular Surgery (F.B.), Heart Center, and Center for Medical Biometry and Medical Informatics (K.K., W.V.) and Clinical Trials Unit (C.S.), Medical Center, University of Freiburg, Freiburg, Project Group Diagnosis Related Groups, German Cardiac Society, Duesseldorf ( J.R., H.R., L.F.), Department of Cardiovascular Medicine, Division of Vascular Medicine, University Hospital Muenster, Muenster (H.R.), and Department of Cardiology, Angiology, and Pulmonology, University of Heidelberg, Heidelberg (L.F.) - all in Germany; and the Department of Cardiology, Rouen University Hospital Charles Nicolle, Rouen, France (A.C.)
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Vahanian A. New perspectives: transcatheter aortic valve implantation in the year 2020. Eur Heart J 2015; 36:1200. [PMID: 25998965 DOI: 10.1093/eurheartj/ehv088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Spargias K. The era of transcatheter valve therapy. Where are we? Hellenic J Cardiol 2015; 56 Suppl A:1-3. [PMID: 26021336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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Shurlock B. European interventionists leading treatment of valvular heart disease. Eur Heart J 2014; 35:2991-2992. [PMID: 25606639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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Kallikazaros IE. Transcatheter aortic valve replacement: current status and future prospects. Hellenic J Cardiol 2014; 55:349-350. [PMID: 25039033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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Maisano F, Nietlispach F. The future of valves for percutaneous insertion. Eur Heart J 2014; 35:1569-70. [PMID: 24952327 DOI: 10.1093/eurheartj/ehu187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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