Early results of the ongoing Polish Registry of Valve Thrombosis after Transcatheter Aortic Valve Implantation (ZAK‑POLTAVI)

BACKGROUND

Conflicting data exist regarding the risk factors for transcatheter heart valve thrombosis (THVT). In addition, no optimal pharmacological strategy to treat THVT has been established so far Aims: The aim of this study was to assess the incidence, risk factors, diagnostic workup, and treatment of THVT in Poland.

METHODS

Data were collected retrospectively in themulticenter registry of patients with THVT (ZAK‑POLTAVI) between November 2008 and November 2018. Transcatheter heart valve thrombosis was defined as an increased mean transvalvular gradient accompanied by a decreased effective orifice area or severe aortic regurgitation, reversible after treatment. Baseline characteristics and procedural data were compared between patients with THVT and those without THVT (matched by age, sex, and diabetic status).

RESULTS

In a group of 2307 patients undergoing transcatheter aortic valve implantation (TAVI), 26 patients with THVT were identified (incidence, 1.14%). In half of the patients, THVT was diagnosed within 6 months after TAVI. As compared with the control group, patients with THVT more frequently had chronic obstructive pulmonary disease (P = 0.035), a smaller aortic valve area (P = 0.007), a higher mean postprocedural transvalvular gradient (P = 0.037), and a lower platelet count (P = 0.029) at the time of the diagnosis. A total of 24 patients (84.6%) received anticoagulation therapy for THVT, and complete resolution of THVT was noted in 12 individuals (46.1%). We observed thromboembolic complications in 2 patients (7.7%).

CONCLUSIONS

Transcatheter heart valve thrombosis is a rare complication of TAVI. However, a higher risk of THVT may be expected in patients with chronic obstructive pulmonary disease, a smaller aortic valve area, a higher mean postprocedural transvalvular gradient, and a lower platelet count. Anticoagulation alone or combined with antiplatelet therapy seems to be the optimal pharmacological treatment in this population.

Short- and intermediate-term improvement of patient quality of life after transcatheter aortic valve implantation: a single-centre study

BACKGROUND

Transcatheter aortic valve implantation (TAVI) is a treatment option for elderly high-risk patients with symptomatic severe aortic stenosis. Improvement of quality of life (QoL) is a relevant issue in this group of patients.

AIM

To assess changes in QoL after TAVI.

METHODS

Forty patients who underwent TAVI in our institution were included in this QoL study. All subjects were screened for TAVI in a standard fashion, including QoL assessment with the EQoL (EQ-5D-3L). The pre- and postprocedural scores obtained up to a 12-month follow-up were assessed.

RESULTS

Median of logistic EuroScore I was 21.5% (13.5-26.75%), and Society of Thoracic Surgeons score was 5.5% (4.0-10.75%). Comparison of baseline values with follow-up data at one, six and 12 months after TAVI showed significant improvement of QoL (p < 0.001). Visual Analogue Scale score (VAS score) was assessed. There was an incremental increase in VAS score during follow-up (p < 0.001). Median of six-minute walk test distance at baseline was 200 m (IQR 150-300) and 325 m (IQR 250-400) 12 months after TAVI (p < 0.001).

CONCLUSIONS

TAVI provides improved QoL and effectively relieves symptoms.

Acute myocardial infarction in a patient with chronic renal failure and endocarditis

We report a case of a 55 year-old female with chronic renal failure who received routine haemodialysis and suffered from acute myocardial infarction of inferior wall. Based on coronary angiogram, transoesophageal echocardiography, and autopsy,coronary embolisation with vegetations in the course of infective endocarditis was identified as a rare cause of ST-segment elevation myocardial infarction.

Current approach to transfemoral aortic valve replacement

We present a case of a 73 year-old male with severe aortic stenosis and high perioperative risk who was considered as candidate for percutaneous valve treatment. After precise clinical assessment, the subject underwent successful transfemoral aortic valve replacement with 29 mm device in analgosedation.

Primary percutaneous coronary intervention during on- vs off-hours in patients with ST-elevation myocardial infarction. Results from EUROTRANSFER Registry

BACKGROUND

Primary percutaneous coronary intervention (PPCI) is regarded as the treatment of choice for ST elevation myocardial infarction (STEMI) patients. It has been emphasised that only experienced centres with round-the-clock cathlab facilities should perform PPCI. Some investigators have doubted whether PPCI performed during 'off-hours' is as effective and safe as that performed during regular hours. Papers supporting both possibilities have been published.

AIM

To investigate whether off-hours PPCI is associated with impaired immediate and long-term outcomes based on a contemporary European registry study.

METHODS

Consecutive data on STEMI patients referred for PPCI in hospital STEMI networks between November 2005 and January 2007 was gathered. Patients were divided into two groups: PPCI performed during 'on-hours' and PPCI performed during 'off-hours (including Saturdays and Sundays)'.

RESULTS

Data from a total of 1,650 patients were collected in the EUROTRANSFER Registry. There were 1,005 patients in the off-hours group (61%) and 645 (39%) patients in the on-hours group. Patients in both groups did not differ in baseline demographics. Thrombolysis before admission to cathlab was more frequently administered to patients off-hours (4.1% vs 2.3%, p = 0.041). The PPCI complications were rare and occurred in similar frequency in the studied groups. Time from chest pain onset to diagnosis of STEMI was shorter in the off-hours group (173 ± 210 vs 183 ± 187, p = 0.007). In-hospital mortality was 3.4% in the on-hours group and 4.3% in the off-hours group (NS).

CONCLUSIONS

The PPCI performed in high-volume, experienced invasive cardiology centres in Europe during off-hours is associated with a comparable outcome and safety profile as PPCI performed during regular working hours.