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Çakal S, Çakal B, Karaca O, Güler Y, Özcan ÖU, Güneş HM, Yılmaz FK, Yıldırım A, Boztosun B. Vascular complications after transcatheter transfemoral aortic valve implantation: Modified sheath-to-femoral artery ratio as a new predictor. Anatol J Cardiol 2022; 26:49-56. [PMID: 35191386 PMCID: PMC8878940 DOI: 10.5152/anatoljcardiol.2021.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE Vascular complications (VCs) contribute to increased morbidity and mortality in patients who have undergone transcatheter aortic valve implantation (TAVI); however, studies on their incidence and predictors show conflicting results. In this study, we sought to assess the incidence, impact, and predictors of VCs in transfemoral (TF) TAVI and also investigated the predictive role of manufacturer's size charts and a new predictor modified sheath-to-femoral artery ratio. METHODS A total of 223 patients undergoing TF-TAVI were categorized into 2 groups. The patients were divided as eligible and ineligible according to the manufacturer's guidelines (MG), and the same patient cohort was dichotomized into eligible and ineligible on the basis of sheath-to-femoral artery ratio (SFAR) value of less than or greater than or equal to modified SFAR (md-SFAR). VCs (defined according to the Valve Academic Research Consortium II criteria) were retrospectively compared. RESULTS According to the manufacturer's size charts, 65 patients were unsuitable; however, 35 patients were ineligible for TF-TAVI per the md-SFAR criteria. Although VCs occurred in 42 (18.8%) patients, 17 (27.7%) of those patients were classified as ineligible according to MG, whereas 14 (41.2%) were classified as ineligible in the md-SFAR group. In a multiple logistic regression analysis that included md-SFAR, MG, SFAR ≥1.05, peripheral artery disease, and minimum iliofemoral artery diameter, only md-SFAR was the independent predictor of VCs (odds ratio=3.71, 95% confidence interval=1.13-12.53, p=0.031). CONCLUSION According to our results, md-SFAR might provide better patient selection to prevent VCs and improve outcomes in TF-TAVI procedures.
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Affiliation(s)
- Sinem Çakal
- Department of Cardiology, Faculty of Medicine, İstanbul Medipol University; İstanbul-Turkey
- Department of Cardiology, Haseki Training and Research Hospital; İstanbul-Turkey
| | - Beytullah Çakal
- Department of Cardiology, Faculty of Medicine, İstanbul Medipol University; İstanbul-Turkey
| | - Oğuz Karaca
- Department of Cardiology, Faculty of Medicine, İstanbul Medipol University; İstanbul-Turkey
| | - Yeliz Güler
- Department of Cardiology, Faculty of Medicine, İstanbul Medipol University; İstanbul-Turkey
| | - Özgür Ulaş Özcan
- Department of Cardiology, Faculty of Medicine, İstanbul Medipol University; İstanbul-Turkey
| | - Hacı Murat Güneş
- Department of Cardiology, Faculty of Medicine, İstanbul Medipol University; İstanbul-Turkey
| | | | - Arzu Yıldırım
- Department of Cardiology, Faculty of Medicine, İstanbul Medipol University; İstanbul-Turkey
| | - Bilal Boztosun
- Department of Cardiology, Faculty of Medicine, İstanbul Medipol University; İstanbul-Turkey
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Prevalence of Posttranscatheter Aortic Valve Implantation Vascular Complications in Real Life. J Interv Cardiol 2021; 2021:5563486. [PMID: 34729054 PMCID: PMC8526196 DOI: 10.1155/2021/5563486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 09/13/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Vascular complications (VCs) are commonly observed after transfemoral transcatheter aortic valve implantation (TAVI) procedures. Closure devices for the access site were developed to reduce their incidence. We aim to evaluate the prevalence, predictors, and outcomes of the occurrence of post-TAVI VCs. Materials and Methods A retrospective study was conducted on 1336 consecutive patients who underwent TAVI at the University Hospital of Toulouse, France, between January 2016 and March 2020. All included procedures were performed through the common femoral artery, and ProGlide® was the used closure device. The studied population was divided into two groups depending on the occurrence of VCs defined according to Valve Academic Research Consortium-2 criteria. Results The mean age of the studied population was 84.4 ± 6.9, and 48% were male. 90% of TAVI interventions were performed through the right femoral artery. The prevalence of VCs was 18.8%, and 3.7% were major. Prolonged procedure duration was an independent predictor of VCs. Using the right access site and smaller introducer size (14 Fr) were preventive factors. No significant difference in mortality rate was detected between the two groups. Conclusion This study showed a low prevalence for post-TAVI VCs, especially for the major type. An increase in bleeding events and prolonged cardiac care unit stay were the common adverse outcomes.
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Miura D, Yamada Y, Kusaba S, Nogami E, Yunoki J, Sakamoto Y, Hikichi Y, Node K, Sakaguchi Y. Influence of preoperative serum creatinine level and intraoperative volume of contrast medium on the risk of acute kidney injury after transfemoral transcatheter aortic valve implantation: a retrospective observational study. BMC Res Notes 2019; 12:484. [PMID: 31383003 PMCID: PMC6683543 DOI: 10.1186/s13104-019-4527-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/26/2019] [Indexed: 11/10/2022] Open
Abstract
Objective This study aimed to determine if contrast medium volume (CMV) is a risk factor for acute kidney injury (AKI) during transcatheter aortic valve implantation (TAVI) via a transfemoral approach performed without major complications. All TAVI procedures performed at our institution between March 2014 and March 2018 were retrospectively reviewed. AKI was diagnosed using the Acute Kidney Injury Network classification based on the Valve Academic Research Consortium-2 definition. Procedures performed via a transapical approach and those in which circulatory dynamics failed intraoperatively were excluded. Results Eighty-one (96.4%) of 100 patients scheduled for TAVI were enrolled; seven (8.6%) developed AKI and 74 (91.4%) did not. The serum creatinine (SCr) level was significantly higher (p < 0.05) and the estimated glomerular filtration rate was significantly lower in the AKI group (p < 0.05). The CMV was significantly higher in the AKI group (103 ml vs 84 ml, p < 0.05), as was the CMV × SCr/BW value (3.34 vs 1.49, p < 0.01). The area under the curve for CMV × SCr/BW was 0.9228 and the cut-off value was 2.99. The CMV, SCr, and estimated glomerular filtration rate affect the likelihood of AKI after transfemoral TAVI and a CMV × SCr/BW value > 2.99 accurately predicts AKI. Electronic supplementary material The online version of this article (10.1186/s13104-019-4527-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daisuke Miura
- Department of Anesthesiology, Saga University Medical Hospital, Saga, Japan.
| | - Yasutaka Yamada
- Department of Anesthesiology, Saga University Medical Hospital, Saga, Japan
| | - Shinichiro Kusaba
- Department of Anesthesiology, Saga University Medical Hospital, Saga, Japan
| | - Eijiro Nogami
- Department of Thoracic and Cardiovascular Surgery, Saga University Medical Hospital, Saga, Japan
| | - Junji Yunoki
- Department of Thoracic and Cardiovascular Surgery, Saga University Medical Hospital, Saga, Japan
| | - Yoshiko Sakamoto
- Department of Cardiology, Saga University Medical Hospital, Saga, Japan
| | - Yutaka Hikichi
- Department of Cardiology, Saga University Medical Hospital, Saga, Japan
| | - Koichi Node
- Department of Cardiology, Saga University Medical Hospital, Saga, Japan
| | - Yoshiro Sakaguchi
- Department of Anesthesiology, Saga University Medical Hospital, Saga, Japan
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Schymik G, Herzberger V, Bergmann J, Bramlage P, Conzelmann LO, Würth A, Luik A, Schröfel H, Tzamalis P. Evolution of transcatheter aortic valve implantation over 7 years: results of a prospective single-centre registry of 2000 patients in a large municipal hospital (TAVIK Registry). BMJ Open 2018; 8:e022574. [PMID: 30366914 PMCID: PMC6224754 DOI: 10.1136/bmjopen-2018-022574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Use of transcatheter aortic valve implantation (TAVI) to treat severe aortic stenosis (AS) has gained popularity, accompanied by an evolution of patient and clinical factors. We aimed to characterise changes and evaluate their impact on outcomes. SETTING In this single-centre, German TAVIK registry patients undergoing TAVI between 2008 and 2015 were documented prospectively. PARTICIPANTS/INTERVENTIONS 2000 consecutive patients with AS undergoing TAVI were divided in four cohorts. 500 patients underwent TAVI in each of the following time bins: April 2008 to July 2010 (cohort I), July 2010 to April 2013 (cohort II), April 2012 to October 2013 (cohort III) and October 2013 to March 2015 (cohort IV). RESULTS The mean age was 81.8 years, without significant variation across cohorts. Compared with cohort I, prior MI (5.4%vs11.0%; p<0.001) and New York Heart Association class IV (10.0%vs3.6%; p<0.001) were less common in cohort IV. Across cohorts, there was a fall in EuroSCORE (24.3%-18.7%), frailty (48.4%-17.0%) and use of transapical access (43.6%-29.0%), while transfemoral access increased (56.4%-71.0%; p<0.001 for each). Periprocedurally, there was a fall in moderate/severe aortic regurgitation (3.2%-0.0%) and rate of unplanned cardiopulmonary bypass (4.0%-1.0%; both p<0.001). A similar trend applied to 30-day rate of major vascular complications (5.2%-1.8%; p=0.006), life-threatening bleeding (7.0%-3.0%; p<0.001) and cardiovascular mortality (4.4%-1.8%; p=0.020). One-year post-TAVI, mortality and stroke rates did not differ. CONCLUSIONS Evolution of TAVI between 2008 and 2015 saw a trend towards its usage in lower risk patients and rapid progression towards improved safety. Evaluation and refinement should now continue to further lessen stroke and pacemaker rates.
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Affiliation(s)
- Gerhard Schymik
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Valentin Herzberger
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Jens Bergmann
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | | | - Alexander Würth
- Department of Cardiology, Medical Clinic III, Vicentius Hospital Karlsruhe, Karlsruhe, Germany
| | - Armin Luik
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Holger Schröfel
- Department Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Panagiotis Tzamalis
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
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Chaudhry MA, Sardar MR. Vascular complications of transcatheter aortic valve replacement: A concise literature review. World J Cardiol 2017; 9:574-582. [PMID: 28824787 PMCID: PMC5545141 DOI: 10.4330/wjc.v9.i7.574] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/25/2017] [Accepted: 05/15/2017] [Indexed: 02/06/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a relatively newer therapeutic modality which offers a promising alternative to surgical aortic valve replacement for patients with prohibitive, high and intermediate surgical risk. The increasing trend to pursue TAVR in these patients has also led to growing awareness of the associated potential vascular complications. The significant impact of these complications on eventual clinical outcome and mortality makes prompt recognition and timely management a critical factor in TAVR patients. We hereby present a concise review with emphasis on diverse vascular complications associated with TAVR and their effective management to improve overall clinical outcomes.
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Kleczynski P, Dziewierz A, Bagienski M, Rzeszutko L, Sorysz D, Trebacz J, Sobczynski R, Tomala M, Stapor M, Dudek D. Association Between Blood Transfusions and 12-Month Mortality After Transcatheter Aortic Valve Implantation. Int Heart J 2017; 58:50-55. [DOI: 10.1536/ihj.16-131] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Thongprayoon C, Cheungpasitporn W, Gillaspie EA, Greason KL, Kashani KB. The risk of acute kidney injury following transapical versus transfemoral transcatheter aortic valve replacement: a systematic review and meta-analysis. Clin Kidney J 2016; 9:560-6. [PMID: 27478597 PMCID: PMC4957730 DOI: 10.1093/ckj/sfw055] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 04/13/2016] [Indexed: 01/11/2023] Open
Abstract
Background The aim of this systematic review is to examine the literature for the risk of acute kidney injury (AKI) in patients who underwent transcatheter aortic valve replacement (TAVR) based on transapical (TA) versus transfemoral (TF) approaches. Methods A literature search was conducted utilizing Embase, Medline, Cochrane Database of Systematic Reviews and ClinicalTrials.gov from inception through December 2015. Studies that reported relative risk, odds ratio or hazard ratio comparing the AKI risk in patients who underwent TA-TAVR versus TF-TAVR were included. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a random effect, generic inverse variance method. Results Seventeen cohort studies with 5085 patients were enrolled in the analysis to assess the risk of AKI in patients undergoing TA-TAVR versus TF-TAVR. The pooled RR of AKI in patients who underwent TA-TAVR was 2.26 (95% CI 1.79–2.86) when compared with TF-TAVR. When meta-analysis was confined to the studies with adjusted analysis for confounders evaluating the risk of AKI following TAVR, the pooled RR of TA-TAVR was 2.89 (95% CI 2.12–3.94). The risk for moderate to severe AKI [RR 1.02 (95% CI 0.57–1.80)] in patients who underwent TA-TAVR compared with TF-TAVR was not significantly higher. Conclusions Our meta-analysis demonstrates an association between TA-TAVR and a higher risk of AKI. Future studies are required to assess the risks of moderate to severe AKI and mortality following TA-TAVR versus TF-TAVR.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension , Mayo Clinic , 200 First Street SW, Rochester, MN 55905 , USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension , Mayo Clinic , 200 First Street SW, Rochester, MN 55905 , USA
| | - Erin A Gillaspie
- Division of Cardiovascular Surgery, Department of Surgery , Mayo Clinic , Rochester, MN , USA
| | - Kevin L Greason
- Division of Cardiovascular Surgery, Department of Surgery , Mayo Clinic , Rochester, MN , USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Subban V, Murdoch D, Savage M, Crowhurst J, Saireddy R, Poon K, Incani A, Bett N, Burstow D, Scalia G, Clarke A, Raffel O, Aroney C, Walters D. Outcomes of transcatheter aortic valve implantation in high surgical risk and inoperable patients with aortic stenosis: a single Australian Centre experience. Intern Med J 2016; 46:42-51. [DOI: 10.1111/imj.12938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/06/2015] [Accepted: 10/12/2015] [Indexed: 11/29/2022]
Affiliation(s)
- V. Subban
- Heart and Lung Institute; The Prince Charles Hospital
| | - D. Murdoch
- Heart and Lung Institute; The Prince Charles Hospital
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - M.L. Savage
- Heart and Lung Institute; The Prince Charles Hospital
| | - J. Crowhurst
- Heart and Lung Institute; The Prince Charles Hospital
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - R. Saireddy
- Heart and Lung Institute; The Prince Charles Hospital
| | - K.K. Poon
- Heart and Lung Institute; The Prince Charles Hospital
| | - A. Incani
- Heart and Lung Institute; The Prince Charles Hospital
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - N. Bett
- Heart and Lung Institute; The Prince Charles Hospital
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - D.J. Burstow
- Heart and Lung Institute; The Prince Charles Hospital
| | - G.M. Scalia
- Heart and Lung Institute; The Prince Charles Hospital
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - A. Clarke
- Heart and Lung Institute; The Prince Charles Hospital
| | - O.C. Raffel
- Heart and Lung Institute; The Prince Charles Hospital
| | - C.N. Aroney
- Heart and Lung Institute; The Prince Charles Hospital
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - D.L. Walters
- Heart and Lung Institute; The Prince Charles Hospital
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
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Mangla A, Gupta S. Vascular complications post-transcatheter aortic valve procedures. Indian Heart J 2016; 68:724-731. [PMID: 27773416 PMCID: PMC5079127 DOI: 10.1016/j.ihj.2015.11.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 10/31/2015] [Accepted: 11/16/2015] [Indexed: 12/19/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has rapidly emerged as the standard of care for severe symptomatic aortic stenosis in patients whose comorbidities put them at prohibitive risk for surgical aortic valve replacement (SAVR). Several trials have demonstrated superior outcomes with TAVR compared to medical management alone. TAVR has also shown favorable outcomes in patients at high risk for SAVR. TAVR can be associated with significant vascular complications, which adversely impact outcomes, and operators should be cognizant of their early recognition and appropriate management. In this article, we review the major vascular complications associated with TAVR, along with optimal prevention and management strategies.
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Affiliation(s)
- Ashvarya Mangla
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, United States
| | - Saurabh Gupta
- Director, Cardiac Catheterization Laboratories, Associate Professor of Medicine (Clinical), Oregon Health & Science University, Portland, OR 97239, United States.
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Arnold SV, Spertus JA, Vemulapalli S, Dai D, O'Brien SM, Baron SJ, Kirtane AJ, Mack MJ, Green P, Reynolds MR, Rumsfeld JS, Cohen DJ. Association of Patient-Reported Health Status With Long-Term Mortality After Transcatheter Aortic Valve Replacement: Report From the STS/ACC TVT Registry. Circ Cardiovasc Interv 2015; 8:e002875. [PMID: 26643740 PMCID: PMC4673686 DOI: 10.1161/circinterventions.115.002875] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although transcatheter aortic valve replacement (TAVR) is an effective treatment for aortic stenosis, long-term mortality after TAVR remains high and challenging to predict. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a health status measure, assessed directly from patients, that integrates 2 clinically relevant factors (symptoms and functional status) that may predict TAVR outcomes. METHODS AND RESULTS Among 7769 patients from 286 sites in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry, we examined the association between preprocedure (baseline) patient health status, as assessed by the KCCQ, and 1-year mortality after TAVR. The KCCQ Overall Summary Score was categorized as very poor: <25, poor: 25 to 49, fair: 50 to 74, or good: ≥75. Before TAVR, health status was rated as very poor in 28%, poor in 38%, fair in 24%, and good in 10%. Patients with worse health status were more likely to be women and had more comorbidities and higher STS mortality risk scores. Compared with those with good health status before TAVR and after adjusting for a broad range of baseline covariates, patients with very poor health status had a 2-fold increased hazard of death over the first year after TAVR (adjusted hazard ratio, 2.00; 95% confidence interval, 1.58-2.54), whereas those with poor and fair health status had intermediate outcomes (adjusted hazard ratio, 1.54; 95% confidence interval, 1.22-1.95 and adjusted hazard ratio, 1.20; 95% confidence interval, 0.94-1.55, respectively). CONCLUSIONS In a national, contemporary practice cohort, worse preprocedure patient health status, as assessed by the KCCQ, was associated with greater long-term mortality after TAVR. These results support the measurement and integration of the KCCQ into mortality risk assessments for patients considering TAVR.
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Affiliation(s)
- Suzanne V Arnold
- From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.).
| | - John A Spertus
- From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.)
| | - Sreekanth Vemulapalli
- From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.)
| | - Dadi Dai
- From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.)
| | - Sean M O'Brien
- From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.)
| | - Suzanne J Baron
- From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.)
| | - Ajay J Kirtane
- From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.)
| | - Michael J Mack
- From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.)
| | - Philip Green
- From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.)
| | - Matthew R Reynolds
- From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.)
| | - John S Rumsfeld
- From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.)
| | - David J Cohen
- From the Department of Medicine, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (S.V.A., J.A.S., S.J.B., D.J.C.); Department of Medicine, Duke University, Durham, NC (S.V., D.D., S.M.O.); Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital (A.J.K., P.G.); Department of Cardiovascular Disease, Baylor Scott and White Health, Plano, TX (M.J.M.); Department of Medicine, Lahey Hospital and Medical Center and Harvard Clinical Research Institute, Boston, MA (M.R.R.); and Department of Medicine, Denver VA Medical Center, CO (J.S.R.)
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11
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Abstract
Even though experience and techniques have constantly improved over the last years, peri- and postprocedural complications in high risk TAVI-collectives remain a major issue affecting outcome and survival. Acute kidney injury (AKI) is a frequent complication after transcatheter aortic valve implantation (TAVI) and effects outcome and survival. However, the definition of AKI in published studies dealing with the phenomenon of AKI after TAVI varies widely and lacks standardization. This Review aims to present an overview over the current literature concerning AKI after TAVI with regard to the definition of AKI, the impact of AKI on mortality and potential risk factors for renal impairment after TAVI.
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Affiliation(s)
- Maximilian Scherner
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
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12
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Rahman MS, Sharma R, Brecker SJ. Transcatheter aortic valve implantation in patients with pre-existing chronic kidney disease. IJC HEART & VASCULATURE 2015; 8:9-18. [PMID: 28785672 PMCID: PMC5497245 DOI: 10.1016/j.ijcha.2015.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 04/16/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND We investigated the effect of chronic kidney disease (CKD) on morbidity and mortality following transcatheter aortic valve implantation (TAVI) including patients on haemodialysis, often excluded from randomised trials. METHODS AND RESULTS We performed a retrospective post hoc analysis of all patients undergoing TAVI at our centre between 2008 and 2012. 118 consecutive patients underwent TAVI; 63 were considered as having (CKD) and 55 not having (No-CKD) significant pre-existing CKD, (defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2). Chronic haemodialysis patients (n = 4) were excluded from acute kidney injury (AKI) analysis. Following TAVI, in CKD and No-CKD patients respectively, AKI occurred in 23.7% and 14.5% (p = 0.455) and renal replacement therapy (RRT) was necessary in 8.5% and 3.6% (relative risk (RR) [95% CI] = 2.33 [0.47-11.5], p = 0.440); 30-day mortality rates were 6.3% and 1.8% (p = 0.370); and 1-year mortality rates were 17.5% and 18.2% (p = 0.919). Patients who developed AKI had a significantly increased risk of 30-day (12.5% vs. 1.1%, p = 0.029) mortality. We found the presence of diabetes (odds ratio (OR) [95% CI] = 4.58 [1.58-13.3], p = 0.005) and elevated baseline serum creatinine (OR [95% CI] = 1.02 [1.00-1.03], p = 0.026) to independently predict AKI to statistical significance by multivariate analysis. CONCLUSION TAVI is a safe, acceptable treatment for patients with pre-existing CKD, however caution must be exercised, particularly in patients with pre-existing diabetes mellitus and elevated pre-operative serum creatinine levels as this confers a greater risk of AKI development, which is associated with increased short-term post-operative mortality.
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Affiliation(s)
- Mohammed Shamim Rahman
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, UK
- Department of Cardiology and Cardiothoracic Surgery, St George's Hospital, London, UK
- Corresponding author at: Imperial College London, Room 5N1 Commonwealth Building, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK. Tel.: + 44 20 3313 2214; fax: + 44 20 8383 2062.
| | - Rajan Sharma
- Department of Cardiology and Cardiothoracic Surgery, St George's Hospital, London, UK
| | - Stephen J.D. Brecker
- Department of Cardiology and Cardiothoracic Surgery, St George's Hospital, London, UK
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13
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Chen C, Zhao ZG, Liao YB, Peng Y, Meng QT, Chai H, Li Q, Luo XL, Liu W, Zhang C, Chen M, Huang DJ. Impact of renal dysfunction on mid-term outcome after transcatheter aortic valve implantation: a systematic review and meta-analysis. PLoS One 2015; 10:e0119817. [PMID: 25793780 PMCID: PMC4368625 DOI: 10.1371/journal.pone.0119817] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 01/16/2015] [Indexed: 02/05/2023] Open
Abstract
Background There is conflicting evidence regarding the impact of preexisting renal dysfunction (RD) on mid-term outcomes after transcatheter aortic valve implantation (TAVI) in patients with symptomatic aortic stenosis (AS). Methods and results Forty-seven articles representing 32,131 patients with AS undergoing a TAVI procedure were included in this systematic review and meta-analysis. Pooled analyses were performed with both univariate and multivariate models, using a fixed or random effects method when appropriate. Compared with patients with normal renal function, mid-term mortality was significantly higher in patients with preexisting RD, as defined by the author (univariate hazard ratio [HR]: 1.69; 95% confidence interval [CI]: 1.50–1.90; multivariate HR: 1.47; 95% CI: 1.17–1.84), baseline estimated glomerular filtration rate (eGFR) (univariate HR: 1.65; 95% CI: 1.47–1.86; multivariate HR: 1.46; 95% CI: 1.24–1.71), and serum creatinine (univariate HR: 1.69; 95% CI: 1.48–1.92; multivariate HR: 1.65; 95% CI: 1.36–1.99). Advanced stage of chronic kidney disease (CKD stage 3–5) was strongly related to bleeding (univariate HR in CKD stage 3: 1.30, 95% CI: 1.13–1.49; in CKD stage 4: 1.30, 95% CI: 1.04–1.62), acute kidney injure (AKI) (univariate HR in CKD stage 3: 1.28, 95% CI: 1.03–1.59; in CKD stage 4: 2.27, 95% CI: 1.74–2.96), stroke (univariate HR in CKD stage 4: 3.37, 95% CI: 1.52–7.46), and mid-term mortality (univariate HR in CKD stage 3: 1.57, 95% CI: 1.26–1.95; in CKD stage 4: 2.77, 95% CI: 2.06–3.72; in CKD stage 5: 2.64, 95% CI: 1.91–3.65) compared with CKD stage 1+2. Patients with CKD stage 4 had a higher incidence of AKI (univariate HR: 1.70, 95% CI: 1.34–2.16) and all-cause death (univariate HR: 1.60, 95% CI: 1.28–1.99) compared with those with CKD stage 3. A per unit decrease in serum creatinine was also associated with a higher mortality at mid-term follow-up (univariate HR: 1.24, 95% CI: 1.18–1.30; multivariate HR: 1.19, 95% CI: 1.08–1.30). Conclusions Preexisting RD was associated with increased mid-term mortality after TAVI. Patients with CKD stage 4 had significantly higher incidences of peri-procedural complications and a poorer prognosis, a finding that should be factored into the clinical decision-making process regarding these patients.
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Affiliation(s)
- Chi Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Zhen-Gang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yan-Biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Qing-Tao Meng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Hua Chai
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Qiao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xiao-Lin Luo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Wei Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Chen Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
- * E-mail:
| | - De-Jia Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
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14
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Luo X, Zhao Z, Chai H, Zhang C, Liao Y, Li Q, Peng Y, Liu W, Ren X, Meng Q, Chen C, Chen M, Feng Y, Huang D. Efficacy of transcatheter aortic valve implantation in patients with aortic stenosis and reduced LVEF. A systematic review. Herz 2015; 40 Suppl 2:168-80. [PMID: 25712464 DOI: 10.1007/s00059-014-4193-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 10/20/2014] [Accepted: 11/29/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is safe and effective for patients with aortic stenosis (AS) who have a high operative risk. However, there is still debate on the effect of TAVI in AS patients with reduced left ventricular ejection fraction (REF). The objective of the review is to clarify the efficacy of TAVI and the impact of REF on the 30-day and midterm mortality in these patients. METHODS Studies on TAVI were searched in PubMed, Embase, and the Cochrane Library databases and were included in this review following predefined criteria. Data were extracted and pooled risk ratios (RR) were synthesized to explore the relationship between REF and 30-day plus midterm mortality. RESULTS Twenty-eight studies comprising 14,099 patients were included in the analysis of the association of REF with the prognosis of patients after TAVI. An average increase in left ventricular ejection fraction of 8-10 % was observed among these patients after TAVI. REF was not related to the 30-day mortality [RR = 1.90, 95 % confidence interval (CI) = 0.80-4.47]; however, it was related to the midterm mortality (RR = 1.49, 95 %CI = 1.14-1.93) of patients undergoing TAVI. Patients with low-flow and low-gradient AS had a higher 30-day mortality (RR = 1.54, 95 %CI = 1.11-2.13) and midterm mortality rate (RR = 1.69, 95 %CI = 1.33-2.14) compared with AS patients without these characteristics. The mortality of TAVI patients was significantly lower than that of those undergoing conservative therapy, and was similar to that of patients undergoing surgical aortic valve replacement. CONCLUSION REF was not associated with 30-day mortality, but it was associated with the midterm mortality of TAVI patients. Patients with REF could benefit from TAVI compared with conservative therapy.
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Affiliation(s)
- X Luo
- Department of Cardiology, West China Hospital of Sichuan University, No.37 Guo Xue Xiang of Wuhou District, 610041, Chengdu, Sichuan, P.R. China
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15
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Arnold SV, Reynolds MR, Lei Y, Magnuson EA, Kirtane AJ, Kodali SK, Zajarias A, Thourani VH, Green P, Rodés-Cabau J, Beohar N, Mack MJ, Leon MB, Cohen DJ. Predictors of poor outcomes after transcatheter aortic valve replacement: results from the PARTNER (Placement of Aortic Transcatheter Valve) trial. Circulation 2014; 129:2682-90. [PMID: 24958751 DOI: 10.1161/circulationaha.113.007477] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is a less invasive option for treatment of high-risk patients with severe aortic stenosis. We sought to identify patients at high risk for poor outcome after TAVR using a novel definition of outcome that integrates quality of life with mortality. METHODS AND RESULTS Among 2137 patients who underwent TAVR in the PARTNER (Placement of Aortic Transcatheter Valve) trial or its associated continued access registry, quality of life was assessed with the Kansas City Cardiomyopathy Questionnaire-Overall Summary Scale (KCCQ-OS; range 0-100, where a higher score equates to a better quality of life) at baseline and at 1, 6, and 12 months after TAVR. A poor 6-month outcome (defined as death, KCCQ-OS score <45, or ≥10-point decrease in KCCQ-OS score compared with baseline) occurred in 704 patients (33%). Using a split-sample design, we developed a multivariable model to identify a parsimonious set of covariates to identify patients at high risk for poor outcome. The model demonstrated moderate discrimination (c-index=0.66) and good calibration with the observed data, performed similarly in the separate validation cohort (c-index=0.64), and identified 211 patients (10% of the population) with a ≥50% likelihood of a poor outcome after TAVR. A second model that explored predictors of poor outcome at 1 year identified 1102 patients (52%) with ≥50% likelihood and 178 (8%) with ≥70% likelihood of a poor 1-year outcome after TAVR. CONCLUSIONS Using a large, multicenter cohort, we have developed and validated predictive models that can identify patients at high risk for a poor outcome after TAVR. Although model discrimination was moderate, these models may help guide treatment choices and offer patients realistic expectations of outcomes based on their presenting characteristics. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00530894.
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Affiliation(s)
- Suzanne V Arnold
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Columbia-Presbyterian Hospital, New York, NY (A.J.K., S.K.K., P.G., M.B.L.); Washington University, St. Louis, MO (A.Z.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Laval University, Quebec, Canada (J.R.-C.); Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL (N.B.); and Baylor Healthcare System, Plano, TX (M.J.M.).
| | - Matthew R Reynolds
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Columbia-Presbyterian Hospital, New York, NY (A.J.K., S.K.K., P.G., M.B.L.); Washington University, St. Louis, MO (A.Z.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Laval University, Quebec, Canada (J.R.-C.); Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL (N.B.); and Baylor Healthcare System, Plano, TX (M.J.M.)
| | - Yang Lei
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Columbia-Presbyterian Hospital, New York, NY (A.J.K., S.K.K., P.G., M.B.L.); Washington University, St. Louis, MO (A.Z.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Laval University, Quebec, Canada (J.R.-C.); Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL (N.B.); and Baylor Healthcare System, Plano, TX (M.J.M.)
| | - Elizabeth A Magnuson
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Columbia-Presbyterian Hospital, New York, NY (A.J.K., S.K.K., P.G., M.B.L.); Washington University, St. Louis, MO (A.Z.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Laval University, Quebec, Canada (J.R.-C.); Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL (N.B.); and Baylor Healthcare System, Plano, TX (M.J.M.)
| | - Ajay J Kirtane
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Columbia-Presbyterian Hospital, New York, NY (A.J.K., S.K.K., P.G., M.B.L.); Washington University, St. Louis, MO (A.Z.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Laval University, Quebec, Canada (J.R.-C.); Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL (N.B.); and Baylor Healthcare System, Plano, TX (M.J.M.)
| | - Susheel K Kodali
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Columbia-Presbyterian Hospital, New York, NY (A.J.K., S.K.K., P.G., M.B.L.); Washington University, St. Louis, MO (A.Z.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Laval University, Quebec, Canada (J.R.-C.); Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL (N.B.); and Baylor Healthcare System, Plano, TX (M.J.M.)
| | - Alan Zajarias
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Columbia-Presbyterian Hospital, New York, NY (A.J.K., S.K.K., P.G., M.B.L.); Washington University, St. Louis, MO (A.Z.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Laval University, Quebec, Canada (J.R.-C.); Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL (N.B.); and Baylor Healthcare System, Plano, TX (M.J.M.)
| | - Vinod H Thourani
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Columbia-Presbyterian Hospital, New York, NY (A.J.K., S.K.K., P.G., M.B.L.); Washington University, St. Louis, MO (A.Z.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Laval University, Quebec, Canada (J.R.-C.); Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL (N.B.); and Baylor Healthcare System, Plano, TX (M.J.M.)
| | - Philip Green
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Columbia-Presbyterian Hospital, New York, NY (A.J.K., S.K.K., P.G., M.B.L.); Washington University, St. Louis, MO (A.Z.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Laval University, Quebec, Canada (J.R.-C.); Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL (N.B.); and Baylor Healthcare System, Plano, TX (M.J.M.)
| | - Josep Rodés-Cabau
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Columbia-Presbyterian Hospital, New York, NY (A.J.K., S.K.K., P.G., M.B.L.); Washington University, St. Louis, MO (A.Z.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Laval University, Quebec, Canada (J.R.-C.); Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL (N.B.); and Baylor Healthcare System, Plano, TX (M.J.M.)
| | - Nirat Beohar
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Columbia-Presbyterian Hospital, New York, NY (A.J.K., S.K.K., P.G., M.B.L.); Washington University, St. Louis, MO (A.Z.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Laval University, Quebec, Canada (J.R.-C.); Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL (N.B.); and Baylor Healthcare System, Plano, TX (M.J.M.)
| | - Michael J Mack
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Columbia-Presbyterian Hospital, New York, NY (A.J.K., S.K.K., P.G., M.B.L.); Washington University, St. Louis, MO (A.Z.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Laval University, Quebec, Canada (J.R.-C.); Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL (N.B.); and Baylor Healthcare System, Plano, TX (M.J.M.)
| | - Martin B Leon
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Columbia-Presbyterian Hospital, New York, NY (A.J.K., S.K.K., P.G., M.B.L.); Washington University, St. Louis, MO (A.Z.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Laval University, Quebec, Canada (J.R.-C.); Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL (N.B.); and Baylor Healthcare System, Plano, TX (M.J.M.)
| | - David J Cohen
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., E.A.M., D.J.C.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., E.A.M., D.J.C.); Harvard Clinical Research Institute, Boston, MA (M.R.R.); Columbia-Presbyterian Hospital, New York, NY (A.J.K., S.K.K., P.G., M.B.L.); Washington University, St. Louis, MO (A.Z.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Laval University, Quebec, Canada (J.R.-C.); Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, FL (N.B.); and Baylor Healthcare System, Plano, TX (M.J.M.)
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16
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Development of a risk score for outcome after transcatheter aortic valve implantation. Clin Res Cardiol 2014; 103:631-40. [PMID: 24643728 DOI: 10.1007/s00392-014-0692-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 02/24/2014] [Indexed: 10/25/2022]
Abstract
AIMS Transcatheter aortic valve implantation (TAVI) is an increasingly common procedure in elderly and multimorbid patients with aortic stenosis. We aimed at developing a pre-procedural risk evaluation scheme beyond current surgical risk scores. METHODS We developed a risk algorithm for 1-year mortality in two cohorts consisting of 845 patients undergoing routine TAVI procedures by commercially available devices, mean age 80.9 ± 6.5, 51 % women. Clinical variables were determined at baseline. Multivariable Cox regression related clinical data to mortality (n = 207 deaths). RESULTS To account for variability related to age and sex and by enrolment site we forced age, sex, and cohort into the score model. Body mass index, estimated glomerular filtration rate, hemoglobin, pulmonary hypertension, mean transvalvular gradient and left ventricular ejection fraction at baseline were most strongly associated with mortality and entered the risk prediction algorithm [C-statistic 0.66, 95 % confidence interval (CI) 0.61-0.70, calibration χ (2)-statistic = 6.51; P = 0.69]. Net reclassification improvement compared to existing surgical risk predication schemes was positive. The score showed reasonable model fit and calibration in external validation in 333 patients, N = 55 deaths (C-statistic 0.60, 95 % CI 0.52-0.68; calibration χ (2)-statistic = 16.2; P = 0.06). Additional measurement of B-type natriuretic peptide and troponin I did not improve the C-statistic. Frailty increased the C-statistic to 0.71, 95 % CI 0.65-0.76. CONCLUSIONS We present a new risk evaluation tool derived and validated in routine TAVI cohorts that predicts 1-year mortality. Biomarkers only marginally improved risk prediction. Frailty increased the discriminatory ability of the score and needs to be considered. Risk algorithms specific for TAVI may help to guide decision-making when patients are evaluated for TAVI.
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17
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Arnold SV, Spertus JA, Lei Y, Green P, Kirtane AJ, Kapadia S, Thourani VH, Herrmann HC, Beohar N, Zajarias A, Mack MJ, Leon MB, Cohen DJ. How to define a poor outcome after transcatheter aortic valve replacement: conceptual framework and empirical observations from the placement of aortic transcatheter valve (PARTNER) trial. Circ Cardiovasc Qual Outcomes 2013; 6:591-7. [PMID: 24021691 DOI: 10.1161/circoutcomes.113.000354] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [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 less invasive option for valve replacement of patients with severe aortic stenosis. Although it has been recommended that TAVR should not be offered to patients who will not improve functionally or derive meaningful survival benefit from the procedure, no guidance exists on how best to identify such patients. The first step in this process is to define a poor outcome that can then be used as a foundation for subsequent case identification. We sought to evaluate potential definitions of a poor outcome after TAVR that combine both mortality and quality of life components. METHODS AND RESULTS Using data from 463 patients who underwent TAVR as part of the Placement of AoRTic TraNscathetER Valve (PARTNER) trial, we evaluated 6-month mortality and quality of life outcomes using the Kansas City Cardiomyopathy Questionnaire to explore potential definitions of a poor outcome. We then compared the strengths and weaknesses of each potential definition by examining the relationship between baseline and 6-month Kansas City Cardiomyopathy Questionnaire scores for each patient. Based on these analyses, we argue that the most appropriate definition of a poor outcome after TAVR is (1) death, (2) Kansas City Cardiomyopathy Questionnaire overall summary score <45, or (3) Kansas City Cardiomyopathy Questionnaire decrease of ≥10 points, which best reflects a failure to achieve the therapeutic goals of TAVR. CONCLUSIONS Using empirical data on a large number of patients enrolled in the PARTNER trial, we propose a definition for poor outcome after TAVR that combines both mortality and quality of life measures into a single composite end point. Use of this end point (or other similar end points) in future studies can facilitate development of predictive models that may be useful to identify patients who are poor candidates for TAVR and to provide such patients and their families with appropriate expectations of functional recovery after TAVR.
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