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Yamamoto H, Nakayama T, Ishii N, Nakamura Y. Minimally Invasive Surgical Versus Transcatheter Aortic Valve Replacement: A Retrospective Observational Single-Center Study in Japan. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:547-556. [PMID: 37933787 PMCID: PMC10714700 DOI: 10.1177/15569845231205587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVE This study aimed to compare the outcomes of minimally invasive aortic valve replacement (MICS-AVR) versus transfemoral transcatheter aortic valve replacement (TF-TAVR) in Asian patients. METHODS We conducted a retrospective, observational, single-center study in Japan, including cases of MICS-AVR (n = 202) and TF-TAVR (n = 248) between 2014 and 2021. In a total of 450 cases, propensity score matching was performed at a ratio of 1:1, resulting in 96 pairs. Furthermore, we performed competing-risk regression and mediation analyses to determine the treatment effect on outcomes of interests, considering death as a competing risk, and to evaluate the mediation effect of paravalvular leak (PVL) severity. RESULTS There were similar incidences of all-cause death, cardiac death, stroke and cerebral hemorrhage, and aortic valve reintervention between the 2 groups. However, the TF-TAVR cohort had a longer hospital length of stay and higher rates of significant PVL compared with the MICS-AVR cohort. Multivariable-adjusted Cox regression analyses revealed that heart failure hospitalization (hazard ratio [HR] = 0.129, 95% confidence interval [CI]: 0.038 to 0.445, p = 0.001) and permanent pacemaker implantation (HR = 0.050, 95% CI: 0.006 to 0.409, p = 0.005) favored MICS-AVR. Competing-risk regression analyses confirmed similar findings. All outcomes were unrelated to PVL severity. CONCLUSIONS To our knowledge, this is the first comparative study of clinical outcomes in Asian patients undergoing MICS-AVR versus TF-TAVR, revealing that MICS-AVR could be a feasible and efficient alternative to TF-TAVR. Future larger-scale randomized controlled trials are needed to validate the present results.
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Affiliation(s)
- Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Japan
| | - Taisuke Nakayama
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Japan
| | - Naoki Ishii
- Department of Gastroenterology, Tokyo Shinagawa Hospital, Japan
| | - Yoshitsugu Nakamura
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Matsudo, Japan
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Prieto-Lobato A, Nuche J, Avvedimento M, Paradis JM, Dumont E, Kalavrouziotis D, Mohammadi S, Rodés-Cabau J. Managing the challenge of a small aortic annulus in patients with severe aortic stenosis. Expert Rev Cardiovasc Ther 2023; 21:747-761. [PMID: 37869793 DOI: 10.1080/14779072.2023.2271395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Small aortic annulus (SAA) poses a challenge in the management of patients with severe aortic stenosis requiring aortic valve replacement - both surgical and transcatheter - since it has been associated with worse clinical outcomes. AREAS COVERED This review aims to comprehensively summarize the available evidence regarding the management of aortic stenosis in patients with SAA and discuss the current controversies as well as future perspectives in this field. EXPERT OPINION It is paramount to agree in a common definition for diagnosing and properly treating SAA patients, and for that purpose, multidetector computer tomography is essential. The results of recent trials led to the expansion of transcatheter aortic valve replacement among patients of all the surgical-risk spectrum, and the choice of treatment (transcatheter, surgical) should be based on patient comorbidities, anatomical characteristics, and patient preferences.
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Affiliation(s)
- Alicia Prieto-Lobato
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
- Hospital del Mar, Barcelona, Spain
| | - Jorge Nuche
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Marisa Avvedimento
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | | | - Eric Dumont
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | | | - Siamak Mohammadi
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
- Clínic Barcelona, Barcelona, Spain
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Abushouk AI, Spilias N, Isogai T, Kansara T, Agrawal A, Hariri E, Abdelfattah O, Krishnaswamy A, Reed GW, Puri R, Yun J, Kapadia S. Three-Year Outcomes of Balloon-Expandable Transcatheter Aortic Valve Implantation According to Annular Size. Am J Cardiol 2023; 194:9-16. [PMID: 36921423 DOI: 10.1016/j.amjcard.2023.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/23/2023] [Accepted: 01/31/2023] [Indexed: 03/18/2023]
Abstract
Data on the association between annular size and transcatheter aortic valve implantation (TAVI) outcomes beyond 1 year are limited. The present study assessed the association between the aortic annulus size and TAVI clinical and hemodynamic outcomes at 3 years of follow-up. Patients were classified according to the aortic annulus size as having small, intermediate, and large annuli (size <400, 400 to 574, and ≥575 mm2, respectively). The co-primary endpoints were all-cause mortality and heart failure hospitalization. Further, the changes in hemodynamic outcomes over the follow-up period (median 37, interquartile range: 26 to 45 months) were assessed. The present analysis included 850 patients, with 182 patients (21.4%), 538 patients (63.3%), and 130 patients (15.3%) in the small, intermediate, and large-sized aortic annulus groups, respectively. The groups had comparable age and pre-TAVI pressure gradients; however, patients with small annuli had higher Society of Thoracic Surgeons risk scores. Adjusted Cox regression analysis showed that compared to patients with intermediate-sized annuli, patients with small and large annuli had similar all-cause mortality (hazard ratio [HR] = 1.11, 95% confidence interval [CI] 0.72 to 1.69 and HR = 0.74, 95% CI 0.48 to 1.16, respectively) and heart failure hospitalization rates (HR = 0.96, 95% CI 0.55 to 1.69 and HR = 1.26, 95% CI 0.73 to 2.17, respectively). However, patients with small annuli had consistently higher mean and peak pressure gradients and a higher risk of patient-prosthesis mismatch. The risks of moderate-to-severe regurgitation and structural valve deterioration were similar between the three groups. In conclusion, although patients with small annuli had higher transvalvular gradients, there was no significant association between the aortic annulus size and TAVI clinical outcomes at 3 years of follow-up. Future studies should compare the performance of transcatheter valve types in patients with different aortic annulus sizes.
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Affiliation(s)
- Abdelrahman I Abushouk
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nikolaos Spilias
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Tikal Kansara
- Department of Internal Medicine, Cleveland Clinic Union Hospital, Dover, Ohio
| | - Ankit Agrawal
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Essa Hariri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Omar Abdelfattah
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - James Yun
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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Okajima K, Komatsu I, Seto TB. Low Incidence of Prosthesis-Patient Mismatch Following Extremely Small Transcatheter Aortic Valve Replacement with 20-mm Sapien 3. Int J Angiol 2021; 31:120-125. [DOI: 10.1055/s-0041-1732316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022] Open
Abstract
AbstractTranscatheter aortic valve replacement has been developed as an emerging technique to treat patients with aortic valve disease. However, safety and outcome data on extremely small transcatheter heart valves (THV) is limited. We aimed to assess hemodynamic profiles and clinical outcome of very small balloon expandable THVs with 20-mm Sapien 3 (SP3).We examined data for all patients who received third-generation SP3 THV at a single hospital. Complications and clinical outcomes were defined based on the VARC-2 criteria. Postoperative prosthesis-patient mismatch (PPM) was defined as indexed effective orifice area (EOA) < 0.85 cm2/m2. We compared clinical characteristics and outcome between patients with 20-mm (n = 21), 23-mm (n = 67), and 26- or 29-mm (n = 113) sized valves.The 20-mm group included significantly higher number of Asian and female populations with lower body surface area. The baseline CT annular area in the 20-mm group was 316.5 ± 24.9 mm2. There was no significant difference between groups in procedural mortality or early safety at 30 days. The higher procedural complication was observed in 20-mm group due to significant differences in minor vascular and bleeding complications. Despite higher post-THV gradients and smaller indexed EOA in 20-mm group, no PPM was observed in 20-mm group. The mortality at 30 days and 1 year in 20-mm group was 4.8% and 16.7%, respectively.The patients who received very small THVs with 20-mm SP3 did not result in PPM and experienced favorable early safety and midterm outcome in our cohort.
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Affiliation(s)
- Kazue Okajima
- Department of Cardiology, University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii
- Department of Cardiology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, Texas
| | - Ikki Komatsu
- Department of Cardiology, Queens Medical Center, Honolulu, Hawaii
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Todd B. Seto
- Department of Cardiology, University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii
- Department of Cardiology, Queens Medical Center, Honolulu, Hawaii
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5
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Lee YJ, Lee SJ, Hong SJ, Shim CY, Ahn CM, Kim JS, Kim BK, Hong GR, Ko YG, Choi D, Jang Y, Hong MK. Comparison of Transcatheter Aortic Valve Replacement between Self-Expanding versus Balloon-Expandable Valves in Patients with Small Aortic Annulus. Korean Circ J 2021; 51:222-231. [PMID: 33655721 PMCID: PMC7925971 DOI: 10.4070/kcj.2020.0409] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/26/2020] [Accepted: 11/17/2020] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Transcatheter aortic valve replacement (TAVR) has been reported as a good alternative for surgical aortic valve replacement in patients with small aortic annulus. Head-to-head comparisons of different transcatheter aortic valves in these patients are insufficient. We compared the outcomes after TAVR between two different types of recent transcatheter aortic valves (self-expanding vs. balloon-expandable) in patients with small aortic annulus. Methods A total of 70 patients with severe aortic stenosis and small annulus (mean diameter ≤23 mm or minimal diameter ≤21 mm on computed tomography) underwent TAVR with either a self-expanding valve with supra-annular location (n=45) or a balloon-expandable valve with intra-annular location (n=25). The echocardiographic hemodynamic parameters after TAVR and 1-year follow-up were compared. Results Between the self-expanding and balloon-expandable valve-treated patients, the clinical outcomes including permanent pacemaker implantation (11.1% vs. 8.0%), acute kidney injury stage 2 or 3 (4.4% vs. 4.0%), and major vascular complication (4.4% vs. 0.0%) were similar without all-cause mortality, stroke, and life-threatening bleeding during 30-day follow-up. Compared with the balloon-expandable valve-treated patients, the self-expanding valve-treated patients presented larger effective orifice area (EOA) (1.46±0.28 vs. 1.75±0.42 cm2, p=0.002) and indexed EOA (0.95±0.21 vs. 1.18±0.28 cm2/m2, p=0.001), whereas mean aortic valve gradient (11.7±2.9 vs. 8.9±5.2 mmHg, P=0.005) and incidence of ≥moderate prosthesis-patient mismatch (36.0% vs. 8.9%, p=0.009) were lower. These hemodynamic differences were maintained at 1-year follow-up. Conclusions TAVR with self-expanding valves was associated with superior hemodynamic outcomes compared with balloon-expandable valves in patients with small aortic annulus.
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Affiliation(s)
- Yong Joon Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Seung Jun Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Sung Jin Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Chi Young Shim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Chul Min Ahn
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Jung Sun Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Byeong Keuk Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Geu Ru Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Young Guk Ko
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Myeong Ki Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
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6
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Naik M, McNamara C, Jabbour RJ, Gopalan D, Mikhail GW, Mirsadraee S, Ariff B. Imaging of transcatheter aortic valve replacement complications. Clin Radiol 2020; 76:27-37. [PMID: 31964536 DOI: 10.1016/j.crad.2019.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/11/2019] [Indexed: 01/05/2023]
Abstract
Aortic stenosis is increasing in incidence and is now commonly managed with transcatheter aortic valve replacement (TAVR) in intermediate and high-risk patients. Radiologists are likely to encounter patients undergoing this procedure both pre- and postoperatively, and therefore, an understanding of procedural complications is essential. Complications may relate to the access site or approach, or the valve itself. This article will review the most common complications described in literature and focuses on the role of multidetector computed tomography (CT) in their evaluation either exclusively, or complementary to other imaging methods.
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Affiliation(s)
- M Naik
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - C McNamara
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - R J Jabbour
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - D Gopalan
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - G W Mikhail
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - S Mirsadraee
- Department of Radiology, Harefield Hospital, Hill End Road, Uxbridge, UB9 6JH, UK
| | - B Ariff
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.
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7
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Nejjari M, Cacoub L, Digne F. [Management of non-rhythmic complications of TAVI procedures]. Ann Cardiol Angeiol (Paris) 2019; 68:439-442. [PMID: 31676032 DOI: 10.1016/j.ancard.2019.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 12/20/2022]
Abstract
Transcatheter aortic valve (TAVI) is the treatment of choice in patients with severe symptomatic aortic stenosis at high surgical risk. Recent data have also shown favorable results in patients considered to have an intermediate operative risk, which broadens the application of this new technology. Despite its success, the TAVI procedure has been associated with life-threatening complications. Advances in preoperative screening and patient selection have reduced the incidence of these complications. When these complications occur, early recognition and rapid management are essential. The purpose of this review is to describe non-rhythmic mechanical complications attributable to TAVI procedures with their predictive factors, how to prevent and manage them.
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Affiliation(s)
- M Nejjari
- Département d'hémodynamique, centre cardiologique du Nord, 32, rue des Moulins-Gémeaux, 93200 Saint-Denis, France.
| | - L Cacoub
- Département d'hémodynamique, centre cardiologique du Nord, 32, rue des Moulins-Gémeaux, 93200 Saint-Denis, France
| | - F Digne
- Département d'hémodynamique, centre cardiologique du Nord, 32, rue des Moulins-Gémeaux, 93200 Saint-Denis, France
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8
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Shirakawa K, Murata M. Significance of echocardiographic evaluation for transcatheter aortic valve implantation. Cardiovasc Interv Ther 2019; 35:85-95. [PMID: 31502235 DOI: 10.1007/s12928-019-00617-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is widely accepted as an alternative to surgical aortic valve replacement (SAVR) for the treatment of severe aortic stenosis (AS). Existing scientific evidence demonstrates that TAVI is superior to SAVR, and it is expected that indications for the clinical applications of TAVI will be expanded in the future. Echocardiography plays a key role in perioperative assessment of patients undergoing TAVI. Preprocedural echocardiographic evaluation is important to determine the severity of AS in addition to patients' anatomical suitability for TAVI. Furthermore, echocardiography is essential for intraoperative guidance, assessment of complications, postoperative evaluation, and prognostic prediction. Inaccurate echocardiographic measurements and evaluation can lead to less-than-optimal/inappropriate treatment strategies in patients with AS. Therefore, a thorough understanding of the limitations of echocardiographic evaluation is important. This review summarizes the role of echocardiographic evaluation in patients undergoing TAVI.
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Affiliation(s)
- Kohsuke Shirakawa
- Japan Society for the Promotion of Science, Tokyo, Japan.,Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mitsushige Murata
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. .,School of Medicine, Center for Preventive Medicine, Keio University, Tokyo, Japan.
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Yashima F, Yamamoto M, Tanaka M, Yanagisawa R, Arai T, Shimizu H, Fukuda K, Watanabe Y, Naganuma T, Shirai S, Araki M, Tada N, Yamanaka F, Hayashida K. Transcatheter aortic valve implantation in patients with an extremely small native aortic annulus: The OCEAN-TAVI registry. Int J Cardiol 2018; 240:126-131. [PMID: 28606674 DOI: 10.1016/j.ijcard.2017.01.076] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/08/2016] [Accepted: 01/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has been reported to be advantageous over surgical aortic valve replacement owing to the low incidence of prosthesis-patient mismatch (PPM) and large effective orifice area (EOA). However, data on TAVI for extremely small annuli are limited. The present study aimed to compare post-procedural hemodynamics and morphology between 20-mm and 23-mm Sapien XT (SXT) transcatheter heart valves (THVs) with extremely small annuli (<314mm2). METHODS All patients with severe aortic stenosis treated with TAVI at eight Japanese centers between October 2013 and January 2016 were prospectively included in the Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) registry. In the overall cohort of 20-mm (19 patients) and 23-mm SXTs (492 patients) with extremely small annuli, the patient groups were matched one-to-one using propensity scores, and post-procedural echocardiography and multidetector computed tomography data were compared for 18 matched patients from each group (matched cohort). RESULTS In the matched cohort, the mean gradient was higher (15.4±4.1 vs. 12.2±4.8mmHg, p=0.04), EOA was lower (1.22±0.25 vs. 1.44±0.37cm2, p=0.02) and THV area was lower (245.6±19.1 vs. 298.5±33.3mm2, p<0.01) in the 20-mm group than in the 23-mm group. However, all patients in both groups were asymptomatic. Although moderate PPM was more prevalent in the 20-mm group than in the 23-mm group (31.6% vs. 7.9%, p<0.01), the incidence of severe PPM was low and similar between the groups (0% vs. 0.4%, p=1.00) in the overall cohort. CONCLUSION A 20-mm SXT in patients who require a small bioprosthesis leads to favorable short-term outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Motoharu Araki
- Saiseikai Yokohama-City Eastern Hospital, Yokohama, Japan
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10
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Hioki H, Watanabe Y, Kozuma K, Yamamoto M, Naganuma T, Araki M, Tada N, Shirai S, Yamanaka F, Higashimori A, Mizutani K, Tabata M, Takagi K, Ueno H, Hayashida K. Risk stratification using lean body mass in patients undergoing transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2018; 92:1365-1373. [PMID: 29469953 DOI: 10.1002/ccd.27547] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/18/2017] [Accepted: 01/28/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND The prognostic impact of skeletal muscle mass, assessed using lean body mass (LBM), remain unclear in patients who underwent transcatheter aortic valve replacement (TAVR). The aim of this study to assess prognostic impact of LBM on mortality after TAVR. METHODS We assessed 1,613 patients (median age 85 years, 70% female) who underwent TAVI from October 2013 to April 2016 using OCEAN (Optimized transCathEter vAlvular interveNtion)-TAVI registry data. LBM was calculated using the James formula. The primary endpoint was all-cause death after TAVR. RESULTS Median follow-up period was 287 days (interquartile range 110-462). The Kaplan-Meier analysis demonstrated that patients with low LBM had significantly higher incidence of all-cause death than those with high LBM in male (32.3% vs. 9.9%, log rank P < 0.001) and female (15.8% vs. 9.2%, log-rank P = 0.011). On contrary, the risk stratification using body mass index (BMI) could not validate into female patients who underwent TAVR. The multivariate analysis showed that the LBM was an independent predictor of all-cause death in male (Hazard ratio [HR] 0.93; 95% confidence interval [CI] 0.89-0.98) and female (HR 0.94; 95% CI 0.89-0.99). Inversely, the assessment using BMI could not identify the high-risk population in a female. CONCLUSIONS The patients with low LBM had the higher incidence of all-cause death after TAVR than those with high LBM, regardless of gender. Thus, the risk stratification using LBM might provide further insight to identify the high-risk TAVR population, compared to conventional risk stratification using BMI.
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Affiliation(s)
- Hirofumi Hioki
- Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, Tokyo, Japan
| | - Yusuke Watanabe
- Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, Tokyo, Japan
| | - Ken Kozuma
- Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, Tokyo, Japan
| | - Masanori Yamamoto
- Division of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan
| | - Toru Naganuma
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Motoharu Araki
- Department of Cardiovascular Medicine, Yokohama City Eastern Hospital, Kanagawa, Japan
| | - Norio Tada
- Department of Cardiovascular Center, Sendai Kosei Hospital, Miyagi, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Futoshi Yamanaka
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | | | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hiroshi Ueno
- Department of the Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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11
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Nakashima M, Watanabe Y. Transcatheter Aortic Valve Implantation in Small Anatomy: Patient Selection and Technical Challenges. Interv Cardiol 2018; 13:66-68. [PMID: 29928310 DOI: 10.15420/icr.2017:28:1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has become a standard treatment for severe aortic stenosis. Although this technique has reached relative maturity, further optimisation of patient selection and device implantation is essential to improve prognosis. Smaller body size is a predictor of a challenging TAVI procedure due to specific anatomical difficulty and adverse events including annulus rupture, acute coronary obstruction and vascular complications. A newer generation, lower profile TAVI system is useful for patients with smaller anatomy. Moreover, TAVI is superior to surgical aortic valve replacement in patients with a narrowing annulus because this treatement has a low incidence of prosthesis-patient mismatch.
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Affiliation(s)
- Makoto Nakashima
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
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12
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Coughlan JJ, Kiernan T, Mylotte D, Arnous S. Annular Rupture During Transcatheter Aortic Valve Implantation: Predictors, Management and Outcomes. Interv Cardiol 2018; 13:140-144. [PMID: 30443272 DOI: 10.15420/icr.2018.20.2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is the treatment of choice in patients with symptomatic severe aortic stenosis who are either inoperable or at high risk for conventional surgical aortic valve replacement. Recent data have also shown favourable outcomes in patients deemed to be at intermediate operative risk, which expands the application of this novel technology. Despite its success, TAVI has been associated with rare life-threatening complications. Of these, aortic annular rupture is considered to be the most devastating. Advances in pre-procedural screening and patient selection have reduced the incidence of annular rupture. When this complication occurs, early recognition and prompt management are essential. This article is intended to provide a comprehensive review of the predictors, management and clinical outcomes of aortic annular rupture.
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Affiliation(s)
- J J Coughlan
- University Hospital Limerick Dooradoyle, Co Limerick, Ireland.,University Hospital and National University of Ireland Galway, Ireland
| | - Thomas Kiernan
- University Hospital Limerick Dooradoyle, Co Limerick, Ireland.,University Hospital and National University of Ireland Galway, Ireland
| | - Darren Mylotte
- University Hospital Limerick Dooradoyle, Co Limerick, Ireland.,University Hospital and National University of Ireland Galway, Ireland
| | - Samer Arnous
- University Hospital Limerick Dooradoyle, Co Limerick, Ireland.,University Hospital and National University of Ireland Galway, Ireland
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Nakashima M, Watanabe Y, Hioki H, Nara Y, Nagura F, Hosogoe N, Kawashima H, Kataoka A, Otsuki S, Konno K, Kyono H, Yokoyama N, Kozuma K. Efficacy and safety of transcatheter aortic valve implantation with Edwards SAPIEN 3 and XT in smaller Asian anatomy. Cardiovasc Interv Ther 2017; 33:384-390. [PMID: 29185181 DOI: 10.1007/s12928-017-0502-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 11/20/2017] [Indexed: 12/19/2022]
Abstract
We aimed to compare the efficacy and safety of transcatheter aortic valve implantation (TAVI) using Edwards SAPIEN 3 (S3) valve and SAPIEN XT) in smaller anatomy. The new generation S3 TAVI device has been used worldwide; however, its efficacy and safety in smaller Asian anatomy remain unknown. Between February 2014 and March 2017, 166 consecutive patients (S3, 54; XT, 112) were treated with balloon-expandable TAVI in a single center and their outcomes were analyzed. Median patient age was 85 (range: 81-88) years and mean body surface area was 1.41 ± 0.15 m2. A 23-mm size valve was used in S3 and XT groups (70 vs. 62%, p = 0.224). The transfemoral approach was more frequently used in the S3 than in the XT group (96 vs. 72%, p < 0.001). Although, the minimal luminal diameter of the femoral artery was smaller in the S3 group (5.9 vs. 6.4 mm, p = 0.001), the rates of major (2 vs. 11%, p = 0.226) and minor (11 vs. 5%, p = 0.107) vascular complications did not increase. The frequency of paravalvular leaks (PVL) ≥ 2 was significantly reduced in the S3 group (11 vs. 61%, p < 0.001); however, pre- (24 vs. 91%, p < 0.001) and post- (4 vs. 19%, p < 0.001) dilatations were less frequently performed. Pacemaker implantation incidence did not increase (4 vs. 5%, p = 1.0) and peak velocity of the transcatheter heart valve was significantly higher in the S3 group (2.3 vs. 2.2 m/s, p = 0.046). Device success was high (89 vs. 93%, p = 0.387) while the 30-day all-cause mortality was low (2 vs. 1%, p = 0.583) in both groups. TAVI with the S3 device was safe and effective, with low incidence of vascular complications and reduced PVL, in smaller body-sized Asians.
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Affiliation(s)
- Makoto Nakashima
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan.
| | - Yusuke Watanabe
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Hirofumi Hioki
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Yugo Nara
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Fukuko Nagura
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Naoyoshi Hosogoe
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Hideyuki Kawashima
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Akihisa Kataoka
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Shuji Otsuki
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Kumiko Konno
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Hiroyuki Kyono
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Naoyuki Yokoyama
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Ken Kozuma
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
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14
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Nara Y, Watanabe Y, Kozuma K, Kataoka A, Nakashima M, Hioki H, Kawashima H, Nagura F, Shirai S, Tada N, Araki M, Naganuma T, Yamanaka F, Yamamoto M, Hayashida K. Incidence, Predictors, and Mid-Term Outcomes of Percutaneous Closure Failure After Transfemoral Aortic Valve Implantation Using an Expandable Sheath (from the Optimized Transcatheter Valvular Intervention [OCEAN-TAVI] Registry). Am J Cardiol 2017; 119:611-617. [PMID: 27939382 DOI: 10.1016/j.amjcard.2016.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/02/2016] [Accepted: 11/02/2016] [Indexed: 12/14/2022]
Abstract
The aim of this study was to evaluate the incidence, predictors, and outcomes of percutaneous closure device (PCD) failure during transfemoral transcatheter aortic valve implantation (TAVI) with an Edwards Sapien-XT prosthesis using an expandable sheath (eSheath). From October 2013 to April 2016, 1,215 patients who underwent TAVI were prospectively enrolled in the Optimized Transcatheter Valvular Intervention (OCEAN-TAVI) registry. Of these, 478 patients underwent transfemoral TAVI with Sapien-XT prosthesis using an eSheath and percutaneous closure with a Perclose ProGlide system. We evaluated the predictors of PCD failure and whether it affected the clinical outcomes. Patients were aged 85 years (interquartile range 82 to 88 years). PCD failure occurred in 36 patients (8%). Sheath-to-femoral artery ratio (SFAR) (per 1 increase) (odds ratio 5.40, 95% confidence interval 1.28 to 22.92, p = 0.022) predicted PCD failure in a multivariate model. The sensitivity-specificity curves identified an SFAR threshold of 1.03; the area under the curve for SFAR as a predictor of PCD failure was 0.629. The PCD failure group did not have a higher rate of 30-day mortality (0% vs 1%, p = 0.52) or mid-term (365-day) mortality (log-rank test p = 0.85) compared with the PCD success group in the Kaplan-Meier analysis. In conclusion, PCD failures occurred in 8% of the patients and were not associated with 30-day or mid-term mortality rates after percutaneous transfemoral TAVI. The SFAR threshold of 1.03 was useful for predicting PCD failures.
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Affiliation(s)
- Yugo Nara
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
| | - Ken Kozuma
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Akihisa Kataoka
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Makoto Nakashima
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirofumi Hioki
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Hideyuki Kawashima
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Fukuko Nagura
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kousei Hospital, Miyagi, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Kanagawa, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonankamakura General Hospital, Kanagawa, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Aichi, Japan; Department of Cardiology, Nagoya Heart Center, Aichi, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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15
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Sannino A, Schiattarella GG, Toscano E, Gargiulo G, Giugliano G, Galderisi M, Losi MA, Stabile E, Cirillo P, Imbriaco M, Grayburn PA, Trimarco B, Esposito G. Meta-Analysis of Effect of Body Mass Index on Outcomes After Transcatheter Aortic Valve Implantation. Am J Cardiol 2017; 119:308-316. [PMID: 27839771 DOI: 10.1016/j.amjcard.2016.09.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 09/29/2016] [Accepted: 09/29/2016] [Indexed: 12/20/2022]
Abstract
Controversial data exist regarding the impact of body mass index (BMI) on TAVI outcomes. Thirteen TAVI studies were included and analyzed for the incidence of procedural complications, 30-day, and long-term all-cause mortality. Three comparisons were executed: (1) underweight versus normal weight, (2) overweight versus normal weight, and (3) obese versus normal weight patients. Underweight patients (BMI <20 kg/m2) had similar 30-day all-cause mortality compared with the normal, although they displayed a significant worse survival at long-term follow-up (hazard ratio 1.68, 95% confidence interval (CI) 1.09 to 2.59, p = 0.02). Underweight patients showed a higher incidence of major and life-threatening bleedings (2,566 patients, odds ratio 1.64, 95% CI 1.10 to 2.45, p = 0.02) and of major vascular complications (2,566 patients, odds ratio 1.86, 95% CI 1.16 to 2.98, p = 0.01), compared with normal weight patients. Overweight patients (BMI ≥25 and <30 kg/m2) display similar 30-day and long-term all-cause mortality, as well as similar procedural complication rate compared with normal weight patients. Obese patients (BMI >30 kg/m2) had similar 30-day all-cause mortality rates compared with the normal weight category, whereas they displayed a significant better survival at long-term (hazard ratio 0.79, 95% CI 0.67 to 0.93, p = 0.004). Procedural complications did not differ between obese and normal body weight patients. In conclusion, a low BMI is linked to a significantly worse prognosis after TAVI. Therefore, BMI represents an important and handily tool that might be used in the risk prediction of patients to be addressed for TAVI.
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16
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Arsalan M, Filardo G, Kim WK, Squiers JJ, Pollock B, Liebetrau C, Blumenstein J, Kempfert J, Van Linden A, Arsalan-Werner A, Hamm C, Mack MJ, Moellmann H, Walther T. Prognostic value of body mass index and body surface area on clinical outcomes after transcatheter aortic valve implantation. Clin Res Cardiol 2016; 105:1042-1048. [PMID: 27535139 DOI: 10.1007/s00392-016-1027-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/05/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Inverse associations between Body Mass Index (BMI) and Body Surface Area (BSA) with mortality in patients after Transcatheter Aortic Valve Implantation (TAVI) have been reported. This "obesity paradox" is controversial, and it remains unclear which parameter, BMI or BSA, is of greater prognostic value. The aim of this study was to investigate the association of BMI and BSA on short- and mid-term outcomes after TAVI. METHODS AND RESULTS This prospective, observational study consisted of 917 consecutive patients undergoing TAVI at our center from 2011 to 2014. The association between BMI/BSA and mortality (at 30 days and 1 year) was assessed using restricted cubic spline functions in propensity-adjusted (by Society of Thoracic Surgeons (STS) risk factors) logistic and Cox proportional models, respectively. The median age of the patients was 82.6 years, with a mean STS Predicted Risk of Mortality (STS-PROM) of 6.6 ± 4.3 %. Throughout the study period (mean follow-up time was 297 days), 150 (16.4 %) patients died; 72 (7.9 %) patients died within 30 days of TAVI. After risk adjustment, the association between body constitution and 30-day mortality was not significant for either measure (BMI p = 0.25; BSA p = 0.32). However, BMI (p = 0.01), but not BSA (p = 0.13), was significantly associated with 1-year survival. There was no association between stroke, vascular complications, or length of stay with BMI or BSA. CONCLUSIONS BMI was associated with survival at 1-year after TAVI. Despite the trend towards implementing BSA in risk score calculation, BMI may be more suitable for the assessment of TAVI patients.
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Affiliation(s)
- Mani Arsalan
- Department of Cardiac Surgery, Heart Center, Kerckhoff-Klinik, Benekestrasse 2-8, 61231, 06032-9960, Bad Nauheim, Germany.
| | - Giovanni Filardo
- Department of Epidemiology, Baylor Scott and White Health, Dallas, TX, USA
| | - Won-Keun Kim
- Department of Cardiology, Heart Center, Kerckhoff-Klinik, Bad Nauheim, Germany
| | | | - Benjamin Pollock
- Department of Epidemiology, Baylor Scott and White Health, Dallas, TX, USA
| | - Christoph Liebetrau
- Department of Cardiology, Heart Center, Kerckhoff-Klinik, Bad Nauheim, Germany
| | | | - Jörg Kempfert
- Department of Cardiac Surgery, Heart Center, Kerckhoff-Klinik, Benekestrasse 2-8, 61231, 06032-9960, Bad Nauheim, Germany
| | - Arnaud Van Linden
- Department of Cardiac Surgery, Heart Center, Kerckhoff-Klinik, Benekestrasse 2-8, 61231, 06032-9960, Bad Nauheim, Germany
| | - Annika Arsalan-Werner
- Department of Cardiac Surgery, Heart Center, Kerckhoff-Klinik, Benekestrasse 2-8, 61231, 06032-9960, Bad Nauheim, Germany
| | - Christian Hamm
- Department of Cardiology, Heart Center, Kerckhoff-Klinik, Bad Nauheim, Germany
| | | | - Helge Moellmann
- Department of Cardiology, Heart Center, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Heart Center, Kerckhoff-Klinik, Benekestrasse 2-8, 61231, 06032-9960, Bad Nauheim, Germany
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17
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Oguri A, Ando J. Is Dual Antiplatelet Therapy Necessary in Transcatheter Aortic Valve Implantation? Int Heart J 2016; 57:129-31. [PMID: 26973265 DOI: 10.1536/ihj.16-068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Atsushi Oguri
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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18
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Inohara T, Hayashida K, Watanabe Y, Yamamoto M, Takagi K, Yashima F, Arai T, Shimizu H, Chevalier B, Lefèvre T, Fukuda K, Morice MC. Streamlining the learning process for TAVI: Insight from a comparative analysis of the OCEAN-TAVI and the massy registries. Catheter Cardiovasc Interv 2015; 87:963-70. [DOI: 10.1002/ccd.26266] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/26/2015] [Accepted: 09/16/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Taku Inohara
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - Kentaro Hayashida
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - Yusuke Watanabe
- Division of Cardiology, Department of Internal Medicine; Teikyo University School of Medicine; Tokyo Japan
| | - Masanori Yamamoto
- Division of Cardiovascular Medicine; Toyohashi Heart Center; Toyohashi Japan
| | - Kensuke Takagi
- Interventional Cardiology Unit; New Tokyo Hospital; Chiba Japan
| | - Fumiaki Yashima
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - Takahide Arai
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
- Department of Interventional Cardiology; Institut Cardiovasculaire Paris Sud; Massy France
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery; Keio University School of Medicine; Tokyo Japan
| | - Bernard Chevalier
- Department of Interventional Cardiology; Institut Cardiovasculaire Paris Sud; Massy France
| | - Thierry Lefèvre
- Department of Interventional Cardiology; Institut Cardiovasculaire Paris Sud; Massy France
| | - Keiichi Fukuda
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - Marie-Claude Morice
- Department of Interventional Cardiology; Institut Cardiovasculaire Paris Sud; Massy France
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19
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Editorial: Transcatheter aortic valve implantation as a daily clinical practice in Japan. J Cardiol Cases 2015; 12:117-118. [PMID: 30546572 PMCID: PMC6281859 DOI: 10.1016/j.jccase.2015.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Indexed: 11/24/2022] Open
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20
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"Dual role" guiding catheter: a new technique for patients requiring coronary protection during transcatheter aortic valve implantation. Cardiovasc Interv Ther 2015; 31:131-5. [PMID: 25761453 DOI: 10.1007/s12928-015-0326-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 03/02/2015] [Indexed: 10/23/2022]
Abstract
Coronary occlusion is a life-threatening complication during transcatheter aortic valve implantation (TAVI) that requires immediate revascularization. Conventionally, a total of 3 catheters are required to protect the coronary ostia during TAVI: a pigtail catheter for the angiographic evaluation of valve positioning, a guiding catheter, and a TAVI delivery system. In this case series, we present a new, simplified technique for patients who require coronary protection during TAVI using a total of only 2 catheters: a guiding catheter and TAVI delivery system. This simplified technique results in a simpler procedure and reduces vascular complications in this high-risk cohort.
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Effect of body mass index <20 kg/m(2) on events in patients who underwent transcatheter aortic valve replacement. Am J Cardiol 2015; 115:227-33. [PMID: 25534764 DOI: 10.1016/j.amjcard.2014.10.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/14/2014] [Accepted: 10/14/2014] [Indexed: 12/20/2022]
Abstract
The Valve Academic Research Consortium-2 has defined body mass index (BMI) <20 as indicative of frailty, which may be one of the co-morbidities not captured by traditional risk factors after transcatheter aortic valve replacement (TAVR). This study aimed to assess the impact of low BMI on clinical outcomes after TAVR. A total of 777 consecutive patients scheduled for TAVR were classified into 3 groups as BMI <20 (n = 56), 20 to 24.9 (n = 322), and ≥25 (n = 399). Procedural complications and clinical outcomes were compared among the 3 groups. They were also analyzed according to propensity-matching model A (BMI <20 [n = 50] vs ≥20 [n = 50]), model B (BMI <20 [n = 50] vs 20 to 24.9 [n = 50]), and model C (BMI <20 [n = 47] vs ≥25 [n = 47]). The differences in baseline characteristics among the 3 groups were adequately adjusted in 3 matched models. Valve Academic Research Consortium-2-defined end points and other complications were similar among the 3 groups in each model. Kaplan-Meier curves indicated no significant differences in cumulative 30-day survival (BMI <20 [91.0%] vs 20 to 24.9 [86.3%], p = 0.33; BMI <20 [91.0%] vs ≥25 [91.4%], p = 0.91, respectively) and 1-year survival (BMI <20 [74.3%] vs 20 to 24.9 [71.8%], p = 0.71; BMI <20 [74.3%] vs ≥25 [77.0%], p = 0.71; respectively). These survival rates were also similar in each of the 3 matched models. In conclusion, BMI <20 was not associated with increased early or midterm mortality. BMI <20 alone may not constitute an additional co-morbidity factor in patients who underwent TAVR.
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22
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Fuku Y, Goto T, Komiya T, Sakaguchi G, Shimamoto T, Maruo T, Hasegawa D, Otsuru S, Saito N, Hyodo Y, Ueno G, Kadota K, Mitsudo K. Thirty-day outcome of transcatheter aortic valve implantation with the edwards SAPIEN XT prosthesis via the transiliofemoral approach. Circ J 2014; 78:1357-63. [PMID: 24694765 DOI: 10.1253/circj.cj-13-1220] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Few data exist on the results of transcatheter aortic valve implantation (TAVI) via the transfemoral approach in small slightly built Japanese patients with severe aortic stenosis who are ineligible or at high-risk for conventional surgical aortic valve replacement (SAVR). Therefore, the purpose was to investigate the early outcomes of TAVI using the transiliofemoral approach in Japan. METHODS AND RESULTS Between June 2010 and June 2013, 21 consecutive patients (mean age, 81.0 years; 81.0% female) underwent TAVI with Edwards SAPIEN XT valves using the transiliofemoral approach. The mean body surface area was 1.44±0.15m(2). The device success rate was 90.5%. Although 2 patients did not meet the echocardiographic criteria for device success, no failure to deliver and deploy a valve occurred. The mean effective aortic valve area increased from 0.54±0.12cm(2) at baseline to 1.46±0.29cm(2) after the procedure (P<0.001), and the mean aortic transvalvular pressure gradient decreased from 51.0±15.6 at baseline to 11.2±3.6 after the procedure (P<0.001). The 30-day mortality and combined safety endpoint rates were 0% and 4.8%, respectively. All patients achieved New York Heart Association functional class I or II at 30 days. CONCLUSIONS Early outcome of TAVI with the Edwards-SAPIEN XT valve via the transiliofemoral approach at Kurashiki Central Hospital is satisfactory for patients who are ineligible or at high risk for SAVR.
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Affiliation(s)
- Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital
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