1
|
Ramphul K, Dhaliwal JS, Verma R, Sakthivel H, Arora GS. An Update on the Outcomes of Solid Organ Transplant Patients undergoing Transcatheter Aortic Valve Replacement Compared to Surgical Aortic Valve Replacement in the United States. Curr Probl Cardiol 2023; 48:101994. [PMID: 37487851 DOI: 10.1016/j.cpcardiol.2023.101994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Affiliation(s)
| | | | - Renuka Verma
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV
| | - Hemamalini Sakthivel
- Department of Internal Medicine, One Brooklyn Health System/Interfaith Medical Ctr Program, Brooklyn, NY
| | | |
Collapse
|
2
|
Fong KY, Ong JHW, Chan YH, Yap J, Ho KW, Aslim EJ, Ng LG, Gan VHL, Lim EJ. A Systematic Review and Meta-Analysis of Transcatheter Versus Surgical Aortic Valve Replacement in Kidney Transplant Patients. Am J Cardiol 2023; 204:22-25. [PMID: 37536199 DOI: 10.1016/j.amjcard.2023.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jonathan Yap
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Kay Woon Ho
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | - Lay Guat Ng
- Department of Urology, Singapore General Hospital, Singapore
| | - Valerie Huei Li Gan
- Department of Urology, Singapore General Hospital, Singapore; SingHealth Duke-NUS Transplant Centre, Singapore
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore.
| |
Collapse
|
3
|
Jaiswal V, Ang SP, Ishak A, Joshi A, Chia JE, Lnu K, Attia AM, Sharma P, Biswas M, Grubb KJ. Transcatheter versus Surgical Aortic Valve Replacement Outcomes among Solid Organ Transplant Patients: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101685. [PMID: 36931333 DOI: 10.1016/j.cpcardiol.2023.101685] [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: 02/19/2023] [Accepted: 03/02/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND The safety and clinical outcomes of transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR) among patients with solid organ transplants (SOT) is not well understood. OBJECTIVE This study aimed to evaluate the clinical outcomes of TAVR and SAVR among patients with a history of solid organ transplantation. METHOD We performed a systematic literature search of databases for relevant articles from inception until May 1st, 2022. Unadjusted odds ratios (OR) were pooled using a random-effect model, and a p-value of <0.05 was considered statistically significant. RESULT A total of 3240 studies were identified of which 3 studies with a total of 2960 patients were included in the final analysis. For SOT patients, the odds of in-hospital mortality (OR 0.37, 95% CI 0.20 to 0.71, p<0.001), 30-day mortality (OR 0.51, 95% CI 0.35 to 0.74, p<0.001), acute kidney injury (OR 0.45, 95% CI 0.35 to 0.59, p<0.001), and bleeding (OR 0.35, 95% CI 0.27 to 0.46, p<0.001) were significantly lower in patients undergoing TAVR compared to SAVR. In contrast, the odds of pacemaker implantation (OR 2.60, 95% CI 0.36 to 18.90, p=0.34), post-procedural stroke (OR 0.36, 95% CI 0.13 to 1.03, p=0.06) were similar between both groups of patients. Length of hospital stay was significantly lower in TAVR compared to SAVR patients (SMD -0.82, 95% CI -0.95 to -0.70, p<0.001). CONCLUSION In solid organ transplant patients, TAVR appeared to be a safe procedure with fewer post-procedure complications, shorter length of hospital stay, and lower in hospital mortality compared with SAVR.
Collapse
Affiliation(s)
- Vikash Jaiswal
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, Fl, USA.
| | - Song Peng Ang
- Department of Internal Medicine, Rutgers Health/Community Medical Center, New Jersey, USA
| | - Angela Ishak
- Department of Research and Academic affairs, Larkin Community Hospital, South Miami, Fl, USA
| | - Amey Joshi
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, Fl, USA
| | - Jia Ee Chia
- Department of Medicine, International Medical University, Malaysia
| | - Kriti Lnu
- Department of Cardiology, Medstar Washington Hospital Center, WD, USA
| | | | - Prachi Sharma
- Department of Cardiology, King George's Medical University, Lucknow, India
| | - Monodeep Biswas
- General Cardiology & Advanced Heart Failure, Wellspan Cardiology, Lancaster, Pennsylvania, USA & University of Maryland Medical Center, Baltimore
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
| |
Collapse
|
4
|
Zahid S, Sanchez-Nadales A, Hashem A, Sarkar A, Sleiman J, Lewis A, Uppal D, Nimmagadda M, Ullah W, Leiby B, Snipelisky D, Baez-Escudero J, Asher C. Trends and Outcomes of Left Atrial Appendage Occlusion in Renal and Liver Transplant Recipients: Insights From the United States National Inpatient and Readmission Database. Curr Probl Cardiol 2023; 48:101488. [PMID: 36351464 DOI: 10.1016/j.cpcardiol.2022.101488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Abstract
Left atrial appendage occlusion using the Watchman device has emerged as an alternative treatment strategy for preventing strokes in patients with atrial fibrillation. However, there is no data on its safety and clinical outcomes in prior renal or liver transplant recipients. We included a total of 61,995 patients from the National Inpatient Sample (NIS, in-hospital outcomes) and 55,048 patients from the National Readmission Database (NRD, 30-day outcomes) who underwent percutaneous left atrial appendage occlusion (LAAO). From this group, 0.65% (n=405) and 0.62% (n=339) were renal and liver transplant recipients in NIS and NRD respectively. Transplant recipients were younger compared with non-transplant recipients (mean age 69 vs 77 years, P=<0.01). There was little difference in terms of in-hospital mortality (0% vs 0.2%, P=0.43), major complications (6.2% vs 5.6%, P=0.61), cardiovascular complications (2.5% vs 2.8%, P=0.73), neurological complications (1.2% vs 0.7%, P=0.21) or bleeding complications (1.2% vs 0.7%, P=0.99) between transplant vs. non-transplant patients. Based on the NRD database, 30-day readmission rate was not meaningfully different for transplant recipients undergoing LAAO (9.44%) when compared to non-transplant patients (8.12%, [log-rank, P=0.56]). There was no difference between 30-day major or cardiovascular complications, however vascular complication rates were significantly higher for transplant recipients (OR 2.56, 95% CI [(1.66-3.47]). Our study findings suggest that LAAO may be safe for patients with a prior renal or liver transplant in terms of major complications, cardiovascular complications, and all-cause readmission rates. However vascular complications may be higher in transplant recipients. Further large-scale studies are needed to confirm these findings.
Collapse
Affiliation(s)
- Salman Zahid
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY.
| | | | - Anas Hashem
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY
| | - Abdullah Sarkar
- Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston, FL
| | - Jose Sleiman
- Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston, FL
| | - Antonio Lewis
- Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston, FL
| | - Dipan Uppal
- Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston, FL
| | - Manojna Nimmagadda
- Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston, FL
| | - Waqas Ullah
- Division of Biostatistics, Thomas Jefferson University, Philadelphia, PA
| | - Benjamin Leiby
- Department of Cardiovascular Disease, Thomas Jefferson University, Philadelphia, PA
| | - David Snipelisky
- Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston, FL
| | - Jose Baez-Escudero
- Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston, FL
| | - Craig Asher
- Department of Cardiovascular Disease, Cleveland Clinic Florida, Weston, FL
| |
Collapse
|
5
|
Ogami T, Kliner DE, Toma C, Serna-Gallegos D, Wang Y, Brown JA, Yousef S, Sultan I. Readmission with infective endocarditis within 90 days following transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2023; 101:170-177. [PMID: 36478377 DOI: 10.1002/ccd.30508] [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: 08/13/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) continues to be the most common modality of treating aortic stenosis in the United States. While infective endocarditis (IE) and its outcomes have been well documented after surgical aortic valve replacement, the incidence and outcomes of early IE after TAVI have not been well described. METHODS All patients who underwent TAVI from 2012 through 2018 were identified using the National Readmission Database. Among them, patients who underwent TAVI at the index admission and readmitted within 90 days were included. Patients who died or had IE during the index admission were excluded. Clinical outcomes were compared between patients readmitted with IE (IE group) and those without (non-IE group). RESULTS A total of 168,283 patients were readmitted to a hospital within 90 days after TAVI. The median age of the IE group and non-IE group were 81 and 82 years old, respectively (p = 0.21). Of those, 525 (0.3%) were readmitted with IE. The median time from TAVI to readmission was 20 days. During readmissions, 11.6% of the IE group died while only 3.15% of the non-IE group experienced death (p < 0.001). The most common causative organism of IE was enterococcus (22.1%). Multivariable analysis revealed that congestive heart failure, cerebrovascular disease, dialysis, concomitant valve disease, Medicaid, and discharge to a facility were independently associated with readmission with IE within 90 days. CONCLUSION The incidence of readmission with IE is low after TAVI. However, the mortality was markedly high during readmissions. Surgical intervention was rarely performed for IE during the first admission. Enterococcus was the most common organism observed in IE after TAVI. DISCLOSURE IS receives institutional research support from Abbott, Atricure, cryolife, and Medtronic. None related to this manuscript. CLINICAL TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- Takuya Ogami
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dustin E Kliner
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Catalin Toma
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Cardiothoracic Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Yisi Wang
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Cardiothoracic Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
6
|
Izzy M, Fortune BE, Serper M, Bhave N, deLemos A, Gallegos-Orozco JF, Guerrero-Miranda C, Hall S, Harinstein ME, Karas MG, Kriss M, Lim N, Palardy M, Sawinski D, Schonfeld E, Seetharam A, Sharma P, Tallaj J, Dadhania DM, VanWagner LB. Management of cardiac diseases in liver transplant recipients: Comprehensive review and multidisciplinary practice-based recommendations. Am J Transplant 2022; 22:2740-2758. [PMID: 35359027 PMCID: PMC9522925 DOI: 10.1111/ajt.17049] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/10/2022] [Accepted: 03/27/2022] [Indexed: 01/25/2023]
Abstract
Cardiac diseases are one of the most common causes of morbidity and mortality following liver transplantation (LT). Prior studies have shown that cardiac diseases affect close to one-third of liver transplant recipients (LTRs) long term and that their incidence has been on the rise. This rise is expected to continue as more patients with advanced age and/or non-alcoholic steatohepatitis undergo LT. In view of the increasing disease burden, a multidisciplinary initiative was developed to critically review the existing literature (between January 1, 1990 and March 17, 2021) surrounding epidemiology, risk assessment, and risk mitigation of coronary heart disease, arrhythmia, heart failure, and valvular heart disease and formulate practice-based recommendations accordingly. In this review, the expert panel emphasizes the importance of optimizing management of metabolic syndrome and its components in LTRs and highlights the cardioprotective potential for the newer diabetes medications (e.g., sodium glucose transporter-2 inhibitors) in this high-risk population. Tailoring the multidisciplinary management of cardiac diseases in LTRs to the cardiometabolic risk profile of the individual patient is critical. The review also outlines numerous knowledge gaps to pave the road for future research in this sphere with the ultimate goal of improving clinical outcomes.
Collapse
Affiliation(s)
- Manhal Izzy
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University, Nashville, TN, USA
| | - Brett E Fortune
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA
| | - Marina Serper
- Department of Medicine, Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicole Bhave
- Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Andrew deLemos
- Department of Medicine, Division of Hepatology, Atrium Health, Charlotte, NC, USA
| | - Juan F. Gallegos-Orozco
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Utah School, Salt Lake City, UT, USA
| | - Cesar Guerrero-Miranda
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA
| | - Shelley Hall
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA
| | - Matthew E Harinstein
- Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maria G. Karas
- Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
| | - Michael Kriss
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado, Aurora, CO, USA
| | - Nicholas Lim
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Maryse Palardy
- Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Deirdre Sawinski
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medical College, New York, NY, USA
| | - Emily Schonfeld
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA
| | - Anil Seetharam
- Department of Medicine, Division of Gastroenterology and Hepatology, Banner - University Medical Center Phoenix, Phoenix, AZ, USA
| | - Pratima Sharma
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Jose Tallaj
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama, Birmingham, AL, USA
| | - Darshana M Dadhania
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medical College, New York, NY, USA
| | - Lisa B. VanWagner
- Department of Medicine, Division of Gastroenterology & Hepatology, and Department of Preventive Medicine, Division of Epidemiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
7
|
Alnajar A, Ibrahim W, Mendoza CE. Are the outcomes of TAVR significantly riskier for solid organ transplant recipients than for the general population? J Card Surg 2022; 37:608-609. [PMID: 35000216 DOI: 10.1111/jocs.16207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ahmed Alnajar
- Department of Cardiothoracic Surgery, Jackson Memorial Hospital/University of Miami, Miami, Florida, USA
| | - Walid Ibrahim
- Department of Cardiology, Jackson Memorial Hospital/University of Miami, Miami, Florida, USA
| | - Cesar E Mendoza
- Department of Cardiology, Jackson Memorial Hospital/University of Miami, Miami, Florida, USA
| |
Collapse
|
8
|
Campany ME, Bhandarkar AR, Bydon M, Donato BB, Sell-Dottin KA. Transcatheter aortic valve replacement outcomes in solid organ transplant recipients. J Card Surg 2022; 37:602-607. [PMID: 34985156 DOI: 10.1111/jocs.16202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Transcatheter aortic valve replacement (TAVR) has become the primary treatment for severe symptomatic aortic stenosis in patients >65 years with volumes exceeding surgical aortic valve replacements (SAVR) since 2019. As a less invasive procedure with lower complication rates, TAVR is preferable in most patient populations, particularly those with increased surgical risk. One such population is patients who have undergone solid organ transplant (SOT). We aimed to evaluate periprocedural outcomes and complication rates following TAVR in SOT recipients as compared to the general TAVR population. METHODS The 2016-2018 National Inpatient Sample (NIS) was queried by ICD-10 PCS codes to identify TAVR cases; hospitalizations were subsequently stratified by SOT history. Multivariate analyses were completed to evaluate complication rates, length of stay (LOS), and cost of stay (COS). RESULTS No significant difference was observed in mortality rates or post-procedural complications between SOT recipients (n = 223) and those without transplant history undergoing TAVR (n = 29,448) except for increased thromboembolic events captured in transplant patients (p < .001). There was no significant variation in LOS or COS between the two populations; female sex and Black or Hispanic race were predictors of increased inpatient time. CONCLUSIONS SOT recipients have no increased risk of mortality or periprocedural complications when undergoing TAVR. Though the rate of thromboembolic events was higher in SOT recipients, observation size was small (n = 27 TAVR, n = 4 TAVR + SOT) thus external validity is limited. Based on these data, transplant recipients experience no difference in outcomes following TAVR as compared to patients without a history of organ transplant.
Collapse
Affiliation(s)
- Megan E Campany
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | | | - Mohamad Bydon
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Britton B Donato
- Division of Cardiothoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | | |
Collapse
|
9
|
Postalian A, Krajcer Z. The best option to treat transplant recipients with severe aortic stenosis. Catheter Cardiovasc Interv 2021; 97:699-700. [PMID: 33721412 DOI: 10.1002/ccd.29567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Alexander Postalian
- Department of Cardiology, Texas Heart Institute, Houston, Texas.,Division of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Zvonimir Krajcer
- Department of Cardiology, Texas Heart Institute, Houston, Texas.,Division of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| |
Collapse
|