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Gard EK, Noaman S, Stub D, Vriesendorp P, Htun N, Johnston R, Gartner E, Dick R, Walton A, Kaye D, Nanayakkara S. The Role of Comorbidities in Predicting Functional Improvement After Transcatheter Aortic Valve Implantation. Heart Lung Circ 2024:S1443-9506(24)00078-7. [PMID: 38582702 DOI: 10.1016/j.hlc.2024.02.002] [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: 06/20/2023] [Revised: 01/05/2024] [Accepted: 02/04/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Patients undergoing transcatheter aortic valve implantation (TAVI) have a high comorbidity burden. We sought to stratify patients into functional outcomes using the Kansas City Cardiomyopathy Questionnaire (KCCQ-12), a patient-reported outcome with benefits over both the New York Heart Association (NYHA) classification and the original 23-item KCCQ, and to evaluate the importance of comorbidities in predicting failure of functional improvement post-TAVI in a contemporary cohort. METHODS In total, 366 patients with severe aortic stenosis undergoing TAVI with baseline KCCQ-12 were retrospectively analysed and divided into two groups. Failure to improve was defined as a score <60 and a change in score <10 at 1 year in either overall score (KCCQ-OS) or clinical summary score (KCCQ-CSS). RESULTS Failure to improve was noted in 13% of patients, who were more likely to have lower KCCQ-OS at baseline (47 [35-59] vs 56 [42-74]), chronic obstructive pulmonary disease (COPD) (19% vs 8%), severe chronic kidney disease (CKD) (13% vs 2%), a clinical frailty score (CFS) ≥5 (41% vs 14%), and lower serum albumin (36 g/L [34-38] vs 38 g/L [35-40]). On multivariate analysis, with an area under the curve of 0.71 (0.63-0.78), baseline KCCQ-OS (adjusted odds ratio [aOR] 0.3 [0.1-0.6], p=0.04), COPD (aOR 2.8 [1.2-6.5], p=0.02), and severe CKD (aOR 5.7 [1.7-18.5], p=0.004) remained independent predictors. CFS alone had a similar predictive value as the multivariable model (OR 2.0 [1.3-3.4], area under the curve 0.69 [0.59-0.80], p<0.001). CONCLUSIONS KCCQ scores were effective in delineating functional outcomes, with most patients in our relatively lower surgical risk cohort showing significant functional improvements post-TAVI. Low baseline KCCQ, moderate or worse COPD, and severe CKD were associated with failure of improvement post-TAVI. Baseline CFS appears to be a good screening tool to predict poor improvement. These factors should be evaluated and weighted accordingly in pre-TAVI assessments and decision-making.
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Affiliation(s)
- Emma K Gard
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Samer Noaman
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Vic, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Vic, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Australia
| | - Pieter Vriesendorp
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia
| | - Nay Htun
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Vic, Australia
| | - Rozanne Johnston
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Elisha Gartner
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Ronald Dick
- Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia
| | - Antony Walton
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia
| | - David Kaye
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Australia; Baker Heart & Diabetes Institute, Melbourne, Vic, Australia
| | - Shane Nanayakkara
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Vic, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia; Baker Heart & Diabetes Institute, Melbourne, Vic, Australia.
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2
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Lauridsen MD, Valentin JB, Strange JE, Jacobsen PA, Køber L, Weinreich U, Johnsen SP, Fosbøl E. Mortality in patients with chronic obstructive pulmonary disorder undergoing transcatheter aortic valve replacement: The importance of chronic obstructive pulmonary disease exacerbation. Am Heart J 2023; 262:100-109. [PMID: 37116603 DOI: 10.1016/j.ahj.2023.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Severe chronic obstructive pulmonary disease (COPD) has been associated with futile outcome after transcatheter aortic valve replacement (TAVR). Data on outcomes according to COPD severity are warranted to aid identification of patients who may not benefit from TAVR. We aimed to examine the association between risk of COPD exacerbation and 1-year mortality after TAVR. METHODS Using Danish nationwide registries we identified patients undergoing first-time TAVR during 2008-2021 by COPD status. COPD severity levels were defined as low or high risk of acute exacerbation of COPD (AE-COPD) and treatment intensity levels (none or short-term, mono/dual, triple therapy, or home oxygen). Kaplan-Meier functions and adjusted Cox regression models were used to assess 1-year mortality comparing COPD severity groups with patients without COPD. RESULTS We identified 7,047 patients with TAVR of whom 644 had a history of COPD (low risk of AE-COPD: 439, high risk of AE-COPD: 205). The median age of the TAVR cohort was 81.4 years (IQR: 76.8-85.1) and 55.8% were males. One-year mortality for TAVR patients without COPD was 8.5% (95% CI: 7.8-9.2) and 15.4% (95% CI: 12.5-18.2) for those with COPD (adjusted HR: 1.63 [95% CI: 1.28-2.07]). Patients with low or high risk of AE-COPD had 1-year mortality of 13.1% (95% CI: 9.8-16.3) and 20.2% (95% CI: 14.6-25.8) corresponding to adjusted HRs of 1.31 (95% CI: 0.97-1.78) and 2.44 (95% CI: 1.70-3.50) compared with patients without COPD. Patients with high risk of AE-COPD and no/short term therapy or use of home oxygen represented the subgroups of patients with the highest 1-year mortality (31.6% [95% CI: 14.5-48.7] and 30.9% [95% CI: 10.3-51.6]). CONCLUSION Among patients undergoing TAVR, increasing risk of exacerbation with COPD was associated with increasing 1-year mortality compared with non-COPD patients. Patients with a high risk of exacerbation with COPD not using any guideline recommended COPD medication and those using home oxygen had the highest 1-year mortality.
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Affiliation(s)
- Marie Dam Lauridsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Danish Center for Clinical Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; The Clinical Institute, Aalborg University, Aalborg, Denmark; Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.
| | - Jan Brink Valentin
- Danish Center for Clinical Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Jarl Emanuel Strange
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Peter A Jacobsen
- The Clinical Institute, Aalborg University, Aalborg, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulla Weinreich
- The Clinical Institute, Aalborg University, Aalborg, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Doldi P, Steffen J, Orban M, Theiss H, Sadoni S, Hagl C, Massberg S, Hausleiter J, Deseive S, Braun D. Clinical Outcome Following Transcatheter Aortic Valve Implantation in Patients With Chronic Obstructive Pulmonary Disease. JACC Cardiovasc Interv 2022; 15:1188-1190. [PMID: 35680203 DOI: 10.1016/j.jcin.2022.03.017] [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: 01/31/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022]
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Patel KP, Treibel TA, Scully PR, Fertleman M, Searle S, Davis D, Moon JC, Mullen MJ. Futility in Transcatheter Aortic Valve Implantation: A Search for Clarity. Interv Cardiol 2022; 17:e01. [PMID: 35111240 PMCID: PMC8790725 DOI: 10.15420/icr.2021.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/05/2021] [Indexed: 12/12/2022] Open
Abstract
Although transcatheter aortic valve implantation (TAVI) has revolutionised the landscape of treatment for aortic stenosis, there exists a cohort of patients where TAVI is deemed futile. Among the pivotal high-risk trials, one-third to half of patients either died or received no symptomatic benefit from the procedure at 1 year. Futility of TAVI results in the unnecessary exposure of risk for patients and inefficient resource utilisation for healthcare services. Several cardiac and extra-cardiac conditions and frailty increase the risk of mortality despite TAVI. Among the survivors, these comorbidities can inhibit improvements in symptoms and quality of life. However, certain conditions are reversible with TAVI (e.g. functional mitral regurgitation), attenuating the risk and improving outcomes. Quantification of disease severity, identification of reversible factors and a systematic evaluation of frailty can substantially improve risk stratification and outcomes. This review examines the contribution of pre-existing comorbidities towards futility in TAVI and suggests a systematic approach to guide patient evaluation.
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Affiliation(s)
- Kush P Patel
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Thomas A Treibel
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Paul R Scully
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Michael Fertleman
- Cutrale Perioperative and Ageing Group, Department of Bioengineering, Imperial College London London, UK
| | - Samuel Searle
- MRC Unit for Lifelong Health and Ageing, University College London London, UK
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing, University College London London, UK
| | - James C Moon
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Michael J Mullen
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
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5
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Catalano MA, Lin D, Mullan CW, Cassiere H, Rutkin B, Maurer G, Berg J, Hartman A, Yu PJ. Impact of chronic lung disease on quality-of-life outcomes in patients undergoing transcatheter aortic valve replacement. J Card Surg 2021; 36:672-677. [PMID: 33403744 DOI: 10.1111/jocs.15248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND As the symptoms for both chronic lung disease (CLD) and aortic stenosis (AS) frequently overlap, it may be challenging to determine the degree of symptomatic improvement expected for a patient with CLD after correction of AS. Our aim was to determine if patients with CLD have the same degree of quality-of-life improvement following transcatheter aortic valve replacement (TAVR) as patients without CLD. METHODS A retrospective review of 238 TAVR patients from January 2017 to November 2018 who underwent preoperative pulmonary function tests and completed 30-day follow-up was performed. Patients were identified as having CLD with FEV1 more than 75% predicted. Postoperative outcomes and changes in Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) were compared between groups. RESULTS Of the 238 patients identified, 143 (60.0%) had CLD, 50 (35.0%) of whom had an obstructive disease pattern. Patients with CLD were more likely to be male, had higher rates of peripheral artery disease, and had lower baseline ejection fraction. There was no difference in STS Predicted Risk of Mortality, but patients with CLD were more likely to be designated as high-risk by surgeon evaluation. While initial and follow-up KCCQ-12 was lower for patients with CLD, there was no significant difference in degree of improvement (p = .900). When comparing patients with obstructive lung disease (FEV1/FVC < 0.70) to those without CLD, there was also no significant difference in the change of quality of life (p = .720). CONCLUSION Although patients with concomitant severe AS and CLD have reduced baseline quality of life compared to patients without CLD, they experience a comparable degree of improvement following TAVR.
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Affiliation(s)
- Michael A Catalano
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhas, New York, USA
| | | | - Clancy W Mullan
- Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Hugh Cassiere
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhas, New York, USA
| | - Bruce Rutkin
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhas, New York, USA
| | - Greg Maurer
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhas, New York, USA
| | - Jacinda Berg
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhas, New York, USA
| | - Alan Hartman
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhas, New York, USA
| | - Pey-Jen Yu
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhas, New York, USA
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6
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Navarese EP, Andreotti F, Kołodziejczak M, Wanha W, Lauten A, Veulemans V, Frediani L, Kubica J, de Cillis E, Wojakowski W, Ochala A, Zeus T, Bortone A, Buffon A, Jung C, Pestrichella V, Gurbel PA. Age-Related 2-Year Mortality After Transcatheter Aortic Valve Replacement: the YOUNG TAVR Registry. Mayo Clin Proc 2019; 94:1457-1466. [PMID: 30824280 DOI: 10.1016/j.mayocp.2019.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 12/21/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To comparatively assess the natural history of patients of different ages undergoing transcatheter aortic valve replacement (TAVR). PATIENTS AND METHODS For this study, we used the YOUNG TAVR, an international, multicenter registry investigating mortality trends up to 2 years in patients with aortic valve stenosis treated by TAVR, classified according to 3 prespecified age groups: 75 years or younger (n=179), 76 to 86 years (n=602), and older than 86 years (n=221). A total of 1002 patients undergoing TAVR were included. Demographic, clinical, and outcome data in the youngest group were compared with those of patients 76 to 86 years and older than 86 years. Patients were followed up for up to 2 years. RESULTS Compared with patients 75 years or younger (reference group), patients aged 76 to 86 years and older than 86 years had nonsignificantly different 30-day mortality (odds ratio, 0.76; 95% CI, 0.41-1.38; P=.37 and odds ratio, 1.27; 95% CI, 0.62-2.60; P=.51, respectively) and 1-year mortality (hazard ratio (HR), 0.72; 95% CI, 0.48-1.09; P=.12 and HR, 1.11; 95% CI, 0.88-1.40; P=.34, respectively). Mortality at 2 years was significantly lower among patients aged 76 to 86 years (HR, 0.62; 95% CI, 0.42-0.90; P=.01) but not among the older group (HR, 1.06; 95% CI, 0.68-1.67; P=.79). The Society of Thoracic Surgeons 30-day mortality score was lower in younger patients who, however, had a significantly higher prevalence of chronic obstructive pulmonary disease (P=.005 vs the intermediate group and P=.02 vs the older group) and bicuspid aortic valves (P=.02 vs both older groups), larger left ventricles, and lower ejection fractions. CONCLUSION In the present registry, mortality at 2 years after TAVR among patients 75 years or younger was higher compared with that of patients aged 75 to 86 years and was not markedly different from that of patients older than 86 years. The findings are attributable at least in part to a greater burden of comorbidities in the younger age group that are not entirely captured by current risk assessment tools.
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Affiliation(s)
- Eliano P Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Mater Dei Hospital, and SIRIO MEDICINE network, Bari, Italy; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada; Cardiovascular Institute, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
| | - Felicita Andreotti
- Institute of Cardiology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University Medical School, Rome, Italy
| | - Michalina Kołodziejczak
- Cardiovascular Institute, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Wojciech Wanha
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada; Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Alexander Lauten
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland; Department of Cardiology, Charité-Universitätsmedizin Berlin, German Centre for Cardiovascular Research (DZHK), University Heart Center, Berlin, Germany
| | - Verena Veulemans
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Düsseldorf, Germany
| | - Lara Frediani
- Department of Cardiology, Azienda Usl Toscana Nord-Ovest Cardiologia UTIC ed Emodinamica-Ospedali Riuniti di Livorno, Italy
| | - Jacek Kubica
- Cardiovascular Institute, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Emanuela de Cillis
- Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy
| | - Wojciech Wojakowski
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada; Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Andrzej Ochala
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada; Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Tobias Zeus
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Düsseldorf, Germany
| | - Alessandro Bortone
- Department of Emergency and Organ Transplantation, Section of Cardiovascular Diseases, School of Medicine, University of Bari, Italy
| | - Antonio Buffon
- Institute of Cardiology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University Medical School, Rome, Italy
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Düsseldorf, Germany
| | - Vincenzo Pestrichella
- Interventional Cardiology and Cardiovascular Medicine Research, Mater Dei Hospital, and SIRIO MEDICINE network, Bari, Italy
| | - Paul A Gurbel
- INOVA Heart and Vascular Institute, Fairfax, VA; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Kwak MJ, Bhise V, Warner MT, Balan P, Nguyen TC, Estrera AL, Smalling RW, Dhoble A. National trend of utilization, clinical and economic outcomes of transcatheter aortic valve replacement among patients with chronic obstructive pulmonary disease. Curr Med Res Opin 2019; 35:1321-1329. [PMID: 30761914 DOI: 10.1080/03007995.2019.1583024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: We aimed to trend the utilization of transcatheter aortic valve replacement (TAVR) among COPD patients, compare its outcomes to surgical aortic valve replacement (SAVR) and assess any social disparities in its outcomes. Background: Patients with chronic obstructive pulmonary disease (COPD) have been increasingly undergoing TAVR, but studies to evaluate the national trend of TAVR utilization and outcomes are still lacking. Methods: We conducted a retrospective observational study using a nationally representative database, the National Inpatient Sample (NIS). Results: From 2010 to 2014, the proportion of TAVR among COPD patients has increased from <1% to >50%. Patients who underwent TAVR were older, more likely to be women or white, carried more public insurance and had more comorbidities. There was no overall difference in mortality between TAVR and SAVR (2.74% vs. 2.59%, p = .860), and it has been consistently similar over time. However, patients with TAVR had shorter length of stay in the hospital after the procedure and were more likely to be discharged home than the SAVR group. Among the TAVR group, there were no gender, race or insurance disparities for in-hospital mortality, but female gender was related to lower discharge home rate, higher cost and longer stay in hospital. Conclusions: The rate of TAVR among COPD patients has been increasing nationally since 2011. In spite of higher comorbidities, TAVR did not show a difference in hospital mortality compared to SAVR but demonstrated shorter length of stay and more home discharges. This suggests that TAVR is a viable and potentially better option for patients with COPD.
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Affiliation(s)
- Min Ji Kwak
- a Department of Internal Medicine , University of Texas McGovern Medical School , Houston , TX , USA
- b Department of Management, Policy and Community Health , University of Texas School of Public Health , Houston , TX , USA
| | - Viraj Bhise
- b Department of Management, Policy and Community Health , University of Texas School of Public Health , Houston , TX , USA
- c Department of Internal Medicine, John A Burns School of Medicine , University of Hawaii at Manoa , Honolulu , HI , USA
| | - Mark T Warner
- a Department of Internal Medicine , University of Texas McGovern Medical School , Houston , TX , USA
- d Memorial Herman Heart and Vascular Center , Texas Medical Center , Houston , TX , USA
| | - Prakash Balan
- a Department of Internal Medicine , University of Texas McGovern Medical School , Houston , TX , USA
- d Memorial Herman Heart and Vascular Center , Texas Medical Center , Houston , TX , USA
| | - Tom C Nguyen
- d Memorial Herman Heart and Vascular Center , Texas Medical Center , Houston , TX , USA
- e Department of Cardiovascular Surgery , University of Texas McGovern Medical School , Houston , TX , USA
| | - Anthony L Estrera
- d Memorial Herman Heart and Vascular Center , Texas Medical Center , Houston , TX , USA
- e Department of Cardiovascular Surgery , University of Texas McGovern Medical School , Houston , TX , USA
| | - Richard W Smalling
- a Department of Internal Medicine , University of Texas McGovern Medical School , Houston , TX , USA
- d Memorial Herman Heart and Vascular Center , Texas Medical Center , Houston , TX , USA
| | - Abhijeet Dhoble
- a Department of Internal Medicine , University of Texas McGovern Medical School , Houston , TX , USA
- d Memorial Herman Heart and Vascular Center , Texas Medical Center , Houston , TX , USA
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Pino JE, Shah V, Ramos Tuarez FJ, Kreidieh OI, Donath E, Lovitz LS, Rothenberg M, Cubeddu RJ, Nores ME, Chait R. The utility of pulmonary function testing in the preoperative risk stratification of patients undergoing transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2019; 95:E179-E185. [PMID: 31313472 DOI: 10.1002/ccd.28402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 05/27/2019] [Accepted: 07/04/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND The role of pulmonary function testing (PFT) as a predictor of clinically relevant endpoints in transcatheter aortic valve replacement (TAVR) is unclear. OBJECTIVE To determine the utility of PFT in the preoperative risk stratification of patients undergoing TAVR. METHODS An evaluation of PFT (i.e., FEV1), arterial blood gases (i.e., PO2), the diagnosis of chronic obstructive lung disease (COPD) by the Global Initiative for COPD (GOLD), and the diagnosis of chronic lung disease (CLD) by the Society of Thoracic Surgeons (STS) was performed to determine whether a relationship exists among these parameters and clinically relevant outcomes, including all-cause 30-day and 1-year mortality. RESULTS A total of 513 patients underwent TAVR between March 2013 and December 2016. Per STS criteria, 269/513 (52%) had CLD with a mean FEV1 of 55.4 ± 12%. Per GOLD criteria, 158/513 (30%) of patients had COPD with a mean FEV1/forced vital capacity of 61.8 ± 8.2%. The severity of CLD was affected by changes in ejection fraction, albumin, creatinine, and B-type natriuretic peptide levels (p = .009, p < .001, p < .001, and p < .001, respectively), whereas the severity of COPD was not affected by these same variables, (p = .302, .079, .137, and .102, respectively). An increased A-a gradient (p = .035), increased PCO2 (p = .016), and decreased PO2 (p = <.001) demonstrated increased risk of 30-day mortality. Neither classification (COPD or CLD), nor PFT changes, showed association with 30-day and 1-year mortality (p = NS). CONCLUSION This study suggests that isolated abnormalities in spirometry are a poor indicator of clinically relevant outcomes in TAVR. When classified correctly, COPD does not predict clinically relevant postoperative outcomes.
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Affiliation(s)
- Jesus E Pino
- University of Miami/JFK Medical Center Palm Beach Regional GME Consortium, Atlantis, Florida
| | - Varun Shah
- University of Miami/JFK Medical Center Palm Beach Regional GME Consortium, Atlantis, Florida
| | - Fergie J Ramos Tuarez
- University of Miami/JFK Medical Center Palm Beach Regional GME Consortium, Atlantis, Florida
| | - Omar I Kreidieh
- University of Miami/JFK Medical Center Palm Beach Regional GME Consortium, Atlantis, Florida
| | - Elie Donath
- University of Miami/JFK Medical Center Palm Beach Regional GME Consortium, Atlantis, Florida
| | - Lawrence S Lovitz
- University of Miami/JFK Medical Center Palm Beach Regional GME Consortium, Atlantis, Florida
| | - Mark Rothenberg
- University of Miami/JFK Medical Center Palm Beach Regional GME Consortium, Atlantis, Florida
| | | | - Marcos E Nores
- University of Miami/JFK Medical Center Palm Beach Regional GME Consortium, Atlantis, Florida
| | - Robert Chait
- University of Miami/JFK Medical Center Palm Beach Regional GME Consortium, Atlantis, Florida
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Dziewierz A, Tokarek T, Kleczynski P, Sorysz D, Bagienski M, Rzeszutko L, Dudek D. Impact of chronic obstructive pulmonary disease and frailty on long-term outcomes and quality of life after transcatheter aortic valve implantation. Aging Clin Exp Res 2018; 30:1033-1040. [PMID: 29185204 PMCID: PMC6096867 DOI: 10.1007/s40520-017-0864-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 11/17/2017] [Indexed: 10/30/2022]
Abstract
BACKGROUND Association between chronic obstructive pulmonary disease (COPD) and long-term mortality as well as the quality of life (QoL) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) is still unclear. AIM We sought to evaluate the impact of COPD on mortality and QoL of patients with AS undergoing TAVI. METHODS A total of 148 consecutive patients who underwent TAVI were enrolled and stratified by history of COPD. RESULTS Of 148 patients enrolled, 19 (12.8%) patients had a history of COPD. Patients with COPD were high-risk patients with higher prevalence of incomplete revascularization and frailty features. At follow-up of 15.8 months, all-cause mortality in patients with COPD was over four times higher than in patients without COPD [17.8% vs. 52.6%; p = 0.002-age/gender-adjusted OR (95% CI) 4.73 (1.69-13.24)]. On the other hand, in Cox regression model, the only independent predictors of all-cause death at long-term follow-up were: incomplete coronary revascularization [HR (95% CI) 5.45 (2.38-12.52); p = 0.001], estimated glomerular filtration rate [per 1 ml/min/1.73 m2 increase: 0.96 (0.94-0.98); p = 0.001], and previous stroke/transient ischemic attack [2.86 (1.17-7.00); p = 0.021]. Also, the difference in mortality between patients with and without COPD was not significant after adjustment for the most of frailty indices. Importantly, groups were comparable in terms of QoL at baseline and 12 months. CONCLUSION COPD may pose an important factor affecting long-term outcomes of patients with severe AS undergoing TAVI. However, its effects might be partially related to coexisting comorbidities and frailty.
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10
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Shimura T, Yamamoto M, Kagase A, Kodama A, Kano S, Koyama Y, Tada N, Takagi K, Araki M, Yamanaka F, Shirai S, Watanabe Y, Hayashida K. The incidence, predictive factors and prognosis of acute pulmonary complications after transcatheter aortic valve implantation. Interact Cardiovasc Thorac Surg 2017; 25:191-197. [PMID: 28453816 DOI: 10.1093/icvts/ivx075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 01/30/2017] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Although acute pulmonary complications (APCs), such as the exacerbation of pulmonary disease (PD) or a newly developed pulmonary event, are thought to be catastrophic after invasive therapy, little is known about the occurrence of APCs after transcatheter aortic valve implantation (TAVI). This study aims to clarify the incidence, predictive factors and impact of APCs on prognosis after TAVI. METHODS We identified 749 patients who underwent TAVI, using data from the Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) Japanese multicentre registry. APCs were defined as exacerbation of a comorbidity or newly developed PD during hospitalization. Patients were divided into 2 groups: an APC group (1.5%, 11/749) and a non-APC group (98.5%, 738/749). Clinical and prognostic outcomes were compared, and predictive factors for APCs were assessed. RESULTS Procedure-related death did not differ between the groups (0.4% vs 0.0%, P = 1.00), although 30-day mortality was significantly higher in the APC group than in the non-APC group (27.3% vs 1.6%, P = 0.001) and the difference in cumulative 1-year mortality increased further (72.7% vs 8.6%, log-rank test: P < 0.001). In particular, concomitant PD and transapical (TA) approach were identified as predictors of APCs after TAVI [univariable odds ratio (uOR) = 24.2, 95% confidence interval (CI) = 3.08-189.9, P = 0.002; uOR = 3.69, 95% CI = 1.11-12.3, P = 0.033, respectively]. CONCLUSIONS Although rare, the occurrence of APCs after TAVI was associated with extremely poor prognosis. Patients undergoing TAVI with concomitant PD and/or TA require careful consideration to avoid the risk of APCs.
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Affiliation(s)
- Tetsuro Shimura
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Ai Kagase
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Atsuko Kodama
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Seiji Kano
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Yutaka Koyama
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
| | - Kensuke Takagi
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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11
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Auffret V, Becerra Munoz V, Loirat A, Dumont E, Le Breton H, Paradis JM, Doyle D, De Larochellière R, Mohammadi S, Verhoye JP, Dagenais F, Bedossa M, Boulmier D, Leurent G, Asmarats L, Regueiro A, Chamandi C, Rodriguez-Gabella T, Voisine E, Moisan AS, Thoenes M, Côté M, Puri R, Voisine P, Rodés-Cabau J. Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Lower-Surgical-Risk Patients With Chronic Obstructive Pulmonary Disease. Am J Cardiol 2017; 120:1863-1868. [PMID: 28886850 DOI: 10.1016/j.amjcard.2017.07.097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/17/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
Respiratory complications are a major factor contributing to postoperative morbidity and mortality, especially in patients with chronic obstructive pulmonary disease (COPD). Our objective was to compare the rate of respiratory complications in patients with COPD with severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR). Low-to-intermediate surgical-risk patients with moderate or severe COPD who underwent TAVI or SAVR at 2 tertiary centers were included in this study. COPD was defined by the Global Initiative for Chronic Lung Disease classification. The primary end point was the 30-day composite of respiratory mortality, prolonged ventilation (>24 hours), the need for reintubation for respiratory causes, tracheostomy, acute respiratory distress syndrome, pneumonia, or pneumothorax. The inverse probability of treatment weighting was determined to reduce baseline imbalance between the 2 groups. A total of 321 patients (mean age 72.4 ± 9.3 years old, 74.5% male, mean Society of Thoracic Surgeons predicted risk of mortality 3.8 ± 1.9%, mean forced expiratory volume 1: 59 ± 13%) were included in the analysis. TAVI was performed in 122 patients, whereas 199 underwent SAVR. There were no differences between the 2 groups regarding the composite respiratory primary end point (SAVR 10.6%, TAVR 7.4%, adjusted odds ratio 0.57, 95% confidence interval 0.20 to 1.65, p = 0.30). Transfemoral TAVI without general anesthesia (28 patients) was associated with the lowest rate of respiratory complications (3.6%). Among patients with moderate or severe COPD at low-to-intermediate surgical risk, TAVI patients had a similar rate of 30-day major pulmonary complications compared with SAVR patients despite a higher baseline risk profile. Future studies should further investigate whether TAVI is associated with reduced respiratory complications, comparing transfemoral TAVI recipients treated with local anesthesia with their SAVR counterparts.
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12
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Chakos A, Wilson-Smith A, Arora S, Nguyen TC, Dhoble A, Tarantini G, Thielmann M, Vavalle JP, Wendt D, Yan TD, Tian DH. Long term outcomes of transcatheter aortic valve implantation (TAVI): a systematic review of 5-year survival and beyond. Ann Cardiothorac Surg 2017; 6:432-443. [PMID: 29062738 DOI: 10.21037/acs.2017.09.10] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation/replacement (TAVI/TAVR) is becoming more frequently used to treat aortic stenosis (AS), with increasing push for the procedure in lower risk patients. Numerous randomized controlled trials have demonstrated that TAVI offers a suitable alternative to the current gold standard of surgical aortic valve replacement (SAVR) in terms of short-term outcomes. The present review evaluates long-term outcomes following TAVI procedures. METHODS Literature search using three electronic databases was performed up to June 2017. Studies which included 20 or more patients undergoing TAVI procedures, either as a stand-alone or concomitant procedure and with a follow-up of at least 5 years, were included in the present review. Literature search and data extraction were performed by two independent researchers. Digitized survival data were extracted from Kaplan-Meier curves in order to re-create the original patient data using an iterative algorithm and subsequently aggregated for analysis. RESULTS Thirty-one studies were included in the present analysis, with a total of 13,857 patients. Two studies were national registries, eight were multi-institutional collaborations and the remainder were institutional series. Overall, 45.7% of patients were male, with mean age of 81.5±7.0 years. Where reported, the mean Logistic EuroSCORE (LES) was 22.1±13.7 and the mean Society of Thoracic Surgeons (STS) score was 9.2±6.6. The pooled analysis found 30-day mortality, cerebrovascular accidents, acute kidney injury (AKI) and requirement for permanent pacemaker (PPM) implantation to be 8.4%, 2.8%, 14.4%, and 13.4%, respectively. Aggregated survival at 1-, 2-, 3-, 5- and 7-year were 83%, 75%, 65%, 48% and 28%, respectively. CONCLUSIONS The present systematic review identified acceptable long-term survival results for TAVI procedures in an elderly population. Extended follow-up is required to assess long-term outcomes following TAVI, particularly before its application is extended into wider population groups.
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Affiliation(s)
- Adam Chakos
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Ashley Wilson-Smith
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Sameer Arora
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, USA
| | - Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Memorial Hermann Hospital - Heart and Vascular Institute, Houston, TX, USA
| | - Abhijeet Dhoble
- Division of Cardiology, University of Texas Health Science Center, Houston, Houston, TX, USA
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University Padua, Padua, Italy
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | - John P Vavalle
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, USA
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Duisburg, Germany
| | - Tristan D Yan
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - David H Tian
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Royal North Shore Hospital, Sydney, Australia
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13
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Honda Y, Watanabe T, Shibata Y, Otaki Y, Kadowaki S, Narumi T, Takahashi T, Kinoshita D, Yokoyama M, Nishiyama S, Takahashi H, Arimoto T, Shishido T, Inoue S, Miyamoto T, Konta T, Kawasaki R, Daimon M, Kato T, Ueno Y, Kayama T, Kubota I. Impact of restrictive lung disorder on cardiovascular mortality in a general population: The Yamagata (Takahata) study. Int J Cardiol 2017; 241:395-400. [DOI: 10.1016/j.ijcard.2017.04.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/03/2017] [Accepted: 04/17/2017] [Indexed: 01/01/2023]
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14
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Shimura T, Yamamoto M, Kano S, Kagase A, Kodama A, Koyama Y, Tsuchikane E, Suzuki T, Otsuka T, Kohsaka S, Tada N, Yamanaka F, Naganuma T, Araki M, Shirai S, Watanabe Y, Hayashida K, Yashima F, Inohara T, Kakefuda Y, Arai T, Yanagisawa R, Tanaka M, Kawakami T, Maekawa Y, Takashi K, Yoshitake A, Iida Y, Yamazaki M, Shimizu H, Yamada Y, Jinzaki M, Tsuruta H, Itabashi Y, Murata M, Kawakami M, Fukui S, Sano M, Fukuda K, Hosoba S, Sato H, Teramoto T, Kimura M, Sago M, Tsunaki T, Watarai S, Tsuzuki M, Irokawa K, Shimizu K, Kobayashi T, Okawa Y, Miyasaka M, Enta Y, Shishido K, Ochiai T, Yamabe T, Noguchi K, Saito S, Kawamoto H, Onishi H, Yabushita H, Mitomo S, Nakamura S, Yamawaki M, Akatsu Y, Honda Y, Takama T, Isotani A, Hayashi M, Kamioka N, Miura M, Morinaga T, Kawaguchi T, Yano M, Hanyu M, Arai Y, Tsubota H, Kudo M, Kuroda Y, Kataoka A, Hioki H, Nara Y, Kawashima H, Nagura F, Nakashima M, Sasaki K, Nishikawa J, Shimokawa T, Harada T, Kozuma K. Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement. Circulation 2017; 135:2013-2024. [DOI: 10.1161/circulationaha.116.025630] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 03/01/2017] [Indexed: 12/14/2022]
Abstract
Background:
The semiquantitative Clinical Frailty Scale (CFS) is a simple tool to assess patients’ frailty and has been shown to correlate with mortality in elderly patients even when evaluated by nongeriatricians. The aim of the current study was to determine the prognostic value of CFS in patients who underwent transcatheter aortic valve replacement.
Methods:
We utilized the OCEAN (Optimized Catheter Valvular Intervention) Japanese multicenter registry to review data of 1215 patients who underwent transcatheter aortic valve replacement. Patients were categorized into 5 groups based on the CFS stages: CFS 1-3, CFS 4, CFS 5, CFS 6, and CFS ≥7. We subsequently evaluated the relationship between CFS grading and other indicators of frailty, including body mass index, serum albumin, gait speed, and mean hand grip. We also assessed differences in baseline characteristics, procedural outcomes, and early and midterm mortality among the 5 groups.
Results:
Patient distribution into the 5 CFS groups was as follows: 38.0% (CFS 1-3), 32.9% (CFS4), 15.1% (CFS 5), 10.0% (CFS 6), and 4.0% (CFS ≥7). The CFS grade showed significant correlation with body mass index (Spearman’s ρ=−0.077,
P
=0.007), albumin (ρ=−0.22,
P
<0.001), gait speed (ρ=−0.28,
P
<0.001), and grip strength (ρ=−0.26,
P
<0.001). Cumulative 1-year mortality increased with increasing CFS stage (7.2%, 8.6%. 15.7%, 16.9%, 44.1%,
P
<0.001). In a Cox regression multivariate analysis, the CFS (per 1 category increase) was an independent predictive factor of increased late cumulative mortality risk (hazard ratio, 1.28; 95% confidence interval, 1.10–1.49;
P
<0.001).
Conclusions:
In addition to reflecting the degree of frailty, the CFS was a useful marker for predicting late mortality in an elderly transcatheter aortic valve replacement cohort.
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Affiliation(s)
- Tetsuro Shimura
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Masanori Yamamoto
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Seiji Kano
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Ai Kagase
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Atsuko Kodama
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Yutaka Koyama
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Etsuo Tsuchikane
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Takahiko Suzuki
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Toshiaki Otsuka
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Shun Kohsaka
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Norio Tada
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Futoshi Yamanaka
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Toru Naganuma
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Motoharu Araki
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Shinichi Shirai
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Yusuke Watanabe
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Kentaro Hayashida
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | | | - Taku Inohara
- Keio University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shogo Fukui
- Keio University School of Medicine, Tokyo, Japan
| | - Motoaki Sano
- Keio University School of Medicine, Tokyo, Japan
| | | | - Soh Hosoba
- Toyohashi Heart Center, Toyohashi, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yui Akatsu
- Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yosuke Honda
- Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Takuro Takama
- Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yugo Nara
- Teikyo University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | | - Ken Kozuma
- Teikyo University School of Medicine, Tokyo, Japan
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15
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Konia MR, Helmer G, Raveendran G, Aposolidou I. Anesthetic Implications of Chronic Lung Disease in Patients Undergoing Transcatheter Valve Implantation. J Cardiothorac Vasc Anesth 2017; 31:657-662. [DOI: 10.1053/j.jvca.2016.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Indexed: 11/11/2022]
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16
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Condado JF, Haider MN, Lerakis S, Keegan P, Caughron H, Thourani VH, Devireddy C, Leshnower B, Mavromatis K, Sarin EL, Stewart J, Guyton R, Forcillo J, Patel A, Simone A, Block PC, Babaliaros V. Does minimalist transfemoral transcatheter aortic valve replacement produce better survival in patients with severe chronic obstructive pulmonary disease? Catheter Cardiovasc Interv 2016; 89:775-780. [DOI: 10.1002/ccd.26683] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/02/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Jose F. Condado
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
| | | | - Stamatios Lerakis
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
| | - Patricia Keegan
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
| | - Hope Caughron
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
| | - Vinod H. Thourani
- Department of Cardiothoracic Surgery; Emory University; Atlanta Georgia
| | - Chandan Devireddy
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
| | - Bradley Leshnower
- Department of Cardiothoracic Surgery; Emory University; Atlanta Georgia
| | - Kreton Mavromatis
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
| | - Eric L. Sarin
- Department of Cardiothoracic Surgery; Emory University; Atlanta Georgia
| | - James Stewart
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
| | - Robert Guyton
- Department of Cardiothoracic Surgery; Emory University; Atlanta Georgia
| | - Jessica Forcillo
- Department of Cardiothoracic Surgery; Emory University; Atlanta Georgia
| | - Ateet Patel
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
| | - Amy Simone
- Department of Cardiothoracic Surgery; Emory University; Atlanta Georgia
| | - Peter C. Block
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
| | - Vasilis Babaliaros
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
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17
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Álvarez-Fernández B, Formiga F, de Mora-Martín M, Calleja F, Gómez-Huelgas R. [Non-cardiac aspects of aortic stenosis in the elderly: A review]. Rev Esp Geriatr Gerontol 2016; 52:87-92. [PMID: 27430997 DOI: 10.1016/j.regg.2016.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/01/2016] [Accepted: 06/02/2016] [Indexed: 01/10/2023]
Abstract
Aortic stenosis (AS) is the most frequent valve disease in the elderly population Treatment is valve replacement either by open surgery, or in the case of patients at high surgical risk, by TAVI (Transcatheter Aortic Valve Implantation). However, almost 40% of patients who have undergone TAVI show poor health outcomes, either due to death or because their clinical status does not improved. This review examines the non-cardiac aspects of patients with AS, which may help answer three key questions in order to evaluate this condition pre-surgically: 1) Are the symptoms presented by the patient exclusively explained by the AS, or are there other factors or comorbidities that could justify or increase them?, 2) What possibilities for improvement of health status and quality of life has the patient after the valve replacement?, and 3) How can we reduce the risk of a futile valve replacement?
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Affiliation(s)
| | - Francesç Formiga
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, España
| | - Manuel de Mora-Martín
- Servicio de Cardiología, Instituto Biomédico de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, España
| | - Fernando Calleja
- Servicio de Cirugía Cardiovascular, Hospital Regional Universitario de Málaga, Málaga, España
| | - Ricardo Gómez-Huelgas
- Servicio de Medicina Interna, Instituto Biomédico de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, España
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18
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Implante de válvula aórtica transcatéter. Una revisión de las vías de abordaje. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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