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Kabahizi A, Sheikh AS, Williams T, Tanseco K, Myat A, Trivedi U, de Belder A, Cockburn J, Hildick-Smith D. Elective versus urgent in-hospital transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2021; 98:170-175. [PMID: 33713533 DOI: 10.1002/ccd.29638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/31/2021] [Accepted: 02/24/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is maturing as a treatment option and is now often undertaken during an unscheduled index hospital admission. The aim of this study was to look at procedural and mid-term outcomes of patients undergoing elective versus urgent in-hospital transcatheter aortic valve implantation. METHODS We identified a total of 1,157 patients who underwent TAVI between November 2007 and November 2019 at the Sussex Cardiac Centre in the UK. We compared the demographics, procedural outcomes, 30-day and 1-year mortality between elective and urgent patients. Emergency and salvage TAVI cases were excluded. RESULTS Of the 1,157 patients who underwent the procedure, 975 (84.3%) had elective while 182 (15.7%) had urgent TAVI. Predominant aortic stenosis was more frequent in elective patients (91.7% vs. 77.4%); p < .01), while predominant aortic regurgitation was seen more commonly in the urgent group (11.5% vs. 4.2%; p < .01). Implantation success was similar between the elective (99.1%) and urgent group (99.4%). In-hospital (1.65% vs. 1.3%: p .11), 30 day (3.5% vs. 3.3%: p .81) and 1 year (10.9% vs. 11%; p .81) mortality rates were similar in the elective and urgent groups, respectively. CONCLUSIONS In contemporary practice, urgent TAVI undertaken on the index admission can be performed at similar risk to elective outpatient TAVI.
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Affiliation(s)
- Alex Kabahizi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - Azeem S Sheikh
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Timothy Williams
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - Kristoffer Tanseco
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - Aung Myat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - Adam de Belder
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
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Patel K, Broyd C, Chehab O, Jerrum M, Queenan H, Bedford K, Barakat F, Kennon S, Ozkor M, Mathur A, Mullen MJ. Transcatheter aortic valve implantation in acute decompensated aortic stenosis. Catheter Cardiovasc Interv 2020; 96:E348-E354. [PMID: 31696656 DOI: 10.1002/ccd.28581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/30/2019] [Accepted: 10/26/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To assess the safety and efficacy of first-line transcatheter aortic valve implantation (TAVI) in patients presenting with acute decompensated aortic stenosis (ADAS). BACKGROUND ADAS is common and is often treated medically or using balloon aortic valvuloplasty in the first instance. This temporizing measure results in suboptimal outcomes. In the current era, TAVI provides an alternative option. METHODS Consecutive patients who had either a TAVI for ADAS or electively were included in the study. The primary outcome was procedural and 30-day mortality and hospital length of stay (LOS). Secondary outcomes included 1-year mortality and procedural complications. RESULTS Of note, 893 patients (mean age 83 ± 7, 50.5% male) underwent TAVI (19% ADAS, 81% elective). ADAS patients were more unwell with worse echocardiographic parameters than elective patients. ADAS patients of 55.9% were known to have significant aortic stenosis prior to their decompensation. Procedural mortality was not different between the ADAS and elective cohorts (1.2 vs. 0.7%; p = .62). The ADAS cohort had a higher 30-day mortality (5.3 vs. 1.1%; p = .002) and longer LOS (31.9 ± 20.7 days vs. 6.1 ± 6.5 days; p < .001). Multivariate analysis identified acute kidney injury and ADAS as significant predictors of 30-day mortality. CONCLUSIONS TAVI for ADAS is safe and effective with procedural outcomes similar to elective patients. However, compared to elective patients, they have worse physiological baseline features, poorer prognosis at 30 days, and longer hospital admissions. Majority of patients who presented with ADAS were known to have AS prior to admission.
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Affiliation(s)
- Kush Patel
- Department of Structural Intervention, Barts Heart Centre, West Smithfield, London, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | - Chris Broyd
- Department of Structural Intervention, Barts Heart Centre, West Smithfield, London, UK
| | - Omar Chehab
- Department of Structural Intervention, Barts Heart Centre, West Smithfield, London, UK
| | - Melanie Jerrum
- Department of Structural Intervention, Barts Heart Centre, West Smithfield, London, UK
| | - Helen Queenan
- Department of Structural Intervention, Barts Heart Centre, West Smithfield, London, UK
| | - Kerry Bedford
- Department of Structural Intervention, Barts Heart Centre, West Smithfield, London, UK
| | - Fahed Barakat
- Cardiovascular division, King's College London, London, UK
| | - Simon Kennon
- Department of Structural Intervention, Barts Heart Centre, West Smithfield, London, UK
| | - Muhiddin Ozkor
- Department of Structural Intervention, Barts Heart Centre, West Smithfield, London, UK
| | - Anthony Mathur
- Department of Structural Intervention, Barts Heart Centre, West Smithfield, London, UK.,The William Harvey Research Institute, London, UK
| | - Michael J Mullen
- Department of Structural Intervention, Barts Heart Centre, West Smithfield, London, UK
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