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Zheng JY, Lodhi SH, Anstead M, Misumida N, Ahmed T. Severe Bicuspid Aortic Valve Disease in an Adult Cystic Fibrosis Patient. Cureus 2023; 15:e50401. [PMID: 38213378 PMCID: PMC10782187 DOI: 10.7759/cureus.50401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
Bicuspid aortic valve is the most common congenital heart disease. Bicuspid aortic valves are prone to accelerated degenerative changes and aortopathies. These changes often manifest in adulthood as severe aortic stenosis or mixed aortic valve disease. Cystic fibrosis patients are at high risk of adverse surgical outcomes. As survival in cystic fibrosis continues to increase, managing comorbidities including severe aortic stenosis requires consideration. The relatively non-invasive transcatheter aortic valve replacement has been posed as an intervention for high-risk patients with severe symptomatic aortic stenosis. However, traditional randomized trials have excluded patients with bicuspid aortic valves. Herein we present an extremely rare association of severe bicuspid aortic valve stenosis in an adult cystic fibrosis patient. Furthermore, we discuss the clinical course and a multi-disciplinary approach for the management of this rare scenario.
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Affiliation(s)
- Jason Y Zheng
- Medicine, University of Kentucky College of Medicine, Lexington, USA
| | - Samra Haroon Lodhi
- Internal Medicine, University of Kentucky College of Medicine, Lexington, USA
| | - Michael Anstead
- Pulmonology, University of Kentucky College of Medicine, Lexington, USA
| | - Naoki Misumida
- Cardiology, University of Kentucky College of Medicine, Lexington, USA
| | - Taha Ahmed
- Internal Medicine, University of Kentucky College of Medicine, Lexington, USA
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2
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Rouhollahi A, Willi JN, Haltmeier S, Mehrtash A, Straughan R, Javadikasgari H, Brown J, Itoh A, de la Cruz KI, Aikawa E, Edelman ER, Nezami FR. CardioVision: A fully automated deep learning package for medical image segmentation and reconstruction generating digital twins for patients with aortic stenosis. Comput Med Imaging Graph 2023; 109:102289. [PMID: 37633032 PMCID: PMC10599298 DOI: 10.1016/j.compmedimag.2023.102289] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/28/2023]
Abstract
Aortic stenosis (AS) is the most prevalent heart valve disease in western countries that poses a significant public health challenge due to the lack of a medical treatment to prevent valve calcification. Given the aging population demographic, the prevalence of AS is projected to rise, resulting in a progressively significant healthcare and economic burden. While surgical aortic valve replacement (SAVR) has been the gold standard approach, the less invasive transcatheter aortic valve replacement (TAVR) is poised to become the dominant method for high- and medium-risk interventions. Computational simulations using patient-specific models, have opened new research avenues for optimizing emerging devices and predicting clinical outcomes. The traditional techniques of generating digital replicas of patients' aortic root, native valve, and calcification are time-consuming and labor-intensive processes requiring specialized tools and expertise in anatomy. Alternatively, deep learning models, such as the U-Net architecture, have emerged as reliable and fully automated methods for medical image segmentation. Two-dimensional U-Nets have been shown to produce comparable or more accurate results than trained clinicians' manual segmentation while significantly reducing computational costs. In this study, we have developed a fully automatic AI tool capable of reconstructing the digital twin geometry and analyzing the calcification distribution on the aortic valve. The developed automatic segmentation package enables the modeling of patient-specific anatomies, which can then be used to simulate virtual interventional procedures, optimize emerging prosthetic devices, and predict clinical outcomes.
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Affiliation(s)
- Amir Rouhollahi
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James Noel Willi
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sandra Haltmeier
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alireza Mehrtash
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ross Straughan
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Hoda Javadikasgari
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Brown
- Clinical and Translation Science Institute, Tufts University, Boston, MA, USA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Akinobu Itoh
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kim I de la Cruz
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elena Aikawa
- Center for Interdisciplinary Cardiovascular Sciences, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Excellence in Vascular Biology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Farhad R Nezami
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Jin Q, Li W, Chen S, Li M, Zhou D, Zhang X, Ge J. Aortic valve morphology and paravalvular leak regression after a self-expandable transcatheter aortic valve replacement. Front Physiol 2023; 13:1088681. [PMID: 36685205 PMCID: PMC9853023 DOI: 10.3389/fphys.2022.1088681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/01/2022] [Indexed: 01/09/2023] Open
Abstract
Aims: The study aimed to compare paravalvular leak (PVL) changes after a transcatheter aortic valve replacement (TAVR) with self-expandable prosthesis between different aortic valve morphologies and evaluate the impact of paravalvular leak regression on clinical prognosis. Methods: Patients with aortic stenosis (AS) successfully treated with a self-expandable TAVR who were followed up for at least 1 year at our centre were consecutively enrolled from January 2016 to August 2019. Paired serial changes in paravalvular leak and other haemodynamic parameters by echocardiography were collected and compared between the bicuspid valve (BAV) and tricuspid aortic valve (TAV). A logistic regression model was used to explore the predictors of paravalvular leak regression (<1 grade) 1 year after transcatheter aortic valve replacement, while its impact on subsequent clinical outcomes (all-cause mortality and rehospitalisation for heart failure (HF)) was further evaluated using Kaplan-Meier analysis. Results: A total of 153 bicuspid valve and 114 tricuspid aortic valve patients were finally enrolled; haemodynamic parameters and paravalvular leak severity were comparable before the discharge between the two groups. The peak transaortic velocity, mean transvalvular gradient, and effective orifice area all significantly improved (p < 0.05) without intergroup differences at all follow-up timepoints. Significant paravalvular leak reduction was observed only in the TAV group (1.75% vs. 4.39%, p = 0.029), while moderate paravalular leak was still more prevalent in BAV (7.19% vs. 1.75%, p = 0.041) at the 1-year follow-up. Multivariable analyses identified the bicuspid valve, asymmetric calcification, and undersizing as independent predictors of failure of the 1-year paravalvular leak reduction in patients with mild or moderate paravalvular leak after discharge. Patients without a paravalvular leak reduction within 1 year showed a relatively higher 2-year all-cause mortality and HF (HR: 5.994, 95% CI: 1.691-21.240, and p = 0.053) rates thereafter. Conclusion: In AS patients after self-expandable transcatheter aortic valve replacement, paravalvular leak regression within 1 year was less prevalent in bicuspid valve morphology. The failure of paravalvular leak reduction might lead to an increased risk of poorer prognosis in the long run.
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Affiliation(s)
- Qinchun Jin
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wei Li
- Department of Echocardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shasha Chen
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Mingfei Li
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Daxin Zhou
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China,National Clinical Research Center for Interventional Medicine, Shanghai, China,*Correspondence: Daxin Zhou, , ; Xiaochun Zhang,
| | - Xiaochun Zhang
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China,National Clinical Research Center for Interventional Medicine, Shanghai, China,*Correspondence: Daxin Zhou, , ; Xiaochun Zhang,
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China,National Clinical Research Center for Interventional Medicine, Shanghai, China
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Bruno VD, Angelini GD. Surgical transcatheter valve implantation: The more pathways, the better. J Card Surg 2022; 37:985-986. [PMID: 35137985 PMCID: PMC9303204 DOI: 10.1111/jocs.16303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 11/29/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is rapidly spreading across the world with the endorsement of the cardiological community and the supporting results of randomized controlled trials. However, TAVI-related complications like aortic dissection, aortic valvular rupture, or left ventricle perforation are still potentially catastrophic.
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Affiliation(s)
- Vito D Bruno
- Bristol Heart Institute, Bristol University, Bristol, UK
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Nso N, Emmanuel K, Nassar M, Bhangal R, Enoru S, Iluyomade A, Marmur JD, Ilonze OJ, Thambidorai S, Ayinde H. Impact of new-onset versus pre-existing atrial fibrillation on outcomes after transcatheter aortic valve replacement/implantation. IJC HEART & VASCULATURE 2022; 38:100910. [PMID: 35146118 PMCID: PMC8802123 DOI: 10.1016/j.ijcha.2021.100910] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022]
Abstract
Atrial fibrillation increases the risk of all primary and secondary outcomes after TAVR/TAVI. NOAF is associated with a higher risk of 30-day mortality, stroke, and extended LOS after TAVR/TAVI. Pre-AF is associated with a higher risk of AKI and early bleeding episodes after TAVR/TAVI.
Patients with aortic stenosis who undergo transcatheter aortic valve replacement/transcatheter aortic valve implantation (TAVR/TAVI) experience a high incidence of pre-existing atrial fibrillation (pre-AF) and new-onset atrial fibrillation (NOAF) post-operatively. This systematic review and meta-analysis aimed to update current evidence concerning the incidence of 30-day mortality, stroke, acute kidney injury (AKI), length of stay (LOS), and early/late bleeding in patients with NOAF or pre-AF who undergo TAVR/TAVI. PubMed, Google Scholar, JSTOR, Cochrane Library, and Web of Science were searched for studies published between January 2012 and December 2020 reporting the association between NOAF/pre-AF and clinical complications after TAVR/TAVI. A total of 15 studies including 158,220 adult patients with TAVI/TAVR and NOAF or pre-AF were identified. Compared to patients in sinus rhythm, patients who developed NOAF had a higher risk of 30-day mortality, AKI, early bleeding events, extended LOS, and stroke after TAVR/TAVI (odds ratio [OR]: 3.18 [95% confidence interval [CI] 1.58, 6.40]) (OR: 3.83 [95% CI 1.18, 12.42]) (OR: 1.70 [95% CI 1.05, 2.74]) (OR: 13.96 [95% CI, 6.41, 30.40]) (OR: 2.51 [95% CI 1.59, 3.97], respectively). Compared to patients in sinus rhythm, patients with pre-AF had a higher risk of AKI and early bleeding episodes after TAVR/TAVI (OR: 2.43 [95% CI 1.10, 5.35]) (OR: 17.41 [95% CI 6.49, 46.68], respectively). Atrial fibrillation is associated with a higher risk of all primary and secondary outcomes. Specifically, NOAF but not pre-AF is associated with a higher risk of 30-day mortality, stroke, and extended LOS after TAVR/TAVI.
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Liang X, Zheng C, Ding K, Huang X, Zhang S, Lei Y, Yu K, Wang Y. Arginine-grafted porcine pericardium by copolymerization to improve cytocompatibility, hemocompatibility and anti-calcification properties of bioprosthetic heart valve materials. J Mater Chem B 2022; 10:5571-5581. [DOI: 10.1039/d2tb00798c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Bioprosthetic heart valves (BHVs) have been used widely due to the development of transcatheter heart valve replacement technology. However, glutaraldehyde crosslinked pericardium (GA), which is widely used as a leaflet...
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Association between time-related changes in routine blood morphological parameters and renal function after transcatheter aortic valve implantation - a preliminary study. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 18:152-158. [PMID: 34703472 PMCID: PMC8525280 DOI: 10.5114/kitp.2021.109368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/17/2022]
Abstract
Introduction Transcatheter aortic valve implantation (TAVI) although minimally invasive is still accompanied by changes in blood morphological parameters, some of them linked to unfavorable outcomes. Aim To find any association between changes in blood morphology reflecting an inflammatory response and acute kidney injury (AKI). Material and methods This study involved 176 consecutive transfemoral TAVI patients with a mean age of 78.4 ±7.0 years. Serum creatinine concentration (CREA) and blood morphology were analyzed in the blood samples taken before the procedure, then approximately 1, 24, 48 and 72 hours after the procedure, and lastly at the time of discharge. Post-procedural maximal or minimal values (max/min) and max/min-to-bs ratio of the laboratory parameters were also calculated. Results Leucocyte (WBC) and neutrophil (NEUT) counts increased significantly after the procedure whereas lymphocyte (LYMPH) counts declined markedly, reaching the highest or lowest values 24 hours after the procedure. A significant increase in neutrophil-to-lymphocyte ratio (NLR) was observed. Platelet count (PLT) dropped to a minimum at 72 hours after TAVI but at discharge did not return to the admission level. TAVI was associated with a marked increase in CREA with a peak at 48 hours after the procedure (135.7 ±75.9 μM/l). Patients with AKI (n = 65; 36.9%) presented more pronounced variations in relative changes in counts of all blood morphological parameters. A positive moderate (r = 0.412) correlation between maximal NLR and relative CREA changes was noted. Conclusions TAVI is associated with significant changes in blood morphological parameters that reflect an inflammatory response. They are more pronounced among subjects with post-procedural AKI.
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Coccia M. Evolution of technology in replacement of heart valves: Transcatheter aortic valves, a revolution for management of valvular heart diseases. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.100512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mahon C, Davies A, Gambaro A, Musella F, Costa AL, Panoulas V, Nicol E, Duncan A, Davies S, Mirsadraee S. Association of individual aortic leaflet calcification on paravalvular regurgitation and conduction abnormalities with self-expanding trans-catheter aortic valve insertion. Quant Imaging Med Surg 2021; 11:1970-1982. [PMID: 33936979 DOI: 10.21037/qims-20-1122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Complication rates of paravalvular aortic regurgitation (PVR) and permanent pacemaker insertion remain high in patients undergoing trans-catheter aortic valve insertion for severe aortic stenosis. The spatial distribution of calcium between individual aortic valve leaflets, and its potential role in these complications is gaining interest. We aimed to assess the accuracy of individual aortic valve leaflet calcium quantification, and to determine its effect on the frequency of these complications. Methods This was a retrospective study of 251 patients who underwent trans-catheter aortic valve insertion using the Evolut RTM valve. The off-line Terarecon software platform was used for Agatston scoring the short axis views. Results There was a correlation between the sum of the individual leaflet and the total aortic valve calcium score. There was a univariate association between an increase [per 100 Agatston unit (AU)] in both right coronary leaflet (RCL) and left coronary leaflet (LCL) calcium with the risk of PVR. There was an association between an increase in LCL calcium score (per 100 AU) and need for post-implantation balloon aortic valvuloplasty (BAV). There was no association between individual leaflet calcification on the risk of permanent pacemaker insertion. Conclusions This study supports the idea that a quantifiable and reproducible method of individual valve leaflet calcification score may serve as an independent risk factor for paravalvular regurgitation, beyond visual assessment of asymmetry. However, the same may not be true of spatial calcium distribution and permanent pacemaker implantation (PPI).
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Affiliation(s)
- Ciara Mahon
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Allan Davies
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Alessia Gambaro
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Ana Luisa Costa
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Edward Nicol
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Alison Duncan
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Simon Davies
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Al-Khadra Y, Sattar Y, Ullah W, Moussa Pacha H, Baibars M, Darmoch F, Abu-Mahfouz M, Afonso L, Devireddy C, Anwaruddin S, Sorajja P, Ajmal R, Kwok CS, Asfour AI, Zehr K, Mamas MA, Alraies MC. Temporal trends and outcomes in utilisation of transcatheter and surgical aortic valve therapies in aortic valve stenosis patients with heart failure. Int J Clin Pract 2021; 75:e13711. [PMID: 32955776 DOI: 10.1111/ijcp.13711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTIONS & AIMS Heart failure (HF) is a common comorbidity in patients undergoing surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). We sought to access the temporal trends and outcomes of TAVR or SAVR in HF patients. METHOD The NIS database from 2011-2014 was queried for patients that underwent TAVR or SAVR and were subsequently diagnosed with HF. Temporal trends in the utilisation of TAVR or SAVR in HF patients were analysed. RESULTS Among 27 982 patients who were diagnosed with HF of whom 17 681 (63.2%) had heart failure with reduced ejection fraction (HFrEF) while 10 301 (36.8%) had heart failure with preserved ejection fraction (HFpEF), 9049 (32.3%) underwent TAVR and 16 933 (76.7%) underwent SAVR. Patients with HFrEF and HFpEF had higher utilisation of TAVR compared with SAVR over the course of the study period (P trend < .001). TAVR was associated with lower mortality [2.8% in 2012 and 1.8% in 2014 (P .013)] compared with SAVR. Similarly, multiple logistic regression showed a statistically significant lower in-hospital mortality in the TAVR group compared with SAVR (aOR 0.634; CI 0.504, 0.798, P < .001). CONCLUSION For patients with severe aortic valve stenosis and heart failure who undergo aortic valve intervention, TAVR is associated with less odds of in-hospital mortality compared with SAVR.
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Affiliation(s)
| | - Yasar Sattar
- Icahn School of Medicine at Mount, Sinai Elmhurst Hospital, Queens, NY, USA
| | - Waqas Ullah
- Abington Jefferson Health, Abington, PA, USA
| | - Homam Moussa Pacha
- McGovern Medical School, Memorial Hermann Heart & Vascular Institute, University of Texas Health Science Center, Houston, TX, USA
| | - Motaz Baibars
- Department of Medicine, John Hopkins University, Baltimore, MD, USA
| | - Fahed Darmoch
- Harvard School of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mohammed Abu-Mahfouz
- Detroit Medical Center, Wayne State University, DMC Heart Hospital, Detroit, MI, USA
| | - Luis Afonso
- Detroit Medical Center, Wayne State University, DMC Heart Hospital, Detroit, MI, USA
| | | | - Saif Anwaruddin
- Department of Cardiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul Sorajja
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Rasikh Ajmal
- Detroit Medical Center, Wayne State University, DMC Heart Hospital, Detroit, MI, USA
| | - Chun Shing Kwok
- Cardiovascular Research Group, Institute for Science & Technology in Medicine, Keel University, Newcastle upon Tyne, UK
| | | | - Kenton Zehr
- Detroit Medical Center, Wayne State University, DMC Heart Hospital, Detroit, MI, USA
| | - Mamas A Mamas
- Department of Cardiology, Keele University, Stoke on Trent, UK
| | - M Chadi Alraies
- Detroit Medical Center, Wayne State University, DMC Heart Hospital, Detroit, MI, USA
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Guo G, Jin L, Wu B, He H, Yang F, Xu L, Lei Y, Wang Y. A method for simultaneously crosslinking and functionalizing extracellular matrix-based biomaterials as bioprosthetic heart valves with enhanced endothelialization and reduced inflammation. Acta Biomater 2021; 119:89-100. [PMID: 33099025 DOI: 10.1016/j.actbio.2020.10.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 11/18/2022]
Abstract
With the coming of an aging society and the emergence of transcatheter valve technology, the implantation of bioprosthetic heart valves (BHVs) in patients with valvular disease has significantly increased worldwide. Currently, most clinically available BHVs are crosslinked with glutaraldehyde (GLUT). However, the GLUT treated BHV is less durable due to the combined effect of multiple factors such as cytotoxicity, immune responses, and calcification. In this study, the in-situ polymerization of sulfonic monomers with a decellularized extracellular matrix (ECM) was performed to simultaneously achieve the crosslinking and functionalization of ECM. Subsequently, the feasibility of the hybrid ECM used as leaflet material of BHV was evaluated. In in-vitro tests, the results indicated that the hybrid ECM fixed collagen efficiently and the introduction of sulfonic polymer promoted the proliferation and migration of human umbilical vein endothelial cells (HUVECs). In in-vivo tests, after being implanted in SD rats and mice, the hybrid ECM significantly inhibited immune response and calcification compared with the non-hybrid counterpart and GLUT crosslinked tissue. These results indicated that the hybrid ECM exhibited more competitive stability and better biocompatibility compared to these features in GLUT-crosslinked valve. Therefore, the sulfonic polymer hybrid ECM provides a potential material for more durable BHV and the in-situ polymerization strategy can serve as a general treatment method for tissue crosslinking as well as tailoring the biophysical properties of ECM.
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Affiliation(s)
- Gaoyang Guo
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Linhe Jin
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Binggang Wu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Haiyang He
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Fan Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Liangpeng Xu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Yang Lei
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China.
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China.
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TAVI imaging: over the echocardiography. Radiol Med 2020; 125:1148-1166. [DOI: 10.1007/s11547-020-01281-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/03/2020] [Indexed: 12/26/2022]
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Latif A, Lateef N, Ahsan MJ, Kapoor V, Usman RM, Cooper S, Andukuri V, Mirza M, Ashfaq MZ, Khouzam R. Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Cardiac Surgery: Meta-Analysis and Systematic Review of the Literature. J Cardiovasc Dev Dis 2020; 7:jcdd7030036. [PMID: 32927705 PMCID: PMC7570107 DOI: 10.3390/jcdd7030036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 11/16/2022] Open
Abstract
The number of patients with severe aortic stenosis (AS) and a history of prior cardiac surgery has increased. Prior cardiac surgery increases the risk of adverse outcomes in patients undergoing aortic valve replacement. To evaluate the impact of prior cardiac surgery on clinical endpoints in patients undergoing transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR), we performed a literature search using PubMed, Embase, Google Scholar, and Scopus databases. The clinical endpoints included in our study were 30-day mortality, 1-2-year mortality, acute kidney injury (AKI), bleeding, stroke, procedural time, and duration of hospital stay. Seven studies, which included a total of 8221 patients, were selected. Our study found that TAVR was associated with a lower incidence of stroke and bleeding complications. There was no significant difference in terms of AKI, 30-day all-cause mortality, and 1-2-year all-cause mortality between the two groups. The average procedure time and duration of hospital stay were 170 min less (p ≤ 0.01) and 3.6 days shorter (p < 0.01) in patients with TAVR, respectively. In patients with prior coronary artery bypass graft and severe AS, both TAVR and SAVR are reasonable options. However, TAVR may be associated with a lower incidence of complications like stroke and perioperative bleeding, in addition to a shorter length of stay.
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Affiliation(s)
- Azka Latif
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
- Correspondence: ; Tel.: +1-402-651-4961
| | - Noman Lateef
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Muhammad Junaid Ahsan
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Vikas Kapoor
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Rana Mohammad Usman
- Department of Internal Medicine, University of Tennessee, Memphis, TN 38152, USA;
| | - Stephen Cooper
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Venkata Andukuri
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Mohsin Mirza
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Muhammad Zubair Ashfaq
- Department of Internal Medicine, Creighton University, Omaha, NE 68124, USA; (N.L.); (M.J.A.); (V.K.); (S.C.); (V.A.); (M.M.); (M.Z.A.)
| | - Rami Khouzam
- Department of Cardiology, University of Tennessee, Memphis, TN 38152, USA;
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14
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Useini D, Beluli B, Christ H, Mügge A, Patsalis P, Schlömicher M, Haldenwang P, Bechtel M, Strauch J. Oversized versus Non-oversized Prosthesis: Midterm Outcomes after Transcatheter Aortic Valve Replacement Using SAPIEN 3 Valve. Thorac Cardiovasc Surg 2020; 69:445-454. [PMID: 32688405 DOI: 10.1055/s-0040-1713168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND A certain degree of prosthesis oversizing is recommended for the SAPIEN 3 (S3; Edwards Lifesciences Corp., Irvine, California, United States) to ensure device success. We aimed to investigate midterm outcomes in patients who received oversized (OS) S3 valve after transapical-transcatheter aortic valve replacement (TA-TAVR). METHODS Out of 122 patients with aortic stenosis who underwent TA-TAVR using S3 at our institution, 42 received OS prosthesis. We used computed tomography (CT) derived effective diameter to assess oversizing. We defined oversizing if the labeled diameter of the selected valve for implantation was ≥2 mm bigger than the effective annulus diameter calculated by the annulus area. We conducted a midterm follow-up and compared the OS cohort with the non-OS (nOS) cohort. RESULTS The study groups showed similar risk score and age (STS [Society of Thoracic Surgery] score: 5.4 ± 3; mean age: 80.7 ± 5.7). The 30-day mortality was 7.1% in OS versus 2.4% in nOS. The 30-day all-stroke was 2.4% in OS versus 0% in nOS. The 1- and 3-year all-cause mortality were 28.5 and 42.8% in OS versus 21.9 and 26.8% in nOS, respectively. Midterm freedom from death and from cardiocerebral events was similar in both groups. Moderate/severe paravalvular leakage occurred in 0% in OS versus 5.4% in nOS. The postdilation rate was 7.1% in OS versus 15.3% in nOS. The rate of new permanent pacemaker implantation (PPI) was 15.7% in OS versus 9.3% in nOS. The STS score was detected as an independent predictor of mortality. CONCLUSION Oversizing reduces the risk of device failure and intraprocedural postdilation but increases the risk of PPI. Early and midterm morbidity and mortality after OS and nOS with S3 are comparable.
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Affiliation(s)
- Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Blerta Beluli
- Department of Internal Medicine, St. Anna Hospital, Herne, Germany
| | - Hildegard Christ
- Institute of Medical Statistics and Computational Biology (IMSB), University Hospital of Cologne, Cologne, Germany
| | - Andreas Mügge
- Department of Cardiology and Angiology, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Polykarpos Patsalis
- Department of Cardiology and Angiology, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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15
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Ultrasound-Guided Percutaneous Balloon Aortic Valvuloplasty for Aortic Stenosis. J Interv Cardiol 2020; 2020:8086796. [PMID: 32256250 PMCID: PMC7102489 DOI: 10.1155/2020/8086796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/18/2020] [Indexed: 11/28/2022] Open
Abstract
Percutaneous balloon aortic valvuloplasty (PBAV), which is used to treat symptomatic aortic stenosis, requires ionizing radiation and contrast agent for imaging guidance. The aim of the study is to evaluate the feasibility and effectiveness of ultrasound-guided PBAV in patients with aortic stenosis. This case series included 30 patients (14 males; mean age, 61.5 ± 4.5 years) with moderate/severe aortic stenosis treated with ultrasound-guided PBAV at the Ultrasound Department, Fuwai Hospital, Beijing, China, between January 2016 and July 2019. Cardiac function (New York Heart Association grade) was assessed before PBAV and 1 month after the procedure. Aortic peak jet velocity, aortic valve orifice area (AVA), mean transvalvular pressure gradient (MTPG), left ventricular end-diastolic diameter (LVDD), left ventricular ejection fraction (LVEF), and left ventricular end-systolic diameter (LVESD) were determined before and immediately after PBAV using Doppler echocardiography. Preprocedural cardiac function was grade I in 3 cases, grade II in 9 cases, grade III in 10 cases, and grade IV in 8 cases. Postprocedural cardiac function was grade I in 22 cases, grade II in 4 cases, and grade III in 4 cases, suggesting that cardiac function was improved by PBAV. Ultrasound-guided PBAV resulted in significant improvements (P < 0.05) in aortic peak jet velocity (3.68 ± 0.811 m/s vs. 4.79 ± 0.63 m/s), MTPG (33.77 ± 13.85 mmHg vs. 54.54 ± 13.81 mmHg), AVA (1.96 ± 0.25 cm2 vs. 0.98 ± 0.12 cm2), LVEDD (51.90 ± 3.21 mm vs. 65.60 ± 6.81 mm), LVEF (63.46 ± 11.29% vs. 56.31 ± 11.04%), and LVESD (35.50 2.62 mm vs. 45.20 ± 2.42 mm). Ultrasound-guided PBAV is feasible and achieves good short-term effects in patients with aortic stenosis.
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16
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Mahon C, Mohiaddin RH. The emerging applications of cardiovascular magnetic resonance imaging in transcatheter aortic valve implantation. Clin Radiol 2019; 76:73.e21-73.e37. [PMID: 31879023 DOI: 10.1016/j.crad.2019.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/13/2019] [Indexed: 12/22/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement in selected patients with severe symptomatic aortic stenosis (AS) and high surgical risk. The planning and follow-up of TAVI requires an array of imaging techniques, each has advantages and limitations. Echocardiography and multidetector computer tomography (MDCT) have established applications in patient selection and procedure guidance, but are limited in some patients. TAVI applications of cardiovascular magnetic resonance imaging (CMRI) are emerging. CMRI can provide the structural and functional imaging details required for TAVI procedure in away comparable or superior to that obtained by echocardiography and MDCT combined. In this review, we look at the continuously evolving role of CMRI as a complimentary or an alternative to more established imaging techniques and address the advantages and disadvantages of CMRI in this setting. We discuss the role of CMRI in selecting anatomically suitable patients for the TAVI procedure and in the post-TAVI follow-up with particular emphasis on its applications for assessing AS severity and haemodynamic impact, vascular imaging for TAVI access route, quantification of paravalvular leaks and LV remodelling in the post TAVI setting as well as providing imaging biomarkers tool for AS risk-stratification.
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Affiliation(s)
- C Mahon
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - R H Mohiaddin
- Royal Brompton and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
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17
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Sangaraju S, Cox I, Dalrymple-Hay M, Lloyd C, Suresh V, Riches T, Melhuish S, Asopa S, Newcombe S, Deutsch C, Bramlage P. Effect of procedural refinement of transfemoral transcatheter aortic valve implantation on outcomes and costs: a single-centre retrospective study. Open Heart 2019; 6:e001064. [PMID: 31673385 PMCID: PMC6802979 DOI: 10.1136/openhrt-2019-001064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/16/2019] [Accepted: 09/12/2019] [Indexed: 11/28/2022] Open
Abstract
Objectives To determine the effect of introducing several procedural refinements of transfemoral transcatheter aortic valve implantation (TAVI) on clinical outcomes and costs. Design Retrospective analysis comparing two consecutive 1-year periods, before and after the introduction of procedural refinements. Setting Tertiary hospital aortic valve programme. Participants Consecutive patients undergoing transfemoral TAVI treated between April 2014 and August 2015 using the initial setup (n=70; control group) or between September 2015 and August 2016 after the introduction of procedural refinements (n=89). Interventions Introduction of conscious sedation, percutaneous access and closure, omission of transoesophageal echocardiography during the procedure, and an early discharge procedure. Outcome measures Procedural characteristics, complications and outcomes; length of stay in intensive care unit (ICU) and hospital; hospital-related direct costs associated with TAVI. Results There were no statistically significant differences in the incidence of complications or mortality between the two groups. The mean length of stay in the ICU was significantly shorter in the procedural-refinement group compared with the control group (5.1 vs 57.2 hours, p<0.001), as was the mean length of hospital stay (4.7 vs 6.6 days, p<0.001). The total cost per TAVI procedure was significantly lower, by £3580, in the procedural-refinement group (p<0.001). This was largely driven by lower ICU costs. Conclusions Among patients undergoing transfemoral TAVI, procedural refinement facilitated a shorter stay in ICU and earlier discharge from hospital and was cost saving compared with the previous setup.
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Affiliation(s)
| | - Ian Cox
- Cardiology, University Hospitals Plymouth NHS, Plymouth, Devon, UK
| | | | - Clinton Lloyd
- Cardiology, University Hospitals Plymouth NHS, Plymouth, Devon, UK
| | | | - Tania Riches
- Cardiology, University Hospitals Plymouth NHS, Plymouth, Devon, UK
| | | | - Sanjay Asopa
- Cardiology, University Hospitals Plymouth NHS, Plymouth, Devon, UK
| | | | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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18
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Meduri CU, Kereiakes DJ, Rajagopal V, Makkar RR, O'Hair D, Linke A, Waksman R, Babliaros V, Stoler RC, Mishkel GJ, Rizik DG, Iyer VS, Schindler J, Allocco DJ, Meredith IT, Feldman TE, Reardon MJ. Pacemaker Implantation and Dependency After Transcatheter Aortic Valve Replacement in the REPRISE III Trial. J Am Heart Assoc 2019; 8:e012594. [PMID: 31640455 PMCID: PMC6898843 DOI: 10.1161/jaha.119.012594] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background As transcatheter aortic valve replacement expands to younger and/or lower risk patients, the long‐term consequences of permanent pacemaker implantation are a concern. Pacemaker dependency and impact have not been methodically assessed in transcatheter aortic valve replacement trials. We report the incidence and predictors of pacemaker implantation and pacemaker dependency after transcatheter aortic valve replacement with the Lotus valve. Methods and Results A total of 912 patients with high/extreme surgical risk and symptomatic aortic stenosis were randomized 2:1 (Lotus:CoreValve) in REPRISE III (The Repositionable Percutaneous Replacement of Stenotic Aortic Valve through Implantation of Lotus Valve System—Randomized Clinical Evaluation) trial. Systematic assessment of pacemaker dependency was pre‐specified in the trial design. Pacemaker implantation within 30 days was more frequent with Lotus than CoreValve. By multivariable analysis, predictors of pacemaker implantation included baseline right bundle branch block and depth of implantation; diabetes mellitus was also a predictor with Lotus. No association between new pacemaker implantation and clinical outcomes was found. Pacemaker dependency was dynamic (30 days: 43%; 1 year: 50%) and not consistent for individual patients over time. Predictors of pacemaker dependency at 30 days included baseline right bundle branch block, female sex, and depth of implantation. No differences in mortality or stroke were found between patients who were pacemaker dependent or not at 30 days. Rehospitalization was higher in patients who were not pacemaker dependent versus patients without a pacemaker or those who were dependent. Conclusions Pacemaker implantation was not associated with adverse clinical outcomes. Most patients with a new pacemaker at 30 days were not dependent at 1 year. Mortality and stroke were similar between patients with or without pacemaker dependency and patients without a pacemaker. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier NCT02202434.
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Affiliation(s)
| | - Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center The Lindner Research Center Cincinnati OH
| | | | | | | | - Axel Linke
- Dresden University Hospital, Heart Center Dresden Germany
| | | | | | | | | | - David G Rizik
- HonorHealth and the Scottsdale-Lincoln Health Network Scottsdale AZ
| | - Vijay S Iyer
- University at Buffalo/Gates Vascular Institute Buffalo NY
| | | | | | | | - Ted E Feldman
- Edwards Lifesciences Irvine California.,Northshore University Health System Evanston Hospital Evanston Illinois
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19
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van Baal JWPM, Roszek B, van Elk M, Geertsma RE. Transcatheter aortic valve replacement: clinical safety and performance data. Expert Rev Med Devices 2019; 16:899-911. [PMID: 31564181 DOI: 10.1080/17434440.2019.1674138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Patients with severe aortic stenosis and regurgitation who are inoperable or at high-risk for surgery can be treated with transcatheter aortic valve replacement (TAVR). The aim of this study was to provide a comprehensive overview of the literature of TAVR and reported clinical and performance outcomes. Areas covered: A total of 16 devices, described in 204 articles describing clinical and performance outcomes, were included. The most frequently observed outcome was 30-day mortality, ranging between 0-23%. Other commonly reported clinical outcomes were 30-day stroke, ranging between 0-14.3% and pacemaker implantation, ranging from 0-44.9%. The most common valve performance outcome was aortic valve regurgitation, however, mostly reported at 7 days follow-up. Next to a follow-up period of 30 days, numerous articles reported outcomes at 6 months and 1 year. The numbers of articles describing outcomes with a longer follow-up as well as including intermediate and low-risk patients were limited. Expert commentary: This literature review provided a clear overview of the reported clinical and performance outcomes of TAVR devices. Despite the frequently used VARC-2 definitions, we identified a huge variation across studies. Future studies using standardized definitions of study set-ups and outcomes are essential and might lead to better insights of TAVR.
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Affiliation(s)
- Jantine W P M van Baal
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM) , Bilthoven , the Netherlands
| | - Boris Roszek
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM) , Bilthoven , the Netherlands
| | - Merel van Elk
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM) , Bilthoven , the Netherlands
| | - Robert E Geertsma
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM) , Bilthoven , the Netherlands
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20
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Outcomes of transcatheter aortic valve replacement in patients with mitral valve regurgitation. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2019; 15:187-194. [PMID: 31497051 PMCID: PMC6727220 DOI: 10.5114/aic.2019.86011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 02/11/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction Transcatheter aortic valve replacement (TAVR) is currently considered a class I indication for patients with severe symptomatic aortic stenosis and high/prohibitive surgical risk. Aim We describe the effect of concomitant mitral valve regurgitation (MR) on post-procedural TAVR outcomes. Material and methods The study population was extracted from the 2014 National Readmissions Data (NRD) using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for TAVR, MR and post-procedural outcomes. Propensity matching was used to extract a control group of TAVR patients without MR (TAVR-C) to the TAVR with concomitant MR group (TAVR-MR). Study outcomes included in-hospital all-cause mortality, in-hospital post-procedural stroke, acute myocardial infarction (AMI), bleeding, mechanical complications of prosthetic valve, vascular complications (VC), need for new permanent pacemaker implantation (PPM) and 30-day readmission rates. Results A total of 1511 patients were identified in each group (mean age: 81.7 years, 49.3% male); the two groups were comparable in terms of baseline characteristics and co-morbidities. When compared to TAVR-C, TAVR-MR was associated with lower post-procedural stroke (3.5% vs. 5.2%, p = 0.03). There was no significant difference between groups in terms of all-cause mortality (4.1% vs. 4.5%, p = 0.59), AMI (3.2% vs. 2.9%, p = 0.59), bleeding (33.4% vs. 35.6%, p = 0.19), mechanical complications of prosthetic valve (2.5% vs. 1.9%, p = 0.31), VC (3.2% vs. 4.4%, p = 0.06), the need for PPM (7.9% vs. 9.1%, p = 0.21) or 30-day readmission rates (19.0% vs. 19.1%, p = 0.95). Conclusions TAVR-MR was associated with lower post-procedural stroke but comparable other in-hospital outcomes and 30-day readmission rates to TAVR-C.
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21
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Delirium is associated with higher mortality in transcatheter aortic valve replacement: systemic review and meta-analysis. Cardiovasc Interv Ther 2019; 35:168-176. [DOI: 10.1007/s12928-019-00592-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/23/2019] [Indexed: 12/15/2022]
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22
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Abstract
Transcatheter aortic valve replacement (TAVR) is indicated in some patients with severe aortic stenosis for whom surgical intervention is not deemed appropriate. This article explores when TAVR may be the preferred treatment option over surgical aortic valve replacement and discusses various prosthetic valve devices. The TAVR procedure, diagnostic screenings, complications, postoperative management, and nursing considerations are also outlined.
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23
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Giordano A, Corcione N, Ferraro P, Pieri P, Avellino R, Frati G, De Persio G, Altamura L, Tomai F, Biondi-Zoccai G. Propensity-score-adjusted comparison of Evolut vs. Portico devices for transcatheter aortic valve implantation. J Cardiovasc Med (Hagerstown) 2019; 20:351-357. [PMID: 30676494 DOI: 10.2459/jcm.0000000000000764] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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24
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Mäkikallio T, Jalava MP, Husso A, Virtanen M, Laakso T, Ahvenvaara T, Tauriainen T, Maaranen P, Kinnunen EM, Dahlbacka S, Jaakkola J, Airaksinen J, Anttila V, Savontaus M, Laine M, Juvonen T, Valtola A, Raivio P, Eskola M, Niemelä M, Biancari F. Ten-year experience with transcatheter and surgical aortic valve replacement in Finland. Ann Med 2019; 51:270-279. [PMID: 31112060 PMCID: PMC7880078 DOI: 10.1080/07853890.2019.1614657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Aim: We investigated the outcomes of transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in Finland during the last decade. Methods: The nationwide FinnValve registry included data from 6463 patients who underwent TAVR or SAVR with a bioprosthesis for aortic stenosis from 2008 to 2017. Results: The annual number of treated patients increased three-fold during the study period. Thirty-day mortality declined from 4.8% to 1.2% for TAVR (p = .011) and from 4.1% to 1.8% for SAVR (p = .048). Two-year survival improved from 71.4% to 83.9% for TAVR (p < .001) and from 87.2% to 91.6% for SAVR (p = .006). During the study period, a significant reduction in moderate-to-severe paravalvular regurgitation was observed among TAVR patients and a reduction of the rate of acute kidney injury was observed among both SAVR and TAVR patients. Similarly, the rate of red blood cell transfusion and severe bleeding decreased significantly among SAVR and TAVR patients. Hospital stay declined from 10.4 ± 8.4 to 3.7 ± 3.4 days after TAVR (p < .001) and from 9.0 ± 5.9 to 7.8 ± 5.1 days after SAVR (p < .001). Conclusions: In Finland, the introduction of TAVR has led to an increase in the invasive treatment of severe aortic stenosis, which was accompanied by improved early outcomes after both SAVR and TAVR. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03385915 Key Messages This study demonstrated that the introduction of transcatheter aortic valve replacement has led to its widespread use as an invasive treatment for severe aortic stenosis. Early and 2-year survival after transcatheter and surgical aortic valve replacement has improved during past decade. Transcatheter aortic valve replacement has fulfilled its previously unmet clinical needs and has surpassed surgical aortic valve replacement as the most common invasive treatment for aortic stenosis.
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Affiliation(s)
- Timo Mäkikallio
- a Department of Internal Medicine , Oulu University Hospital , Oulu , Finland
| | - Maina P Jalava
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | | | - Marko Virtanen
- d Heart Hospital , Tampere University Hospital , Tampere , Finland
| | - Teemu Laakso
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Tuomas Ahvenvaara
- f Department of Surgery , Oulu University Hospital and University of Oulu , Finland
| | - Tuomas Tauriainen
- f Department of Surgery , Oulu University Hospital and University of Oulu , Finland
| | - Pasi Maaranen
- d Heart Hospital , Tampere University Hospital , Tampere , Finland
| | | | | | - Jussi Jaakkola
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Juhani Airaksinen
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Vesa Anttila
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Mikko Savontaus
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Mika Laine
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Tatu Juvonen
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Antti Valtola
- c Heart Center , Kuopio University Hospital , Kuopio , Finland
| | - Peter Raivio
- e Heart Center , Helsinki University Hospital , Helsinki , Finland
| | - Markku Eskola
- d Heart Hospital , Tampere University Hospital , Tampere , Finland
| | - Matti Niemelä
- a Department of Internal Medicine , Oulu University Hospital , Oulu , Finland
| | - Fausto Biancari
- b Heart Center , Turku University Hospital and University of Turku , Turku , Finland.,f Department of Surgery , Oulu University Hospital and University of Oulu , Finland.,g Department of Surgery , University of Turku, Turku , Finland
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25
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Pighi M, Piazza N, Martucci G, Lachapelle K, Perrault LP, Asgar AW, Lauck S, Webb JG, Popma JJ, Kim DH, Lefèvre T, Labinaz M, Lamy A, Peterson MD, Arora RC, Noiseux N, Trnkus A, Afilalo J. Sex-Specific Determinants of Outcomes After Transcatheter Aortic Valve Replacement. Circ Cardiovasc Qual Outcomes 2019; 12:e005363. [DOI: 10.1161/circoutcomes.118.005363] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michele Pighi
- Division of Cardiology (M.P., N.P., G.M.), McGill University Health Centre, Montreal, QC, Canada
| | - Nicolo Piazza
- Division of Cardiology (M.P., N.P., G.M.), McGill University Health Centre, Montreal, QC, Canada
| | - Giuseppe Martucci
- Division of Cardiology (M.P., N.P., G.M.), McGill University Health Centre, Montreal, QC, Canada
| | - Kevin Lachapelle
- Division of Cardiac Surgery (K.L.), McGill University Health Centre, Montreal, QC, Canada
| | - Louis P. Perrault
- Department of Cardiac Surgery (L.P.P.), Institut de Cardiologie de Montréal, Université de Montréal, QC, Canada
| | - Anita W. Asgar
- Division of Cardiology (A.W.A.), Institut de Cardiologie de Montréal, Université de Montréal, QC, Canada
| | - Sandra Lauck
- Centre for Heart Valve Innovation, St Paul’s Hospital, University of Vancouver, BC (S.L., J.G.W.)
| | - John G. Webb
- Centre for Heart Valve Innovation, St Paul’s Hospital, University of Vancouver, BC (S.L., J.G.W.)
| | - Jeffrey J. Popma
- Division of Cardiology (J.J.P.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA
| | - Dae H. Kim
- Division of Gerontology (D.H.K.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA
| | - Thierry Lefèvre
- Division of Cardiology, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France (T.L.)
| | - Marino Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, ON, Canada (M.L.)
| | - Andre Lamy
- Division of Cardiac Surgery, Hamilton Health Sciences, Population Health Research Institute, McMaster University, ON, Canada (A.L.)
| | - Mark D. Peterson
- Division of Cardiac Surgery, St Michael’s Hospital, University of Toronto, ON, Canada (M.D.P.)
| | - Rakesh C. Arora
- Section of Cardiac Surgery, St Boniface Hospital, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (R.C.A.)
| | - Nicolas Noiseux
- Division of Cardiac Surgery, Centre Hospitalier de l’Université de Montréal, Centre de Recherche du CHUM, QC, Canada (N.N.)
| | - Amanda Trnkus
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, QC, Canada (A.T., J.A.)
| | - Jonathan Afilalo
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, QC, Canada (A.T., J.A.)
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (J.A.)
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26
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Jin L, Guo G, Jin W, Lei Y, Wang Y. Cross-Linking Methacrylated Porcine Pericardium by Radical Polymerization Confers Enhanced Extracellular Matrix Stability, Reduced Calcification, and Mitigated Immune Response to Bioprosthetic Heart Valves. ACS Biomater Sci Eng 2019; 5:1822-1832. [DOI: 10.1021/acsbiomaterials.9b00091] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Linhe Jin
- National Engineering Research Center for Biomaterials, Sichuan University, No. 24 South Section 1 Yihuan Road, Chengdu 610064, P. R. China
| | - Gaoyang Guo
- National Engineering Research Center for Biomaterials, Sichuan University, No. 24 South Section 1 Yihuan Road, Chengdu 610064, P. R. China
| | - Wanyu Jin
- National Engineering Research Center for Biomaterials, Sichuan University, No. 24 South Section 1 Yihuan Road, Chengdu 610064, P. R. China
| | - Yang Lei
- National Engineering Research Center for Biomaterials, Sichuan University, No. 24 South Section 1 Yihuan Road, Chengdu 610064, P. R. China
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 24 South Section 1 Yihuan Road, Chengdu 610064, P. R. China
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Factors Associated with Discharge to a Skilled Nursing Facility after Transcatheter Aortic Valve Replacement Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010073. [PMID: 30597877 PMCID: PMC6339195 DOI: 10.3390/ijerph16010073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/18/2018] [Accepted: 12/25/2018] [Indexed: 12/24/2022]
Abstract
An assumption regarding transcatheter aortic valve replacement (TAVR), a minimally invasive procedure for treating aortic stenosis, is that patients remain at, or near baseline and soon return to their presurgical home to resume activities of daily living. However, this does not consistently occur. The purpose of this study was to identify preoperative factors that optimally predict discharge to a skilled nursing facility (SNF) after TAVR. Delineation of these conditions is an important step in developing a risk stratification model to assist in making informed decisions. Data was extracted from the American College of Cardiology (ACC) transcatheter valve therapy (TVT) registry and the Society of Thoracic Surgeons (STS) database on 285 patients discharged from 2012⁻2017 at a tertiary referral heart institute located in the southeastern region of the United States. An analysis of assessment, clinical and demographic variables was used to estimate relative risk (RR) of discharge to a SNF. The majority of participants were female (55%) and white (84%), with a median age of 82 years (interquartile range = 9). Approximately 27% (n = 77) were discharged to a SNF. Age > 75 years (RR = 2.3, p = 0.0026), female (RR = 1.6, p = 0.019), 5-meter walk test (5MWT) >7 s (RR = 2.0, p = 0.0002) and not using home oxygen (RR = 2.9, p = 0.0084) were identified as independent predictive factors for discharge to a SNF. We report a parsimonious risk-stratification model that estimates the probability of being discharged to a SNF following TAVR. Our findings will facilitate making informed treatment decisions regarding this older patient population.
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Health-related quality of life following transcatheter aortic valve implantation using transaortic, transfemoral approaches and surgical aortic valve replacement-a single-center study. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2018; 15:657-665. [PMID: 30534139 PMCID: PMC6283815 DOI: 10.11909/j.issn.1671-5411.2018.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective To evaluate short- and long-term changes in quality of life (QoL) in patients undergoing transcatheter aortic valve implantation (TAVI) and to assess differences in patient QoL when using the TAVI transaortic (TAVI TAo) approach compared with the transfemoral approach (TAVI TF) and surgical aortic valve replacement (SAVR). Methods Ninety-seven patients were assessed. Thirty-two patients underwent TAVI TAo, 31 underwent TAVI TF and 34 patients underwent SAVR. QoL was assessed using the EQ-5D-3L questionnaire at baseline, after one month and one year. Results Mean patient age was 80 years (range, 61–92 years) and the mean logistic EuroSCORE was 12.45% (range, 1.39%–78.98%). Declared health state at baseline was significantly lower in TAVI TF (P < 0.001) and after one month there were no differences between the three groups (P = 0.99). After one year, SAVR patient results of the EQ-5D-3L index value were lower in comparison to both TAVI patient groups (P < 0.05). The analysis also showed significant differences between the results of EQ-5D-3L index value over the one month and one year follow-up (TAVI TAo, P < 0.001; TAVI TF, P < 0.05; SAVR, P < 0.05). In all groups, the values significantly increased after one-month and one-year of follow-up in comparison to baseline value. Significant differences were also demonstrated between Visual Analogue Scale values (VAS). Conclusions A significant improvement in QoL was observed in all three patient groups. Regardless of the TAVI approach, EQ-5D-3L and VAS values were significantly increased after one-month and one-year follow up; the SAVR patients however, reported lower health status when compared to the TAVI patients.
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Lazkani M, Yerasi C, Prakash S, Pershad A, Fang K. Permanent pacemaker implantation and paravalvular leak rates following sutureless aortic valve operations. J Card Surg 2018; 33:808-817. [DOI: 10.1111/jocs.13938] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Mohamad Lazkani
- University of Colorado HealthMedical Center of the RockiesLovelandColorado
| | | | - Sheena Prakash
- University of ArizonaBanner University Medical CenterPhoenixArizona
| | - Ashish Pershad
- University of ArizonaBanner University Medical CenterPhoenixArizona
| | - Kenith Fang
- University of ArizonaBanner University Medical CenterPhoenixArizona
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Sarkar K. TAVI-thick on technology but thin on evidence. Indian J Thorac Cardiovasc Surg 2018; 35:468-472. [PMID: 33061032 PMCID: PMC7525850 DOI: 10.1007/s12055-018-0731-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/06/2018] [Accepted: 08/10/2018] [Indexed: 01/12/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as one of the most popularly deployed interventional innovations of recent times. After addressing the inoperable and high-risk patients, it is application is being extended to intermediate and low-risk category. There is some disquiet about the strength of evidence on which the clinical application is based. Durability and pacemaker requirement are also areas of concern. This review highlights the areas of concern on these aspects. There is also a need to address these deficiencies in future trials and also bring updated database reports in the public domain.
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Affiliation(s)
- Kunal Sarkar
- Medica Superspecialty Hospital, Kolkata, 700099 India
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Nalluri N, Atti V, Patel NJ, Kumar V, Arora S, Nalluri S, Nelluri BK, Maniatis GA, Kandov R, Kliger C. Propensity matched comparison of in-hospital outcomes of TAVR vs. SAVR in patients with previous history of CABG: Insights from the Nationwide inpatient sample. Catheter Cardiovasc Interv 2018; 92:1417-1426. [PMID: 30079611 DOI: 10.1002/ccd.27708] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/03/2018] [Accepted: 05/30/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND The incidence of patients with previous history of coronary artery bypass grafting (CABG) presenting for aortic valvular replacement has been consistently on the rise. Repeat sternotomy for surgical aortic valve replacement (SAVR) carries an inherent risk of morbidity and mortality when compared to Transcatheter aortic valve replacement (TAVR). METHODS The Nationwide inpatient sample (NIS) from 2012 to 2014 was queried using the International Classification of Diseases-Ninth edition, Clinical Modification (ICD-9-CM) codes to identify all patients ≥ 18 years with prior CABG who underwent TAVR (35.05 and 35.06) or SAVR (35.21 and 35.22). Propensity score matching (1:1) was performed and in-hospital outcomes were compared between matched cohorts. RESULTS From 2012 to 2014, there was progressive increase in the annual number of TAVR procedures from 1485 to 4020, with a decrease in patients undergoing SAVR from 2330 to 1955 (Ptrend < 0.0001) in the above population. There was no significant difference in in-hospital mortality rates. Compared to SAVR, TAVR was associated with lower risk of stroke (1.2% vs. 3.3%, P = 0.009), AKI (12.9% vs. 21.3%, P < 0.0001), myocardial infarction (0.9% vs. 2.7%, P = 0.01) and major bleeding (9.1% vs. 25.1%, P < 0.0001). TAVR was associated with higher risk of pacemaker implants (9.6% vs. 4.9%, P = 0.001) and trend toward lower risk of vascular complications (2.3% vs. 4.1%, P = 0.05). CONCLUSION In this large cohort of patients with previous CABG, there is no significant difference in in-hospital mortality between TAVR and SAVR. TAVR was associated with lower risk of in-hospital outcomes.
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Affiliation(s)
- Nikhil Nalluri
- Department of Cardiology, Staten Island University Hospital, New York City, New York
| | - Varunsiri Atti
- Department of Internal medicine, Michigan State University-Sparrow Hospital, East Lansing, Michigan
| | - Nileshkumar J Patel
- Department of Cardiology, University of Miami-Jackson Memorial Hospital, Miami, Florida
| | - Varun Kumar
- Department of Cardiology, Mount Sinai St Luke's Roosevelt hospital, New York City, New York
| | - Shilpkumar Arora
- Department of Internal medicine, Guthrie Robert Packer Hospital, Sayre, Pennsylvania
| | | | | | - Gregory A Maniatis
- Department of Cardiology, Staten Island University Hospital, New York City, New York
| | - Ruben Kandov
- Department of Cardiology, Staten Island University Hospital, New York City, New York
| | - Chad Kliger
- Department of Cardiology, Structural Heart Disease Lenox Hill Hospital, New York City, New York
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Nguyen TC, Rice RD, Umana-Pizano JB, Loyalka P. Minimally invasive removal of an infected Edwards S3 transcatheter aortic valve. J Thorac Cardiovasc Surg 2018; 157:e113-e116. [PMID: 33207405 DOI: 10.1016/j.jtcvs.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/18/2018] [Accepted: 06/05/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Memorial Hermann Hospital-Heart and Vascular Institute, Houston, Tex.
| | - Robert D Rice
- Department of Cardiothoracic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Ga
| | - Juan B Umana-Pizano
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Memorial Hermann Hospital-Heart and Vascular Institute, Houston, Tex
| | - Pranav Loyalka
- Division of Cardiology, Department of Internal Medicine, University of Texas Health Science Center Houston, McGovern Medical School, Memorial Hermann Hospital-Heart and Vascular Institute, Houston, Tex
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