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Hu Q, Li YS, Ren Q, Liang YC, Zhang J, Wang YX, Wang CL, Hong TL, Wang SY, Zhang Y, Zhang QY, Han YL. Efficacy and Safety of Moderate-Intensity Continuous Training on the Improvement of Cardiopulmonary Function in Patients After Transcatheter Aortic Valve Replacement (ENERGY): A Randomized Controlled Trial. J Am Med Dir Assoc 2023; 24:1783-1790.e2. [PMID: 37295458 DOI: 10.1016/j.jamda.2023.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate the effect of moderate-intensity continuous training (MICT) on the improvement of cardiopulmonary function for patients undergoing transcatheter aortic valve replacement (TAVR). DESIGN Randomized controlled study. SETTING AND PARTICIPANTS Between August 20, 2021, and February 28, 2022, a total of 66 patients after TAVR were screened for inclusion and randomly divided into the MICT and control groups at a ratio of 1:1. MICT was scheduled 3 times per week for 3 months in the intervention group. Patients in the control group received one-time advice on physical activity according to the current guideline. METHODS The primary endpoint was the 3-month change in peak oxygen consumption (peak VO2) assessed by cardiopulmonary exercise testing. The secondary endpoints included the 3-month change in 6-minute walk test (6MWT), the 12-Item Short Form Health Survey (SF-12), New York Heart Association (NYHA) class, echocardiographic parameters, and laboratory parameters. RESULTS After 3 months, the change in peak VO2 was higher in the MICT group than that in the control group (1.63 mL/kg/min, 95% CI 0.58-2.67, P = .003). Change in 6MWT (21.55 m, 95% CI 0.38-42.71, P = .046) was higher in the MICT group compared with the control group. A significant change in favor of MICT was also observed for low-density lipoprotein cholesterol (-0.62 mmol/L, 95% CI -1.00 to -0.23, P = .002). However, there were no significant changes in other echocardiographic indices, laboratory parameters, and SF-12 between the 2 groups (all P > .05). CONCLUSIONS AND IMPLICATIONS MICT had a positive effect on the cardiopulmonary function and physical capacity of patients after TAVR.
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Affiliation(s)
- Qiang Hu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China; Department of Cardiology, Air Force Hospital of Western Theater Command, Chengdu, China
| | - Yu-Shan Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Qiang Ren
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yan-Chun Liang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Jian Zhang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yan-Xia Wang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Cai-Lian Wang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Tai-Lian Hong
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Sheng-Yi Wang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yi Zhang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Quan-Yu Zhang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China.
| | - Ya-Ling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China.
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Kuck KH, Leidl R, Frankenstein L, Wahlers T, Sarmah A, Candolfi P, Shore J, Green M. Cost-Effectiveness of SAPIEN 3 Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in German Severe Aortic Stenosis Patients at Low Surgical Mortality Risk. Adv Ther 2023; 40:1031-1046. [PMID: 36622552 PMCID: PMC9988804 DOI: 10.1007/s12325-022-02392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/28/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION In the randomized PARTNER 3 trial, transcatheter aortic valve implantation (TAVI) with the SAPIEN 3 device significantly reduced a composite of all-cause death, stroke, and rehospitalization, compared with surgical aortic valve replacement (SAVR), in patients with severe symptomatic aortic stenosis and low risk of surgical mortality. Furthermore, TAVI has been shown to be cost-effective in low-risk patients, compared with SAVR, in a number of countries. This study aimed to determine the cost-effectiveness of TAVI with SAPIEN 3 versus SAVR in Germany. METHODS A previously published two-stage Markov-based model that captured clinical outcomes from the PARTNER 3 trial was adapted for the German context using the German Statutory Health Insurance perspective. The model had a lifetime horizon. The cost-utility analysis estimated changes in direct healthcare costs as well as survival and health-related quality of life using TAVI with SAPIEN 3 compared with SAVR. RESULTS TAVI with SAPIEN 3 increased quality-adjusted life years (QALYs) by + 0.72 at an increased cost of €8664 per patient. The incremental cost-effectiveness/QALY ratio was €12,037, which fell below that of other cardiovascular interventions in use in Germany. The cost-effectiveness of TAVI over SAVR remained robust across multiple challenging scenarios and was driven by lower longer-term management costs compared with SAVR. CONCLUSIONS TAVI with SAPIEN 3 appears to be a clinically meaningful, cost-effective treatment option over SAVR for patients with severe symptomatic aortic stenosis and low risk for surgical mortality in Germany. CLINICAL TRIAL REGISTRATION NUMBER www. CLINICALTRIALS gov identifier: NCT02675114.
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Affiliation(s)
- Karl H Kuck
- Department of Cardiology, University Heart Center, Lübeck, Germany.,LANS Cardio, Hamburg, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.,Munich School of Management, Ludwig-Maximilians-Universität, Munich, Germany
| | - Lutz Frankenstein
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | | | | | - Judith Shore
- York Health Economics Consortium, University of York, York, UK
| | - Michelle Green
- York Health Economics Consortium, University of York, York, UK
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Isogai T, Agrawal A, Shekhar S, Spilias N, Hodges K, Yun JJ, Puri R, Reed GW, Krishnaswamy A, Kapadia SR. One-year clinical and echocardiographic outcomes of transcatheter aortic valve replacement with SAPIEN 3 Ultra versus SAPIEN 3. Catheter Cardiovasc Interv 2022; 101:417-430. [PMID: 36511393 DOI: 10.1002/ccd.30515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The newest-generation balloon-expandable valve, SAPIEN 3 Ultra (S3U), is expected to function well with the enhanced sealing skirt compared with SAPIEN 3 (S3). However, current literature on the comparison between these two valves is limited to short-term follow-ups. Therefore, we aimed to evaluate the 1-year outcomes and echocardiographic changes of S3U compared with S3. METHODS We retrospectively identified patients who underwent transfemoral-transcatheter aortic valve replacement with S3U or S3 (20/23/26 mm) at our institution in 2018-2020. Outcomes were 1-year clinical events and echocardiographic parameters, and were compared between S3U and S3 after adjustment with inverse probability of treatment weighting. RESULTS The S3U and S3 groups included 297 (25.7%) and 858 (74.3%) patients, respectively. There were no significant differences between the two groups in clinical events (death 5.8% vs. 5.5%, hazard ratio [HR] 1.07, 95% confidence interval [CI] 0.81-1.90; death or heart failure hospitalization 10.3% vs. 10.1%, HR 1.04, 95% CI 0.67-1.62). The S3U group had a lower prevalence of mild paravalvular leakage (PVL) (13.7% vs. 22.3%, p = 0.044), with similar moderate PVL (0.7% vs. 1.2%, p > 0.99). No significant differences were observed in aortic valve mean gradient and Doppler velocity index at 1 year. However, the S3U group had a larger increase in mean gradient from implantation to 1 year (median +4.70 vs. +1.63 mmHg, p < 0.001). CONCLUSIONS S3U and S3 carried similarly favorable clinical event risks. Nonetheless, S3U was associated with less frequent mild PVL but a larger increase in transprosthetic gradient. Further studies are needed to determine the prognostic impact of these hemodynamic differences.
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Affiliation(s)
- Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nikolaos Spilias
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kevin Hodges
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - James J Yun
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Saito S, Sairenchi T, Hirota S, Niitsuma K, Yokoyama S, Kanno Y, Kanazawa Y, Tezuka M, Takei Y, Tsuchiya G, Konishi T, Shibasaki I, Ogata K, Monta O, Tsutsumi Y, Fukuda H. Prosthetic Valve Function after Aortic Valve Replacement for Severe Aortic Stenosis by Transcatheter Procedure versus Surgery. J Cardiovasc Dev Dis 2022; 9:jcdd9100355. [PMID: 36286307 PMCID: PMC9604414 DOI: 10.3390/jcdd9100355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Background This study compared the clinical outcomes of transcatheter (TAVR) and surgical (SAVR) aortic valve replacements, focusing on postoperative valvular performance assessed by echocardiography. Method and Results A total of 425 patients who underwent TAVR (230 patients) or SAVR (195 patients) were included. Postoperative effective orifice area index (EOAI) was higher in the TAVR group (1.27 ± 0.35 cm2/m2) than in the SAVR group (1.06 ± 0.27 cm2/m2, p < 0.001), and patient−prosthesis mismatch (PPM) was more frequent in the SAVR group (22.6%) than in the TAVR group (8.7%, p < 0.001). Mild or greater paravalvular leakage (PVL) was more frequent in the TAVR group (21.3%) than in the SAVR group (0%, p < 0.001). Moreover, there was no difference in freedom from all-cause death, stroke, or rehospitalization between the groups. Patients with moderate or greater PPM (EOAI < 0.85 cm2/m2) had lower freedom from composite events than those without this PPM criterion (p = 0.008). Patients with mild or greater PVL also had lower freedom from composite events than those without this PVL criterion (p = 0.017). Conclusions Postoperative valvular performance of TAVR was superior to that of SAVR in terms of EOAI. This merit was counterbalanced by the significantly lower rates of PVL in patients who underwent SAVR. The overall clinical outcomes were similar between the study groups.
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Affiliation(s)
- Shunsuke Saito
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
- Correspondence: ; Tel.: +81-282-86-1111; Fax: +81-282-86-2022
| | - Toshimi Sairenchi
- Medical Science of Nursing, School of Nursing, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Shotaro Hirota
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Ken Niitsuma
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Shohei Yokoyama
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Yasuyuki Kanno
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Yuta Kanazawa
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Masahiro Tezuka
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Yusuke Takei
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Go Tsuchiya
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Taisuke Konishi
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Ikuko Shibasaki
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Koji Ogata
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Osamu Monta
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui 910-0833, Japan
| | - Yasushi Tsutsumi
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui 910-0833, Japan
| | - Hirotsugu Fukuda
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
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Bhushan S, Huang X, Li Y, He S, Mao L, Hong W, Xiao Z. Paravalvular Leak After Transcatheter Aortic Valve Implantation Its Incidence, Diagnosis, Clinical Implications, Prevention, Management, and Future Perspectives: A Review Article. Curr Probl Cardiol 2022; 47:100957. [DOI: https:/doi.org/10.1016/j.cpcardiol.2021.100957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Abdelfattah OM, Sayed A, Ghonim M, Saleh Y, Généreux P, Goel SS, Krishnaswamy A, Yun J, Kapadia SR. Meta-Analysis of Transcatheter Aortic Valve Implantation Using the Sapien 3 Versus Sapien 3 Ultra Valves. Am J Cardiol 2022; 168:170-172. [PMID: 35067349 DOI: 10.1016/j.amjcard.2021.12.050] [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: 11/23/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/01/2022]
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Patient-Specific CT-Simulation in TAVR: An emerging guide in the lifetime journey of aortic valve disease. J Cardiovasc Comput Tomogr 2022; 16:e35-e37. [DOI: 10.1016/j.jcct.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/28/2022] [Indexed: 01/26/2023]
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Garot P. Oversizing TAVR in the Low-Risk Era: Is Bigger Still Better? JACC Cardiovasc Interv 2021; 14:2170-2172. [PMID: 34620396 DOI: 10.1016/j.jcin.2021.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/10/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Philippe Garot
- Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France.
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Paravalvular Leak After Transcatheter Aortic Valve Implantation Its Incidence, Diagnosis, Clinical Implications, Prevention, Management, and Future Perspectives: A Review Article. Curr Probl Cardiol 2021; 47:100957. [PMID: 34364915 DOI: 10.1016/j.cpcardiol.2021.100957] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/30/2021] [Indexed: 02/05/2023]
Abstract
Paravalvular leak (PVL) is very common after TAVI and has been reported to have a negative impact on both short- and long-term survival. The current study identified incidence, diagnosis, clinical implications, and prevention, management and future perspectives for post-TAVI paravalvular leak. A systematic literature search was conducted using PubMed and EMBASE, using the MeSH terms and key words "paravalvular leak," "diagnostic criteria," "implication," "influencing factors," and "prevention strategies." Studies were retained for review after meeting strict inclusion criteria that included only prospective studies evaluating Paravalvular leak in patients who had TAVI. Thirty articles were selected for inclusion, incidence of PVL across the studies ranged from 7% to 40%. Many factors have been associated with incidence and increased risk of PVL, including AVC volume, larger annulus dimensions, pre-TAVI transvalvular peak velocity, under sizing of the prosthesis, surgical, and other factors. PVL after TAVI is common and can be predicted by aortic root calcification volume, larger annulus dimensions, and pre-TAVI transvalvular peak velocity, with calcification volume being an independent predictor for PVL. The strength and nature of the association of various degrees of post-TAVI PVL and mortality are still to be further evaluated.
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Bhushan S, Huang X, Li Y, He S, Mao L, Hong W, Xiao Z. Paravalvular Leak After Transcatheter Aortic Valve Implantation Its Incidence, Diagnosis, Clinical Implications, Prevention, Management, and Future Perspectives: A Review Article. Curr Probl Cardiol 2021. [DOI: https://doi.org/10.1016/j.cpcardiol.2021.100957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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