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Boljevic D, Bojic M, Farkic M, Sagic D, Topic D, Kovacevic V, Lakcevic J, Veljkovic S, Dobric M, Hinic S, Ilijevski N, Nikolic M, Kaludjerovic A, Bunc M, Nikolic A. Transcatheter Aortic Valve Implantation: A Report on Serbia's First Systematic Program. Front Cardiovasc Med 2022; 9:882854. [PMID: 35686043 PMCID: PMC9170914 DOI: 10.3389/fcvm.2022.882854] [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: 02/24/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Severe aortic stenosis, a highly-common valve disease in the elderly, has a poor prognosis if left untreated. To address the concern of effective procedures for severe aortic stenosis, a systematic TAVI program was established at the Dedinje Cardiovascular Institute (Belgrade, Serbia). Methods Our cohort was composed of 56 patients (74±15 years old). The mean logistic EuroScore was 10.17%; the mean Society of Thoracic Surgeons score was 3.22%. One third of the patients were categorized as class III or IV of the New York Heart Association (NYHA). The valves selected for use were either self-expandable or balloon expandable (Evolut R, Medtronic; Acurate Neo, Boston Scientific and Myval, Meril). The choice of valve type was made by the Institute's Structural Heart Team, in accordance with the patient's native aortic valve, size and calcification of ilio-femoral vessels, as well as the need for alternative access. TAVI procedure was conducted according to current guidelines provided by the European Society of Cardiology. Results The procedure success rate was 100%. Trans-femoral approach was achieved in 100% of patients; percutaneously in 87.5%, while a surgical cut was necessary in 12.5%. No patient showed moderate or severe aortic regurgitation after the procedure, although trace or mild regurgitation was recorded in 30.3%. Permanent pacemaker was implanted in one patient (1.78%), contrast induced acute kidney injury occured in one patient (1.78%), no stroke was recorded, and three pseudo-aneurysms which required surgical intervention occurred. Three patients required blood transfusions (5.33%). A 30-day all-cause mortality rate was 1.78%. Conclusion The Dedinje Cardiovascular Institute spearheaded all efforts to establish a TAVI program in Serbia. Our initial TAVI results are promising, encouraging, and comparable with the results of previous large randomized trials. This initial experience opens the door for further development with a goal of our Institute to become a high-volume TAVI center.
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Affiliation(s)
| | - Milovan Bojic
- Dedinje Cardiovascular Institute, Belgrade, Serbia
- School of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | | | - Dragan Sagic
- Dedinje Cardiovascular Institute, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragan Topic
- Dedinje Cardiovascular Institute, Belgrade, Serbia
| | | | | | | | - Milan Dobric
- Dedinje Cardiovascular Institute, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sasa Hinic
- Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Nenad Ilijevski
- Dedinje Cardiovascular Institute, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | | | - Matjaz Bunc
- University Clinical Center Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Aleksandra Nikolic
- Dedinje Cardiovascular Institute, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
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Lutz M, Messika-Zeitoun D, Rudolph TK, Schulz E, Thambyrajah J, Lloyd G, Lauten A, Frey N, Kurucova J, Thoenes M, Deutsch C, Bramlage P, Steeds RP. Differences in the presentation and management of patients with severe aortic stenosis in different European centres. Open Heart 2020; 7:openhrt-2020-001345. [PMID: 32934015 PMCID: PMC7493097 DOI: 10.1136/openhrt-2020-001345] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/21/2020] [Accepted: 08/07/2020] [Indexed: 11/08/2022] Open
Abstract
Background An investigation into differences in the management and treatment of severe aortic stenosis (AS) between Germany, France and the UK may allow benchmarking of the different healthcare systems and identification of levers for improvement. Methods Patients with a diagnosis of severe AS under management at centres within the IMPULSE and IMPULSE enhanced registries were eligible. Results Data were collected from 2052 patients (795 Germany; 542 France; 715 UK). Patients in Germany were older (79.8 years), often symptomatic (89.5%) and female (49.8%) and had a lower EF (53.8%) than patients in France and UK. Comorbidities were more common and they had a higher mean Euroscore II. Aortic valve replacement (AVR) was planned within 3 months in 70.2%. This was higher (p<0.001) in Germany than France/ UK. Of those with planned AVR, 82.3% received it within 3 months with a gradual decline (Germany>France> UK; p<0.001). In 253 patients, AVR was not performed, despite planned. Germany had a strong transcatheter aortic valve implantation (TAVI) preference (83.2%) versus France/ UK (p<0.001). Waiting time for TAVI was shorter in Germany (24.9 days) and France (19.5 days) than UK (40.3 days). Symptomatic patients were scheduled for an AVR in 79.4% (Germany> France> UK; p<0.001) and performed in 83.6% with a TAVI preference (73.1%). 20.4% of the asymptomatic patients were intervened. Conclusion Patients in Germany had more advanced disease. The rate of intervention within 3 months after diagnosis was startlingly low in the UK. Asymptomatic patients without a formal indication often underwent an intervention in Germany and France.
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Affiliation(s)
- Matthias Lutz
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - David Messika-Zeitoun
- Department of Cardiology, University of Ottawa Heart Institue, Ottawa, Ontario, Canada
| | - Tanja K Rudolph
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | | | | | - Guy Lloyd
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - Alexander Lauten
- Department of Cardiology, HELIOS Klinikum Erfurt, Erfurt, Germany
| | - Norbert Frey
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | | | | | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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Ammar A, Hassan Rizvi SN, Saghir T, Khan N, Akhtar P, Mengal N, Sial JA, Qamar N. Pakistan Following Foot Prints of Developed World in Structural Interventions: Experience of Transcatheter Aortic Valve Implantation Reported First Time. Cureus 2020; 12:e11497. [PMID: 33354443 PMCID: PMC7744204 DOI: 10.7759/cureus.11497] [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] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to evaluate the safety and efficacy of transcatheter aortic valve implantation (TAVI) program in a Tertiary care hospital in Karachi, Pakistan. Methodology This study was conducted by interventional cardiology department of the National Institute of Cardiovascular Diseases (NICVD), Karachi from July 2015 to February 2020. All patients of severe aortic stenosis (AS) who underwent TAVI were included. Baseline characteristics, in-hospital course and one-month follow-up data were collected. Results This study included 100 consecutive patients with severe AS undergoing TAVI. Sixty-three (63.0%) patients were males and the mean age was 67.38 ± 10.73 years. Eighty-five (85%) patients were in the New York Heart Association (NYHA) class III-IV. Aortic valve mean gradient was 51.33±10.47 mmHg and 50% of patients had bicuspid aortic valves. Core valve was implanted in 86 (86%) and evolute-R aortic valve was implanted in 14 (14%) patients. TAVI was successfully done in 94% of patients. Post-deployment aortic valve mean gradient was 5.33±4.13 mmHg. Major vascular access site complications were noted in 14% and atrioventricular (AV) blocks were seen in 22% of cases. There was a significant difference in symptoms of patients before and after the procedure. Overall, eight (8%) patients expired during hospital stay. At one-month follow-up, 76% of patients were found to have no limitation of physical activities. Conclusions Results of this study showed that TAVI is a safe procedure in these high-risk patients and is an alternative to surgery for AS patients in the region.
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Affiliation(s)
- Ali Ammar
- Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Syed N Hassan Rizvi
- Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Tahir Saghir
- Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Naveedullah Khan
- Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Parveen Akhtar
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Naeem Mengal
- Cardiology/Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Jawaid A Sial
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Nadeem Qamar
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
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Henning KA, Ravindran M, Qiu F, Fam NP, Seth TN, Austin PC, Wijeysundera HC. Impact of procedural capacity on transcatheter aortic valve replacement wait times and outcomes: a study of regional variation in Ontario, Canada. Open Heart 2020; 7:openhrt-2020-001241. [PMID: 32393658 PMCID: PMC7223466 DOI: 10.1136/openhrt-2020-001241] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/05/2020] [Accepted: 04/21/2020] [Indexed: 01/05/2023] Open
Abstract
Background There has been rapid growth in the demand for transcatheter aortic valve replacement (TAVR), which has the potential to overwhelm current capacity. This imbalance between demand and capacity may lead to prolonged wait times, and subsequent adverse outcomes while patients are on the waitlist. We sought to understand the relationship between regional differences in capacity, TAVR wait times and morbidity/mortality on the waitlist. Methods and results We modelled the effect of TAVR capacity, defined as the number of TAVR procedures per million residents/region, on the hazard of having a TAVR in Ontario from April 2012 to March 2017. Our primary outcome was the time from referral to a TAVR procedure or other off-list reasons on the waitlist/end of the observation period as measured in days. Clinical outcomes of interest were all-cause mortality, all-cause hospitalisations or heart failure-related hospitalisations while on the waitlist for TAVR. There was an almost fourfold difference in TAVR capacity across the 14 regions in Ontario, ranging from 31.5 to 119.5 TAVR procedures per million residents. The relationship between TAVR capacity and wait times was complex and non-linear. In general, increased capacity was associated with shorter wait times (p<0.001), reduced mortality (HR 0.94; p=0.08) and all-cause hospitalisations (p=0.009). Conclusions The results of the present study have important policy implications, suggesting that there is a need to improve TAVR capacity, as well as develop wait-time strategies to triage patients, in order to decrease wait times and mitigate the hazard of adverse patient outcomes while on the waitlist.
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Affiliation(s)
- Kayley A Henning
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Mithunan Ravindran
- Department of Cardiology, Schulich Heart Centre, University of Toronto, Toronto, Ontario, Canada
| | - Feng Qiu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Neil P Fam
- Division of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Tej N Seth
- Department of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Department of Cardiology, Schulich Heart Centre, University of Toronto, Toronto, Ontario, Canada
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Interventional cardiology procedures in Poland in 2018. Summary report of the Association of Cardiovascular Interventions of the Polish Cardiac Society (AISN PTK) and Jagiellonian University Medical College. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2019; 15:391-393. [PMID: 31933654 PMCID: PMC6956460 DOI: 10.5114/aic.2019.90212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 11/17/2022] Open
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Increased risk profile in the treatment of patients with symptomatic degenerative aortic valve stenosis over the last 10 years. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:276-284. [PMID: 30302104 PMCID: PMC6173098 DOI: 10.5114/aic.2018.78331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/17/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Currently, Cardiology Centres are overfilled with patients with degenerative aortic valve stenosis (DAS), usually eldery, with severe concommittant comorbidities, who are referred for further decisions and possible intervention. Aim To evaluate changes in the risk profile of patients with severe DAS admitted to the cardiology department a decade ago compared with patients currently being admitted. Material and methods We retrospectively evaluated all patients admitted with confirmed severe DAS, hospitalized during 2005-2006 (group I: 140 patients) and in 2016 (group II: 152 patients), admitted for aortic valve intervention. A standard transthoracic echocardiogram, cardiovascular symptom and risk factor distribution, perioperative risk with the logistic EuroSCORE II and STS mortality scores were obtained. Results Patients in group II were significantly older (p < 0.001), had more cardiovascular risk factors, and more often presented with atrial fibrillation (27% vs. 11.4%, p = 0.001), renal impairment (34.9% vs. 22.8%; p = 0.024), severe lung disease (17.1% vs. 2.1%, p < 0.001), and extracardiac arteriopathy (40.1% vs. 17.8%, p < 0.001). The aortic valve area (AVA) (p = 0.356), mean-transvalvular pressure gradient (p = 0.215), and left ventricular ejection fraction (p = 0.768) were similar in both groups. However, the prevalence of pulmonary hypertension, severe mitral regurgitation, and low-flow, low-gradient DAS were 3.1-, 8.4- and 1.84-fold more frequent in group II than group I. The percentages of subjects with EuroSCORE II and STS scores ≥ 4% in 2005-2006 were 7.1% and 6.4%, as compared to 27% and 26.3% in 2016 (both p < 0.001). 22% of patients in 2016, as compared to 31% in 2005/2006, were considered ineligible for DAS intervention. Conclusions In just a decade, the risk profile of patients admitted with DAS has increased hugely, mainly due to older age, accumulation of comorbidities and more advanced disease at presentation. Although transcatheter aortic valve intervention has expanded the indications for intervention in high-risk patients, the number of patients disqualified from interventional treatment remains high.
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Legutko J, Siudak Z, Parma R, Ochała A, Dudek D. Poland: coronary and structural heart interventions from 2010 to 2015. EUROINTERVENTION 2018; 13:Z51-Z54. [PMID: 28504231 DOI: 10.4244/eij-d-16-00836] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
For the last five years, invasive cardiology in Poland has developed extensively. Currently, 98% of the 161 Polish cathlabs operate in 24/7 mode, 37 of them supported by cardiac surgery departments on-site. A certification curriculum for interventional cardiology operators is supported by dedicated workshops and scientific meetings during national conferences. The rise in the number of coronary angiographies and PCIs was paralleled by an increased use of drug-eluting stents, bioresorbable vascular scaffolds and physiologic assessment of coronary arteries. Radial artery access has become the default option for PCI. A rapid adoption of the EAPCI Stent for Life Initiative resulted in a significant increase in primary PCIs. Unlike coronary interventions, structural heart interventions have evolved unevenly, despite the solid network of Heart Teams set up in the 21 most experienced centres. Left atrial appendage closure is offered in an increasing number of cathlabs. MitraClip therapy remains largely underused (1 procedure/million population/year). Despite the slow growth of TAVI since 2008, the current annual number of 17.1 TAVI procedures per million population is incomparable with countries in Western Europe. A recently introduced EAPCI Valve for Life campaign was followed by a 42.6% annual increase in TAVI procedures and an improvement in patients' access to therapy in life-saving indications.
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Affiliation(s)
- Jacek Legutko
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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