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Szotek M, Drużbicki Ł, Sabatowski K, Amoroso GR, De Schouwer K, Matusik PT. Transcatheter Aortic Valve Implantation and Cardiac Conduction Abnormalities: Prevalence, Risk Factors and Management. J Clin Med 2023; 12:6056. [PMID: 37762995 PMCID: PMC10531796 DOI: 10.3390/jcm12186056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Over the last decades, transcatheter aortic valve implantation (TAVI) or replacement (TAVR) has become a potential, widely accepted, and effective method of treating aortic stenosis in patients at moderate and high surgical risk and those disqualified from surgery. The method evolved what translates into a noticeable decrease in the incidence of complications and more beneficial clinical outcomes. However, the incidence of conduction abnormalities related to TAVI, including left bundle branch block and complete or second-degree atrioventricular block (AVB), remains high. The occurrence of AVB requiring permanent pacemaker implantation is associated with a worse prognosis in this group of patients. The identification of risk factors for conduction disturbances requiring pacemaker placement and the assessment of their relation to pacing dependence may help to develop methods of optimal care, including preventive measures, for patients undergoing TAVI. This approach is crucial given the emerging evidence of no worse outcomes for intermediate and low-risk patients undergoing TAVI in comparison to surgical aortic valve replacement. This paper comprehensively discusses the mechanisms, risk factors, and consequences of conduction abnormalities and arrhythmias, including AVB, atrial fibrillation, and ventricular arrhythmias associated with aortic stenosis and TAVI, as well as provides insights into optimized patient care, along with the potential of conduction system pacing and cardiac resynchronization therapy, to minimize the risk of unfavorable clinical outcomes.
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Affiliation(s)
- Michał Szotek
- Department of Electrocardiology, The John Paul II Hospital, 80 Prądnicka St., 31-202 Kraków, Poland
| | - Łukasz Drużbicki
- Department of Cardiovascular Surgery and Transplantology, The John Paul II Hospital, 80 Prądnicka St., 31-202 Kraków, Poland
| | - Karol Sabatowski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Kraków, Poland
| | - Gisella R. Amoroso
- Department of Cardiovascular Medicine, “SS Annunziata” Hospital, ASL CN1-Savigliano, Via Ospedali 9, 12038 Savigliano, Italy
| | - Koen De Schouwer
- Department of Cardiology, Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Paweł T. Matusik
- Department of Electrocardiology, The John Paul II Hospital, 80 Prądnicka St., 31-202 Kraków, Poland
- Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 80 Prądnicka St., 31-202 Kraków, Poland
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Chung CH, Wang YJ, Jiao X, Lee CY. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for aortic stenosis in Taiwan: A population-based cohort study. PLoS One 2023; 18:e0285191. [PMID: 37134111 PMCID: PMC10155988 DOI: 10.1371/journal.pone.0285191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 04/17/2023] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE Aortic stenosis (AS) is a heart valve disease characterized by left ventricular outflow fixed obstruction. It can be managed by surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). However, real-world evidence for TAVI or SAVR outcomes is lacking in Taiwan. This study aimed to compare the clinical outcomes of TAVI and SAVR for treating of AS in Taiwan. MATERIALS AND METHODS The National Health Insurance Research Database is a nationally representative cohort that contains detailed registry and claims data from all 23 million residents of Taiwan. This retrospective cohort study used this database to compare patients who underwent SAVR (bioprosthetic valves) or TAVI from 2017 to 2019. Survival outcomes and length of hospital stay (LOS) and intensive care unit (ICU) stay between TAVI and SAVR in the matched cohort. A Cox proportional hazards model was performed to identify the effect of treatment type on survival rates while controlling variables including age, gender, and comorbidities. RESULTS We identified 475 and 1605 patients who underwent TAVI and SAVR with a bioprosthetic valve, respectively. Patients who underwent TAVI were older (82.19 vs. 68.75 y/o) and more likely to be female (55.79% vs. 42.31%) compared with patients who underwent SAVR. Propensity score matching (PSM) on age, gender, and Elixhauser Comorbidity Index (ECI) score revealed that 375 patients who underwent TAVI were matched with patients who underwent SAVR. A significant difference was found in survival rates between TAVI and SAVR. The 1-year mortality rate was 11.44% with TAVI and 17.55% with SAVR. Both the mean total LOS (19.86 vs. 28.24 days) and mean ICU stay (6.47 vs. 11.12 days) for patients who underwent TAVI were shorter than those who underwent SAVR. CONCLUSION Patients who had undergone TAVI had better survival outcomes and shorter LOS compared with patients who had undergone SAVR in Taiwan.
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Affiliation(s)
- Ching-Hu Chung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Yu-Jen Wang
- Edwards Lifesciences (Taiwan) Corp, Taipei, Taiwan
| | - Xiayu Jiao
- Edwards Lifesciences, Irvine, CA, United States of America
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Rouleau SG, Brady WJ, Koyfman A, Long B. Transcatheter aortic valve replacement complications: A narrative review for emergency clinicians. Am J Emerg Med 2022; 56:77-86. [DOI: 10.1016/j.ajem.2022.03.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/11/2022] [Accepted: 03/20/2022] [Indexed: 02/07/2023] Open
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Petronio AS, Giannini C. Atrial Fibrillation After Transcatheter Aortic Valve Replacement: Which Came First, the Chicken or the Egg? JACC Cardiovasc Interv 2022; 15:614-617. [PMID: 35331453 DOI: 10.1016/j.jcin.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
Affiliation(s)
- A Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Altaii H, Morcos R, Riad F, Abdulameer H, Khalili H, Maini B, Lieberman E, Vivas Y, Wiegn P, A Joglar J, Mackall J, G Al-Kindi S, Thal S. Incidence of Early Atrial Fibrillation After Transcatheter versus Surgical Aortic Valve Replacement: A Meta-Analysis of Randomized Controlled Trials. J Atr Fibrillation 2021; 13:2411. [PMID: 34950322 DOI: 10.4022/jafib.2411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/15/2020] [Accepted: 07/25/2020] [Indexed: 11/10/2022]
Abstract
Background Post-operative atrial fibrillation (POAF) is common after aortic valve replacement (AVR) and is associated with worse outcomes. We performed a meta-analysis of randomized controlled trials comparing Surgical Aortic Valve Replacement (SAVR) and Transcatheter Aortic Valve Replacement (TAVR) for incidence of POAF at 30 days. Methods We searched databases from 1/1/1990 to 1/1/2020 for randomized studies comparing TAVR and SAVR. POAF was defined as either worsening or new-onset atrial fibrillation. Random effects model was used to estimate the risk of POAF with TAVR vs SAVR in all trials, and in subgroups (low, intermediate, high risk, and in self-expandable vs balloon expandable valves). Sensitivity analysis was performed including only studies reporting new-onset atrial fibrillation. Results Seven RCTs were identified that enrolled 7,934 patients (3,999 to TAVR and 3,935 to SAVR). The overall incidence of POAF was 9.7% after TAVR and 33.3% after SAVR. TAVR was associated with a lower risk of POAF compared with SAVR (OR 0.21 [0.18-0.24]; P < 0.0001). Compared with SAVR, TAVR was associated with a significantly lower risk of POAF in the high-risk cohort (OR 0.37 [0.27-0.49]; P < 0.0001), in the intermediate-risk cohort (OR 0.23 [0.19-0.28]; P < 0.0001), low-risk cohort (OR 0.13 [0.10-0.16]; P < 0.0001). Sensitivity analysis of 4 trials including only new-onset POAF showed similar summary estimates (OR 0.21, 95% CI [0.18-0.25]; P< 0.0001). Conclusions TAVR is associated with a significantly lower risk of post-operative atrial fibrillation compared with SAVR in all strata. Further studies are needed to identify the contribution of post-operative atrial fibrillation to the differences in clinical outcomes after TAVR and SAVR.
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Affiliation(s)
- Haider Altaii
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL
| | - Ramez Morcos
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL
| | - Fady Riad
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, OH
| | - Halah Abdulameer
- Department of Surgery, Florida Atlantic University, Boca Raton, FL
| | - Houman Khalili
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL.,Tenet Healthcare, Delray Medical Center, Delray Beach, FL
| | - Brijeshwar Maini
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL.,Tenet Healthcare, Delray Medical Center, Delray Beach, FL
| | - Eric Lieberman
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL.,Tenet Healthcare, Delray Medical Center, Delray Beach, FL
| | - Yoel Vivas
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL
| | - Phi Wiegn
- Clinical Cardiac Electrophysiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jose A Joglar
- Clinical Cardiac Electrophysiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Judith Mackall
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, OH
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, OH
| | - Sergio Thal
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, OH
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Xiang B, Ma W, Yan S, Chen J, Li J, Wang C. Rhythm outcomes after aortic valve surgery: Treatment and evolution of new-onset atrial fibrillation. Clin Cardiol 2021; 44:1432-1439. [PMID: 34390255 PMCID: PMC8495075 DOI: 10.1002/clc.23703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/30/2021] [Accepted: 07/19/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The impact of new-onset atrial fibrillation (AF) after aortic valve (AV) surgery on mid- and long-term outcomes is under debate. Here, we sought to follow up heart rhythms after AV surgery, and to evaluate the mid-term prognosis and effectiveness of treatment for patients with new-onset AF. METHODS This single-center cohort study included 978 consecutive patients (median age, 59 years; male, 68.5%) who underwent surgical AV procedures between 2017 and 2018. All patients with postoperative new-onset AF were treated with Class III antiarrhythmic drugs with or without electrical cardioversion (rhythm control). Status of survival, stroke, and rhythm outcomes were collected and compared between patients with and without new-onset AF. RESULTS New-onset AF was detected in 256 (26.2%) patients. For them, postoperative survival was comparable with those without new-onset AF (1-year: 96.1% vs. 99.3%; adjusted P = .30), but rate of stroke was significantly higher (1-year: 4.0% vs. 2.2%; adjusted P = .020). With rhythm control management, the 3-month and 1-year rates of paroxysmal or persistent AF between patients with and without new-onset AF were 5.1% versus 1.3% and 7.5% versus 2.1%, respectively (both P < .001). Multivariate models showed that advanced age, impaired ejection fraction, new-onset AF and discontinuation of beta-blockers were predictors of AF at 1 year. CONCLUSIONS In most cases, new-onset AF after AV surgery could be effectively converted and suppressed by rhythm control therapy. Nevertheless, new-onset AF predisposed patients to higher risks of stroke and AF within 1 year, for whom prophylactic procedures and continuous beta-blockers could be beneficial.
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Affiliation(s)
- Bitao Xiang
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenrui Ma
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shixin Yan
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jinmiao Chen
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jun Li
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
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Ding Y, Wan M, Zhang H, Wang C, Dai Z. Comparison of postprocedural new-onset atrial fibrillation between transcatheter and surgical aortic valve replacement: A systematic review and meta-analysis based on 16 randomized controlled trials. Medicine (Baltimore) 2021; 100:e26613. [PMID: 34260547 PMCID: PMC8284731 DOI: 10.1097/md.0000000000026613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/22/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Presently, transcatheter aortic valve replacement (TAVR) as an effective and convenient intervention has been adopted extensively for patients with severe aortic disease. However, after surgical aortic valve replacement (SAVR) and TAVR, the incidence of new-onset atrial fibrillation (NOAF) is prevalently found. This meta-analysis was designed to comprehensively compare the incidence of NOAF at different times after TAVR and SAVR for patients with severe aortic disease. METHODS A systematic search of PubMed, Embase, Cochrane Library, and Web of Science up to October 1, 2020 was conducted for relevant studies that comparing TAVR and SAVR in the treatment of severe aortic disease. The primary outcomes were the incidence of NOAF with early, midterm and long term follow-up. The secondary outcomes included permanent pacemaker (PM) implantation, myocardial infarction (MI), cardiogenic shock, as well as mortality and other complications. Two reviewers assessed trial quality and extracted the data independently. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2. RESULTS A total of 16 studies including 13,310 patients were identified. The pooled results indicated that, compared with SAVR, TAVR experienced a significantly lower incidence of 30-day/in-hospital, 1-year, 2-year, and 5-year NOAF, with pooled risk ratios (RRs) of 0.31 (95% confidence interval [CI] 0.23-0.41; 5725 pts), 0.30 (95% CI 0.24-0.39; 6321 pts), 0.48 (95% CI 0.38-0.61; 3441 pts), and 0.45 (95% CI 0.37-0.55; 2268 pts) respectively. In addition, TAVR showed lower incidence of MI (RR 0.62; 95% CI 0.40-0.97) and cardiogenic shock (RR 0.34; 95% CI 0.19-0.59), but higher incidence of permanent PM (RR 3.16; 95% CI 1.61-6.21) and major vascular complications (RR 2.22; 95% CI 1.14-4.32) at 30-day/in-hospital. At 1- and 2-year after procedure, compared with SAVR, TAVR experienced a significantly higher incidence of neurological events, transient ischemic attacks (TIA), permanent PM, and major vascular complications, respectively. At 5-year after procedure, compared with SAVR, TAVR experienced a significantly higher incidence of TIA and re-intervention respectively. There was no difference in 30-day, 1-year, 2-year, and 5-year all-cause or cardiovascular mortality as well as stroke between TAVR and SAVR. CONCLUSIONS Our analysis showed that TAVR was superior to SAVR in decreasing the both short and long term postprocedural NOAF. TAVR was equal to SAVR in early, midterm and long term mortality. In addition, TAVR showed lower incidence of 30-day/in-hospital MI and cardiogenic shock after procedure. However, pooled results showed that TAVR was inferior to SAVR in reducing permanent pacemaker implantation, neurological events, TIA, major vascular complications, and re-intervention.
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Affiliation(s)
| | - Minmin Wan
- Outpatient Department, Zhebei Mingzhou hospital, Huzhou, China
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Shahim B, Malaisrie SC, George I, Thourani VH, Biviano AB, Russo M, Brown DL, Babaliaros V, Guyton RA, Kodali SK, Nazif TM, Kapadia S, Pibarot P, McCabe JM, Williams M, Genereux P, Lu M, Yu X, Alu M, Webb JG, Mack MJ, Leon MB, Kosmidou I. Postoperative Atrial Fibrillation or Flutter Following Transcatheter or Surgical Aortic Valve Replacement: PARTNER 3 Trial. JACC Cardiovasc Interv 2021; 14:1565-1574. [PMID: 34294398 DOI: 10.1016/j.jcin.2021.05.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to assess the incidence and prognostic impact of early and late postoperative atrial fibrillation or flutter (POAF) in patients with severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). BACKGROUND There is an ongoing controversy regarding the incidence, recurrence rate, and prognostic impact of early (in-hospital) POAF and late (postdischarge) POAF in patients with AS undergoing TAVR or SAVR. METHODS In the PARTNER (Placement of Aortic Transcatheter Valve) 3 trial, patients with severe AS at low surgical risk were randomized to TAVR or SAVR. Analyses were performed in the as-treated population excluding patients with preexistent atrial fibrillation or flutter. RESULTS Among 781 patients included in the analysis, early POAF occurred in 152 (19.5%) (18 of 415 [4.3%] and 134 of 366 [36.6%] following TAVR and SAVR, respectively). Following discharge, 58 new or recurrent late POAF events occurred within 1 year following the index procedure in 55 of 781 patients (7.0%). Early POAF was not an independent predictor of late POAF following discharge (odds ratio: 1.04; 95% CI: 0.52-2.08; P = 0.90). Following adjustment, early POAF was not an independent predictor of the composite outcome of death, stroke, or rehospitalization (hazard ratio: 1.10; 95% CI: 0.64-1.92; P = 0.72), whereas late POAF was associated with an increased adjusted risk for the composite outcome (hazard ratio: 8.90; 95% CI: 5.02-15.74; P < 0.0001), irrespective of treatment modality. CONCLUSIONS In the PARTNER 3 trial, early POAF was more frequent following SAVR compared with TAVR. Late POAF, but not early POAF, was significantly associated with worse outcomes at 2 years, irrespective of treatment modality.
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Affiliation(s)
- Bahira Shahim
- Cardiovascular Research Foundation, New York, New York, USA
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, USA
| | - Isaac George
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Vinod H Thourani
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Angelo B Biviano
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Mark Russo
- Division of Cardiac Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | | | | | | | - Susheel K Kodali
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Tamim M Nazif
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | | | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
| | | | | | - Philippe Genereux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Michael Lu
- Edwards Lifesciences, Irvine, California, USA
| | - Xiao Yu
- Edwards Lifesciences, Irvine, California, USA
| | - Maria Alu
- Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Martin B Leon
- Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Ioanna Kosmidou
- Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA.
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Fegley MW, Cardi A, Augoustides JG, Horak J, Gutsche JT, Nanda S, Kornfield ZN, Saluja A, Sanders J, Marchant BE, Fernando RJ. Acute Lung Injury Associated With Perioperative Amiodarone Therapy-Navigating the Challenges in Diagnosis and Management. J Cardiothorac Vasc Anesth 2021; 36:608-615. [PMID: 34172364 DOI: 10.1053/j.jvca.2021.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Mark W Fegley
- Critical Care Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alessandra Cardi
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Jiri Horak
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sudip Nanda
- Clinical Electrophysiology, Cardiology Associates, St. Luke's University Health Network, Bethlehem, PA
| | - Zev N Kornfield
- Critical Care Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Abhishek Saluja
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, School of Medicine, Wayne State University, Henry Ford Health System, Detroit, MI
| | - Joseph Sanders
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, School of Medicine, Wayne State University, Henry Ford Health System, Detroit, MI
| | - Bryan E Marchant
- Division of Cardiothoracic Anesthesia and Critical Care, Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
| | - Rohesh J Fernando
- Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
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Krasniqi L, Kronby MP, Riber LPS. Long-term survival after Carpentier-Edwards Perimount aortic valve replacement in Western Denmark: a multi-centre observational study. J Cardiothorac Surg 2021; 16:130. [PMID: 33990211 PMCID: PMC8120717 DOI: 10.1186/s13019-021-01506-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background This study describes the long-term survival, risk of reoperation and clinical outcomes of patients undergoing solitary surgical aortic valve replacement (SAVR) with a Carpentier-Edwards Perimount (CE-P) bioprosthetic in Western Denmark. The renewed interest in SAVR is based on the questioning regarding the long-term survival since new aortic replacement technique such as transcatheter aortic-valve replacement (TAVR) probably have shorter durability, why assessment of long-term survival could be a key issue for patients. Methods From November 1999 to November 2013 a cohort of a total of 1604 patients with a median age of 73 years (IQR: 69–78) undergoing solitary SAVR with CE-P in Western Denmark was obtained November 2018 from the Western Danish Heart Registry (WDHR). The primary endpoint was long-term survival from all-cause mortality. Secondary endpoints were survival free from major adverse cardiovascular and cerebral events (MACCE), risk of reoperation, cause of late death, patient-prothesis mismatch, risk of AMI, stroke, pacemaker or ICD implantation and postoperative atrial fibrillation (POAF). Time-to-event analysis was performed with Kaplan-Meier curve, cumulative incidence function was performed with Nelson-Aalen cumulative hazard estimates. Cox regression was applied to detect risk factors for death and reoperation. Results In-hospital mortality was 2.7% and 30-day mortality at 3.4%. The 5-, 10- and 15-year survival from all-cause mortality was 77, 52 and 24%, respectively. Survival without MACCE was 80% after 10 years. Significant risk factors of mortality were small valves, smoking and EuroSCORE II ≥4%. The risk of reoperation was < 5% after 7.5 years and significant risk factors were valve prosthesis-patient mismatch and EuroSCORE II ≥4%. Conclusions Patients undergoing aortic valve replacement with a Carpentier-Edwards Perimount valve shows a very satisfying long-term survival. Future research should aim to investigate biological valves long-term durability for comparison of different SAVR to different TAVR in long perspective.
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Affiliation(s)
- Lytfi Krasniqi
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark. .,Faculty of Health Science, University of Southern Denmark, Odense, Denmark.
| | - Mads P Kronby
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.,Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Lars P S Riber
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.,Faculty of Health Science, University of Southern Denmark, Odense, Denmark
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Mentias A, Saad M, Desai MY, Krishnaswamy A, Menon V, Horwitz PA, Kapadia S, Sarrazin MV. Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Rheumatic Aortic Stenosis. J Am Coll Cardiol 2021; 77:1703-1713. [PMID: 33832596 DOI: 10.1016/j.jacc.2021.02.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patients with rheumatic aortic stenosis (AS) were excluded from transcatheter aortic valve replacement (TAVR) trials. OBJECTIVES The authors sought to examine outcomes with TAVR versus surgical aortic valve replacement (SAVR) in patients with rheumatic AS, and versus TAVR in nonrheumatic AS. METHODS The authors identified Medicare beneficiaries who underwent TAVR or SAVR from October 2015 to December 2017, and then identified patients with rheumatic AS using prior validated International Classification of Diseases, Version 10 codes. Overlap propensity score weighting analysis was used to adjust for measured confounders. The primary study outcome was all-cause mortality. Multiple secondary outcomes were also examined. RESULTS The final study cohort included 1,159 patients with rheumatic AS who underwent aortic valve replacement (SAVR, n = 554; TAVR, n = 605), and 88,554 patients with nonrheumatic AS who underwent TAVR. Patients in the SAVR group were younger and with lower prevalence of most comorbidities and frailty scores. After median follow-up of 19 months (interquartile range: 13 to 26 months), there was no difference in all-cause mortality with TAVR versus SAVR (11.2 vs. 7.0 per 100 person-year; adjusted hazard ratio: 1.53; 95% confidence interval: 0.84 to 2.79; p = 0.2). Compared with TAVR in nonrheumatic AS, TAVR for rheumatic AS was associated with similar mortality (15.2 vs. 17.7 deaths per 100 person-years (adjusted hazard ratio: 0.87; 95% confidence interval: 0.68 to 1.09; p = 0.2) after median follow-up of 17 months (interquartile range: 11 to 24 months). None of the rheumatic TAVR patients, <11 SAVR patients, and 242 nonrheumatic TAVR patients underwent repeat aortic valve replacement (124 redo-TAVR and 118 SAVR) at follow-up. CONCLUSIONS Compared with SAVR, TAVR could represent a viable and possibly durable option for patients with rheumatic AS.
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Affiliation(s)
- Amgad Mentias
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| | - Marwan Saad
- Cardiovascular Institute, The Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Venu Menon
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Phillip A Horwitz
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Samir Kapadia
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mary Vaughan Sarrazin
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Comprehensive Access and Delivery Research and Evaluation Center (CADRE), VA Medical Center, Iowa City, Iowa, USA
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12
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Brener MI, George I, Kosmidou I, Nazif T, Zhang Z, Dizon JM, Garan H, Malaisrie SC, Makkar R, Mack M, Szeto WY, Fearon WF, Thourani VH, Leon MB, Kodali S, Biviano AB. Atrial Fibrillation Is Associated With Mortality in Intermediate Surgical Risk Patients With Severe Aortic Stenosis: Analyses From the PARTNER 2A and PARTNER S3i Trials. J Am Heart Assoc 2021; 10:e019584. [PMID: 33754803 PMCID: PMC8174321 DOI: 10.1161/jaha.120.019584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The impact of atrial fibrillation (AF) in intermediate surgical risk patients with severe aortic stenosis who undergo either transcatheter or surgical aortic valve replacement (AVR) is not well established. Methods and Results Data were assessed in 2663 patients from the PARTNER (Placement of Aortic Transcatheter Valve) 2A or S3i trials. Analyses grouped patients into 3 categories according to their baseline and discharge rhythms (ie, sinus rhythm [SR]/SR, SR/AF, or AF/AF). Among patients with transcatheter AVR (n=1867), 79.2% had SR/SR, 17.6% had AF/AF, and 3.2% had SR/AF. Among patients with surgical AVR (n=796), 71.7% had SR/SR, 14.1% had AF/AF, and 14.2% had SR/AF. Patients with transcatheter AVR in AF at discharge had increased 2-year mortality (SR/AF versus SR/SR; hazard ratio [HR], 2.73; 95% CI, 1.68-4.44; P<0.0001; AF/AF versus SR/SR; HR, 1.56; 95% CI, 1.16-2.09; P=0.003); patients with SR/AF also experienced increased 2-year mortality relative to patients with AF/AF (HR, 1.77; 95% CI, 1.04-3.00; P=0.03). For patients with surgicalAVR, the presence of AF at discharge was also associated with increased 2-year mortality (SR/AF versus SR/SR; HR, 1.93; 95% CI, 1.25-2.96; P=0.002; and AF/AF versus SR/SR; HR, 1.67; 95% CI, 1.06-2.63; P=0.027). Rehospitalization and persistent advanced heart failure symptoms were also more common among patients with transcatheter AVR and surgical AVR discharged in AF, and major bleeding was more common in the transcatheter AVR cohort. Conclusions The presence of AF at discharge in patients with intermediate surgical risk aortic stenosis was associated with worse outcomes-especially in patients with baseline SR-including increased all-cause mortality at 2-year follow-up. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01314313 and NCT03222128.
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Affiliation(s)
- Michael I Brener
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | - Isaac George
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | - Ioanna Kosmidou
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY.,Cardiovascular Research Foundation New York NY
| | - Tamim Nazif
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | | | - Jose M Dizon
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | - Hasan Garan
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | | | - Raj Makkar
- Cedars-Sinai Medical Center Los Angeles CA
| | | | | | | | | | - Martin B Leon
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY.,Cardiovascular Research Foundation New York NY
| | - Susheel Kodali
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | - Angelo B Biviano
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
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13
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Sayed A, Almotawally S, Wilson K, Munir M, Bendary A, Ramzy A, Hirji S, Ibrahim Abushouk A. Minimally invasive surgery versus transcatheter aortic valve replacement: a systematic review and meta-analysis. Open Heart 2021; 8:openhrt-2020-001535. [PMID: 33455914 PMCID: PMC7813322 DOI: 10.1136/openhrt-2020-001535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has recently been approved for use in patients who are at intermediate and low surgical risk. Moreover, recent years have witnessed a renewed interest in minimally invasive aortic valve replacement (miAVR). The present meta-analysis compared the outcomes of TAVR and miAVR in the management of aortic stenosis (AS). We conducted an electronic search across six databases from 2002 (TAVR inception) to December 2019. Data from relevant studies regarding the clinical and length of hospitalisation outcomes were extracted and analysed using R software. We identified a total of 11 cohort studies, of which seven were matched/propensity matched. Our analysis demonstrated higher rates of midterm mortality (≥1 year) with TAVR (risk ratio (RR): 1.93, 95% CI: 1.16 to 3.22), but no significant differences with respect to 1 month mortality (RR: 1.00, 95% CI: 0.55 to 1.81), stroke (RR: 1.08, 95% CI: 0.40 to 2.87) and bleeding (RR: 1.45, 95% CI: 0.56 to 3.75) rates. Patients undergoing TAVR were more likely to experience paravalvular leakage (RR: 14.89, 95% CI: 6.89 to 32.16), yet less likely to suffer acute kidney injury (RR: 0.38, 95% CI: 0.21 to 0.69) compared with miAVR. The duration of hospitalisation was significantly longer in the miAVR group (mean difference: 1.92 (0.61 to 3.24)). Grading of Recommendations Assessment, Development and Evaluation assessment revealed ≤moderate quality of evidence in all outcomes. TAVR was associated with lower acute kidney injury rate and shorter length of hospitalisation, yet higher risks of midterm mortality and paravalvular leakage. Given the increasing adoption of both techniques, there is an urgent need for head-to-head randomised trials with adequate follow-up periods.
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Affiliation(s)
- Ahmed Sayed
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Karim Wilson
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Malak Munir
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Bendary
- Faculty of Medicine, Cardiology, Benha University, Benha, Egypt
| | - Ahmed Ramzy
- Faculty of Medicine, Cardiology, Benha University, Benha, Egypt
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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14
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Zhang D, Guo W, Al-Hijji MA, El Sabbagh A, Lewis BR, Greason K, Sandhu GS, Eleid MF, Holmes DR, Herrmann J. Outcomes of Patients With Severe Symptomatic Aortic Valve Stenosis After Chest Radiation: Transcatheter Versus Surgical Aortic Valve Replacement. J Am Heart Assoc 2020; 8:e012110. [PMID: 31124737 PMCID: PMC6585322 DOI: 10.1161/jaha.119.012110] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patients with symptomatic severe aortic stenosis and a history of chest radiation therapy represent a complex and challenging cohort. It is unknown how transcatheter aortic valve replacement ( TAVR ) compares with surgical aortic valve replacement in this group of patients, which was the objective of this study. Methods and Results We retrospectively reviewed all patients with severe aortic stenosis who underwent either TAVR or surgical aortic valve replacement at our institution with a history of mediastinal radiation (n=55 per group). End points were echocardiographic and clinical outcomes in-hospital, at 30 days, and at 1 year. Inverse propensity weighting analysis was used to account for intergroup baseline differences. TAVR patients had a higher STS score than surgical aortic valve replacement patients (5.1% [3.2, 7.7] versus 1.6% [0.8, 2.6], P<0.001) and more often ( P<0.01 for all) a history of atrial fibrillation (45.5% versus 12.7%), chronic lung disease (47.3% versus 7.3%), peripheral arterial disease (38.2% versus 7.3%), heart failure (58.2% versus 18.2%), and pacemaker therapy (23.6% versus 1.8%). Postoperative atrial fibrillation was less frequent (1.8% versus 27.3%; P<0.001) and hospital stay was shorter in TAVR patients (4.0 [2.0, 5.0] versus 6.0 [5.0, 8.0] days; P<0.001). The ratio of observed-to-expected 30-day mortality was lower after TAVR as was 30-day mortality in inverse propensity weighting-adjusted Kaplan-Meier analyses. Conclusions In patients with severe aortic stenosis and a history of chest radiation therapy, TAVR performs better than predicted along with less adjusted 30-day all-cause mortality, postoperative atrial fibrillation, and shorter hospitalization compared with surgical aortic valve replacement. These data support further studies on the preferred role of TAVR in this unique patient population.
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Affiliation(s)
- Dongfeng Zhang
- 1 Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing China
| | - Wei Guo
- 2 Department of Emergency Medicine Peking University People's Hospital Beijing China.,3 Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | | | | | - Kevin Greason
- 3 Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | - Mackram F Eleid
- 3 Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - David R Holmes
- 3 Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - Joerg Herrmann
- 3 Department of Cardiovascular Diseases Mayo Clinic Rochester MN
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15
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Ammar A, Elbatran AI, Wijesuriya N, Saberwal B, Ahsan SY. Management of atrial fibrillation after transcatheter aortic valve replacement: Challenges and therapeutic considerations. Trends Cardiovasc Med 2020; 31:361-367. [PMID: 32599334 DOI: 10.1016/j.tcm.2020.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022]
Abstract
Atrial Fibrillation (AF) is very common among patients with severe aortic stenosis. Moreover, new onset AF (NOAF) is a frequent finding after Transcatheter Aortic Valve Replacement (TAVR). There is a significant impact of AF on outcomes in patients undergoing TAVR including mortality, thrombo-embolic and bleeding events. There is lack of clear evidence about the optimal management of AF in TAVR patients. This review aims to summarize the epidemiology, predictors, prognosis, therapeutic considerations and challenges in the management of AF in patients undergoing TAVR.
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Affiliation(s)
- Ahmed Ammar
- Barts Heart Centre, St Bartholomew's Hospital, London, UK; Department of Cardiology, Ain Shams University, Cairo, Egypt.
| | | | | | - Bunny Saberwal
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Syed Y Ahsan
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
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16
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17
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Toutouzas K, Stathogiannis K, Latsios G, Synetos A, Drakopoulou M, Penesopoulou V, Michelongona A, Tsiamis E, Tousoulis D. Biomarkers in Aortic Valve Stenosis and their Clinical Significance in Transcatheter Aortic Valve Implantation. Curr Med Chem 2019; 26:864-872. [PMID: 28748765 DOI: 10.2174/0929867324666170727110241] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 11/30/2016] [Accepted: 12/17/2016] [Indexed: 02/06/2023]
Abstract
Aortic valve stenosis is one of the most common valvular heart disorders and the prevalence will rise as the population ages. Once symptomatic patients with aortic valve stenosis tend to fare worse with high mortality rates. Aortic valve replacement is indicated in these patients and besides the standard surgical replacement, a less invasive approach, transcatheter aortic valve implantation, has gained momentum and has showed promising and solid results in patients with high surgical risk. An important aspect of evaluating patients with aortic valve stenosis is the ability to choose the best possible candidate for the procedure. In addition, predicting the short and long-term clinical outcomes after the valve replacement could offer the treating physicians a better insight and provide information for optimal therapy. Biomarkers are biological parameters that can be objectively measured and evaluated as indicators of normal biological processes and are easily monitored. The aim of this review is to critically assess some of the most widely used biomarkers at present (natriuretic peptides, troponins, C-reactive protein) and provide an insight in novel biomarkers that are currently being investigated (galectin-3, growth differentiation factor-15, microRNAs) for possible diagnostic and prognostic use in aortic valve stenosis and transcatheter aortic valve implantation respectively.
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Affiliation(s)
- Konstantinos Toutouzas
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | | | - George Latsios
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Andreas Synetos
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Maria Drakopoulou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Vicky Penesopoulou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | | | - Eleftherios Tsiamis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
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18
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Yoon YH, Ahn JM, Kang DY, Ko E, Lee PH, Lee SW, Kim HJ, Kim JB, Choo SJ, Park DW, Park SJ. Incidence, Predictors, Management, and Clinical Significance of New-Onset Atrial Fibrillation After Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 123:1127-1133. [PMID: 30683423 DOI: 10.1016/j.amjcard.2018.12.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
There is limited information on the incidence, management, and prognostic impact of new-onset atrial fibrillation (NOAF) following transcatheter aortic valve implantation (TAVI) for severe aortic valve stenosis. In the prospective ASAN-TAVI registry, we evaluated a total of 347 consecutive patients who underwent TAVI from March 2010 to August 2017. The primary end point was a composite of stroke or systemic embolism at 12 months. The study subjects were categorized into 3 groups; pre-existing AF (50 patients), NOAF (31 patients), and non-AF (266 patients) group. NOAF developed in 10.4% of patients without pre-existing AF after TAVI and most cases were paroxysmal type (93.6%). Pharmacologic and electrical cardioversion were tried in 13 (41.9%) and 6 (19.4%) patients and success rates were 61.5% and 33.3%, respectively. NOAF-associated case rate for primary end point was 22.6%. Transfemoral access and cardiac tamponade were independent predictors of NOAF. Patients with NOAF, as compared with those with pre-existing AF and those without AF, had an increased 1-year rate of primary end point (24.0% vs 9.9% vs 7.2%, respectively; p <0.001). By multivariable analysis, NOAF was an independent predictor of 1-year rate of primary end point (adjusted hazard ratio: 3.31; 95% CI: 1.34 to 8.20; p = 0.010). In conclusion, patients with severe aortic valve stenosis who underwent TAVI, NOAF occurred in 10% and 1 of 4 NOAF patients experienced stroke or systemic embolization. The presence of NOAF was associated with a substantially higher risk of stroke or systemic embolization.
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19
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Abstract
Atrial fibrillation (AF) is a known complication of many cardiac procedures, including those undergoing surgical aortic valve replacement (SAVR). In the transcatheter aortic valve replacement (TAVR) era, AF has been noted not only to be present in these patients but also associated with morbidity and mortality. In this article, we first outline the significance of AF in general and then more specifically in patients undergoing cardiac surgery. We then compare and contrast specific clinical issues related to AF in patients with aortic stenosis undergoing aortic valve replacement, traditionally with SAVR, but now increasingly more common with TAVR.
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Affiliation(s)
- Kinjan Parikh
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein 5-435, New York, NY 10032, USA
| | - Jose Dizon
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein 5-435, New York, NY 10032, USA
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein 5-435, New York, NY 10032, USA.
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20
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Rodés-Cabau J, Urena M, Nombela-Franco L, Amat-Santos I, Kleiman N, Munoz-Garcia A, Atienza F, Serra V, Deyell MW, Veiga-Fernandez G, Masson JB, Canadas-Godoy V, Himbert D, Castrodeza J, Elizaga J, Francisco Pascual J, Webb JG, de la Torre JM, Asmarats L, Pelletier-Beaumont E, Philippon F. Arrhythmic Burden as Determined by Ambulatory Continuous Cardiac Monitoring in Patients With New-Onset Persistent Left Bundle Branch Block Following Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:1495-1505. [PMID: 30031719 DOI: 10.1016/j.jcin.2018.04.016] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/26/2018] [Accepted: 04/10/2018] [Indexed: 12/14/2022]
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21
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Doshi R, Decter DH, Meraj P. Incidence of arrhythmias and impact of permanent pacemaker implantation in hospitalizations with transcatheter aortic valve replacement. Clin Cardiol 2018. [PMID: 29532527 DOI: 10.1002/clc.22943] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This study sought to analyze in-hospital outcomes associated with preexisting and newly implanted permanent pacemaker (PPM) in patients who underwent transcatheter aortic valve replacement (TAVR). PPM implantation following the development of conduction abnormalities is a common adverse event following TAVR. Furthermore, PPM implantation rates are higher in TAVR hospitalizations compared with the surgical alternative, thus we have analyzed the predictors of pacing post-TAVR. HYPOTHESIS We hypothesize that incidence of arrhythmias are high post-TAVR and have worse adverse outcomes after receiving PPM. METHODS The study population was identified from the National Inpatient Sample database between 2012 and 2014. TAVR population was identified using ICD-9-CM procedure codes 35.05 and 35.06. Hospitalizations were divided into 3 group: (1) with preexisting PPM, (2) with newly implanted PPM, and (3) without any PPM. RESULTS Overall, 0.8% of hospitalizations presented with preexisting PPM and 23.7% of hospitalizations received new PPM. The overall incidence of atrial fibrillation was 44.5%, left bundle branch block 8.9%, complete atrioventricular block 9.5%, and right bundle branch block 2.7%. In-hospital mortality was higher in hospitalizations receiving PPM compared with those without (4.9% vs 4.0%; P = 0.05). Length of stay and cost were higher in the group receiving new PPM. Female sex, atrial fibrillation, left bundle branch block, and second-degree and complete atrioventricular block were significant predictors for receiving PPM after TAVR. CONCLUSIONS A risk stratification for hospitalizations with conduction disorders is necessary to avoid longer hospital stays, added costs, and mortality. Further research is warranted to investigate additional predictors for PPM after TAVR.
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Affiliation(s)
- Rajkumar Doshi
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Dean H Decter
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Perwaiz Meraj
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
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22
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Tarantini G, Mojoli M, Urena M, Vahanian A. Atrial fibrillation in patients undergoing transcatheter aortic valve implantation: epidemiology, timing, predictors, and outcome. Eur Heart J 2018; 38:1285-1293. [PMID: 27744287 DOI: 10.1093/eurheartj/ehw456] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/11/2016] [Indexed: 12/31/2022] Open
Abstract
Atrial fibrillation (AF) is a common arrhythmia in patients with aortic stenosis. When these patients are treated medically or by surgical aortic valve replacement, AF is associated with increased risk of adverse events including death. Growing evidence suggests a significant impact of AF on outcomes also in patients with aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI). Conversely, limited evidence is available regarding the optimal management of this condition. This review aims to summarize prevalence, pathophysiology, prognosis, and treatment of AF in patients undergoing TAVI.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Marco Mojoli
- Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Marina Urena
- Cardiology Department, Hospital Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France
| | - Alec Vahanian
- Cardiology Department, Hospital Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France
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Affiliation(s)
- Bethany A. Kalich
- University of the Incarnate Word Feik School of Pharmacy; San Antonio Texas
- University of Texas Health at San Antonio; San Antonio Texas
| | | | - Ian B. Hollis
- University of North Carolina Hospitals; Chapel Hill North Carolina
- UNC Eshelman School of Pharmacy; Chapel Hill North Carolina
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Siontis GCM, Praz F, Lanz J, Vollenbroich R, Roten L, Stortecky S, Räber L, Windecker S, Pilgrim T. New-onset arrhythmias following transcatheter aortic valve implantation: a systematic review and meta-analysis. Heart 2017; 104:1208-1215. [DOI: 10.1136/heartjnl-2017-312310] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/26/2017] [Accepted: 12/04/2017] [Indexed: 01/27/2023] Open
Abstract
ObjectiveTo evaluate the prevalence and clinical impact of new-onset arrhythmias in patients following transcatheter aortic valve implantation (TAVI).MethodWe systematically identified studies reporting new-onset arrhythmias after TAVI other than atrioventricular conduction disturbances. We summarised monitoring strategies, type and prevalence of arrhythmias and estimated their effect on risk of death or cerebrovascular events by using random-effects meta-analysis. The study is registered withInternational prospective register of systematic reviews (PROSPERO) (CRD42017058053).ResultsSixty-five studies (43 506 patients) reported new-onset arrhythmias following TAVI. The method of arrhythmia detection was specified only in 31 studies (48%). New-onset atrial fibrillation (NOAF) (2641 patients), bradyarrhythmias (182 patients), supraventricular arrhythmias (29 patients), ventricular arrhythmias (28 patients) and non-specified major arrhythmias (855 patients) were reported. In most studies (52 out of 65), new-onset arrhythmia detection was limited to the first month following TAVI. The most frequently documented arrhythmia was NOAF with trend of increasing summary prevalence of 11%, 14%, 14% and 25% during inhospital, 30-day, 1-year and 2-year follow-ups, respectively (P for trend=0.011). Summary prevalence estimates of NOAF at 30-day follow-up differ significantly between studies of prospective and retrospective design (8% and 21%, respectively, P=0.002). New episodes of bradyarrhythmias were documented with a summary crude prevalence of 4% at 1-year follow-up. NOAF increased the risk of death (relative risk 1.61, 95% CI 1.35 to 1.98, I2=47%) and cerebrovascular events (1.79, 95% CI 1.24 to 2.64, I2=0%). No study commented on therapeutic modifications following the detection of new-onset arrhythmias.ConclusionsSystematic identification of new-onset arrhythmias following TAVI may have considerable impact on subsequent therapeutic management and long-term prognosis in this patient population.
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Harjai KJ, Thakur K, Young B, Hopkins E, Mascarenhas V, Crockett S, Singh D, Stahl R, Bules T, Scalzo L, Paton IN, Vijayaraman P. Suitability for Watchman Implantation in TAVR Patients with Atrial Fibrillation. Structural Heart 2017. [DOI: 10.1080/24748706.2017.1414341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kishore J. Harjai
- Department of Cardiology, Geisinger Northeast, Pearsall Heart Hospital, Wilkes Barre, Pennsylvania, USA
| | - Kamia Thakur
- Department of Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Bonnie Young
- Department of Cardiology, Geisinger Northeast, Pearsall Heart Hospital, Wilkes Barre, Pennsylvania, USA
| | - Eugenia Hopkins
- Department of Cardiology, Geisinger Northeast, Pearsall Heart Hospital, Wilkes Barre, Pennsylvania, USA
| | - Vernon Mascarenhas
- Department of Cardiology, Geisinger Northeast, Pearsall Heart Hospital, Wilkes Barre, Pennsylvania, USA
| | - Samuel Crockett
- Department of Cardiology, Geisinger Northeast, Pearsall Heart Hospital, Wilkes Barre, Pennsylvania, USA
| | - Deepak Singh
- Department of Cardiology, Geisinger Northeast, Pearsall Heart Hospital, Wilkes Barre, Pennsylvania, USA
| | - Russell Stahl
- Department of Cardiology, Geisinger Northeast, Pearsall Heart Hospital, Wilkes Barre, Pennsylvania, USA
| | - Thomas Bules
- Department of Cardiology, Geisinger Northeast, Pearsall Heart Hospital, Wilkes Barre, Pennsylvania, USA
| | - Lori Scalzo
- Department of Cardiology, Geisinger Northeast, Pearsall Heart Hospital, Wilkes Barre, Pennsylvania, USA
| | - Isabella N. Paton
- Department of Cardiology, Geisinger Northeast, Pearsall Heart Hospital, Wilkes Barre, Pennsylvania, USA
| | - Pugazhendhi Vijayaraman
- Department of Cardiology, Geisinger Northeast, Pearsall Heart Hospital, Wilkes Barre, Pennsylvania, USA
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Biviano AB, Nazif T, Dizon J, Garan H, Abrams M, Fleitman J, Hassan D, Kapadia S, Babaliaros V, Xu K, Rodes-Cabau J, Szeto WY, Fearon WF, Dvir D, Dewey T, Williams M, Kindsvater S, Mack MJ, Webb JG, Craig Miller D, Smith CR, Leon MB, Kodali S. Atrial Fibrillation is Associated with Increased Pacemaker Implantation Rates in the Placement of AoRTic Transcatheter Valve (PARTNER) Trial. J Atr Fibrillation 2017; 10:1494. [PMID: 29250217 DOI: 10.4022/jafib.1494] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/02/2016] [Accepted: 05/06/2017] [Indexed: 01/13/2023]
Abstract
Atrial fibrillation (AF) is associated with worse outcomes in many cardiovascular diseases. There are few data examining pacemaker implantation rates and indications in patients with AF who undergo transcatheter aortic valve replacement (TAVR). To examine the impact of AF on the incidence of and indications for pacemakers in patients undergoing TAVR, we evaluated data of 1723 patients without pre-existing pacemakers who underwent TAVR in the Placement of AoRTic TraNscathetER Valve (PARTNER) trial. Permanent pacemaker implantation rates and indications were compared in groups based on baseline and discharge heart rhythm: sinus rhythm (SR) vs. AF. 1211 patients manifested SR at baseline/SR at discharge (SR/SR), 105 SR baseline/AF discharge (SR/AF), and 407 AF baseline/AF discharge (AF/AF). Patients who developed and were discharged with AF (SR/AF) had the highest rates of pacemaker implantation at 30 days (13.7% SR/AF vs. 5.4% SR/SR, p=0.0008 and 5.9% AF/AF, p=0.008) and 1 year (17.7% SR/AF vs. 7.1% SR/SR, p=0.0002 and 8.1% AF/AF, p=0.0034). Conversion from SR to AF by discharge was an independent predictor of increased pacemaker implantation at 30 days (HR 2.19 vs. SR/SR, 95% CI 1.23-3.93, p=0.008) and 1 year (HR 1.91 vs. SR/SR, 95% CI 1.33-3.80). Pacemaker indications differed between groups, with relatively more implanted in the AF groups for sick sinus syndrome (SSS) versus AV block. In conclusion, conversion to AF is an independent predictor of permanent pacemaker implantation in TAVR patients. Indications differ depending on heart rhythm, with patients in AF manifesting clinically significant tachy-brady syndrome versus AV block.
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Affiliation(s)
- Angelo B Biviano
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Tamim Nazif
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Jose Dizon
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Hasan Garan
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Mark Abrams
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Jessica Fleitman
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Dua Hassan
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | | | | | - Ke Xu
- Cardiovascular Research Foundation, New York, NY
| | - Josep Rodes-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Wilson Y Szeto
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - Danny Dvir
- St. Paul's Hospital, Vancouver, BC, Canada
| | - Todd Dewey
- HCA Medical City Dallas Hospital, Dallas, TX
| | | | | | | | | | | | - Craig R Smith
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
| | - Martin B Leon
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY.,Cardiovascular Research Foundation, New York, NY
| | - Susheel Kodali
- Columbia University Medical Center/ New York Presbyterian Hospital, New York, NY
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Hengstenberg C, Chandrasekhar J, Sartori S, Lefevre T, Mikhail G, Meneveau N, Tron C, Jeger R, Kupatt C, Vogel B, Farhan S, Sorrentino S, Sharma M, Snyder C, Husser O, Boekstegers P, Hambrecht R, Widder J, Hildick-Smith D, De Carlo M, Wijngaard P, Deliargyris E, Bernstein D, Baber U, Mehran R, Anthopoulos P, Dangas G. Impact of pre-existing or new-onset atrial fibrillation on 30-day clinical outcomes following transcatheter aortic valve replacement: Results from the BRAVO 3 randomized trial. Catheter Cardiovasc Interv 2017; 90:1027-1037. [DOI: 10.1002/ccd.27155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 04/30/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Christian Hengstenberg
- Division of Cardiology; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance; Munich Germany
- Division of Cardiology, Deutsches Herzzentrum München; Technische Universität München; Munich Germany
| | - Jaya Chandrasekhar
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Samantha Sartori
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Thierry Lefevre
- Division of Cardiology; Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé; Massy France
| | - Ghada Mikhail
- Division of Cardiology; Imperial College Healthcare NHS Trust, Hammersmith Hospital; London United Kingdom
| | | | | | - Raban Jeger
- Department of Cardiology; University Hospital Basel; Switzerland
| | | | - Birgit Vogel
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Serdar Farhan
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Sabato Sorrentino
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Madhav Sharma
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Clayton Snyder
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Oliver Husser
- Division of Cardiology; Deutsches Herzzentrum München; Germany
| | | | - Rainer Hambrecht
- Department of Cardiology and Angiology; Klinikum Links der Weser; Bremen Germany
| | - Julian Widder
- Department of Cardiology and Angiology; Hannover Medical School; Hannover Germany
| | - David Hildick-Smith
- Division of Cardiology; Sussex Cardiac Centre-Brighton & Sussex University Hospitals NHS Trust; Brighton East Sussex United Kingdom
| | - Marco De Carlo
- Division of Cardiology; Azienda Ospedaliero-Universitaria Pisana; Pisa Italy
| | - Peter Wijngaard
- Division of Cardiology; The Medicines Company; Zurich Switzerland
| | | | - Debra Bernstein
- Division of Cardiology; The Medicines Company; Parsippany New Jersey
| | - Usman Baber
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Roxana Mehran
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | | | - George Dangas
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
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Jørgensen TH, Thyregod HGH, Tarp JB, Svendsen JH, Søndergaard L. Temporal changes of new-onset atrial fibrillation in patients randomized to surgical or transcatheter aortic valve replacement. Int J Cardiol 2017; 234:16-21. [DOI: 10.1016/j.ijcard.2017.02.098] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 01/03/2017] [Accepted: 02/20/2017] [Indexed: 11/24/2022]
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Kohno H, Ueda H, Matsuura K, Tamura Y, Watanabe M, Matsumiya G. Long-term consequences of atrial fibrillation after aortic valve replacement. Asian Cardiovasc Thorac Ann 2017; 25:179-191. [DOI: 10.1177/0218492317689902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Atrial fibrillation is a common complication after cardiac surgery, but the risk factors and long-term outcome after primary isolated aortic valve replacement remains to be clarified. Methods A single-center retrospective study was conducted on 157 patients who underwent first-time isolated aortic valve replacement between April 1999 and February 2015. Fifty-eight patients developed new-onset atrial fibrillation within 6 months postoperatively, and they were compared with patients who remained in sinus rhythm. Multivariate analyses, which incorporated the propensity score patient matching technique, were conducted to evaluate the long-term outcome of new-onset postoperative atrial fibrillation and identify patients at risk of developing this arrhythmia. Results At a mean follow-up of 52.4 months (range 8.4–200.7 months), mortality was significantly higher in patients who developed atrial fibrillation compared to those who remained in sinus rhythm (2.8%/patient-year vs. 0.2%/patient-year, respectively; p < 0.05). Patients developing atrial fibrillation were also at an independently increased risk of stroke and readmission during follow-up. Risk analysis revealed that advanced age (>70 years) and absence of a postoperative β-blocker were predictors of atrial fibrillation. Conclusions New-onset atrial fibrillation after first-time isolated aortic valve replacement correlated significantly with late morbidity and mortality. Advanced age and absence of a postoperative β-blocker may increase the incidence of atrial fibrillation.
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Affiliation(s)
- Hiroki Kohno
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hideki Ueda
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kaoru Matsuura
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yusaku Tamura
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Michiko Watanabe
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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Hannan EL, Samadashvili Z, Stamato NJ, Lahey SJ, Wechsler A, Jordan D, Sundt TM, Gold JP, Ruiz CE, Ashraf MH, Smith CR. Utilization and 1-Year Mortality for Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement in New York Patients With Aortic Stenosis: 2011 to 2012. JACC Cardiovasc Interv 2017; 9:578-85. [PMID: 27013157 DOI: 10.1016/j.jcin.2015.12.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/12/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate changes in the use of transcatheter aortic valve replacement (TAVR) relative to surgical aortic valve replacement (SAVR) and to examine relative 1-year TAVR and SAVR outcomes in 2011 to 2012 in a population-based setting. BACKGROUND TAVR has become a popular option for patients with severe aortic stenosis, particularly for higher-risk patients. METHODS New York's Cardiac Surgery Reporting System was used to identify TAVR and SAVR volumes and to propensity match TAVR and SAVR patients using numerous patient risk factors contained in the registry to compare 1-year mortality rates. Mortality rates were also compared for different levels of patient risk. RESULTS The total number of aortic valve replacement patients increased from 2,291 in 2011 to 2,899 in 2012, an increase of 27%. The volume of SAVR patients increased by 7.1% from 1,994 to 2,135 and the volume of TAVR patients increased 157% from 297 to 764. The percentage of SAVR patients that were at higher risk (≥3% New York State [NYS] score, equivalent to a Society of Thoracic Surgeons score of about 8%) decreased from 27% to 23%, and the percentage of TAVR patients that were at higher risk decreased from 83% to 76%. There was no significant difference in 1-year mortality between TAVR and SAVR patients (15.6% vs. 13.1%; hazard ratio [HR]: 1.30 [95% confidence interval (CI): 0.89 to 1.92]). There were no differences among patients with NYS score <3% (12.5% vs. 10.2%; HR: 1.42 [95% CI: 0.68 to 2.97]) or among patients with NYS score ≥3% (17.1% vs. 14.5%; HR: 1.27 [95% CI: 0.81 to 1.98]). CONCLUSIONS TAVR has assumed a much larger share of all aortic valve replacements for severe aortic stenosis, and the average level of pre-procedural risk has decreased substantially. There are no differences between 1-year mortality rates for TAVR and SAVR patients.
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Affiliation(s)
- Edward L Hannan
- School of Public Health, University at Albany, State University of New York, Albany, New York.
| | - Zaza Samadashvili
- School of Public Health, University at Albany, State University of New York, Albany, New York
| | - Nicholas J Stamato
- Department of Cardiology, Campbell County Memorial Hospital, Gillette, Wyoming
| | - Stephen J Lahey
- Division of Cardiothoracic Surgery, University of Connecticut, Storrs, Connecticut
| | - Andrew Wechsler
- Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Desmond Jordan
- Department of Surgery, Columbia-Presbyterian Medical Center, New York, New York
| | - Thoralf M Sundt
- Cardiac Surgical Division, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Carlos E Ruiz
- Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, New York
| | - Mohammed H Ashraf
- Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, New York
| | - Craig R Smith
- Department of Surgery, Columbia-Presbyterian Medical Center, New York, New York
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31
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Villablanca PA, Mathew V, Thourani VH, Rodés-Cabau J, Bangalore S, Makkiya M, Vlismas P, Briceno DF, Slovut DP, Taub CC, McCarthy PM, Augoustides JG, Ramakrishna H. A meta-analysis and meta-regression of long-term outcomes of transcatheter versus surgical aortic valve replacement for severe aortic stenosis. Int J Cardiol 2016; 225:234-243. [DOI: 10.1016/j.ijcard.2016.10.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/04/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
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Sannino A, Stoler RC, Lima B, Szerlip M, Henry AC, Vallabhan R, Kowal RC, Brown DL, Mack MJ, Grayburn PA. Frequency of and Prognostic Significance of Atrial Fibrillation in Patients Undergoing Transcatheter Aortic Valve Implantation. Am J Cardiol 2016; 118:1527-32. [PMID: 27666171 DOI: 10.1016/j.amjcard.2016.08.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 11/21/2022]
Abstract
The prognostic implications of preexisting atrial fibrillation (AF) and new-onset AF (NOAF) in transcatheter aortic valve implantation (TAVI) remain uncertain. This study assesses the epidemiology of AF in patients treated with TAVI and evaluates their outcomes according to the presence of preexisting AF or NOAF. A retrospective analysis of 708 patients undergoing TAVI from 2 heart hospitals was performed. Patients were divided into 3 study groups: sinus rhythm (n = 423), preexisting AF (n = 219), and NOAF (n = 66). Primary outcomes of interest were all-cause death and stroke both at 30-day and at 1-year follow-up. Preexisting AF was present in 30.9% of our study population, whereas NOAF was observed in 9.3% of patients after TAVI. AF and NOAF patients showed a higher rate of 1-year all-cause mortality compared with patients in sinus rhythm (14.6% vs 6.5% for preexisting AF and 16.3% vs 6.5% for NOAF, p = 0.007). No differences in 30-day mortality were observed between groups. In patients with AF (either preexisting and new-onset), those discharged with single antiplatelet therapy displayed higher mortality rates at 1 year (42.9% vs 11.7%, p = 0.006). Preexisting AF remained an independent predictor of mortality at 1-year follow-up (hazard ratio [HR] 2.34, 95% CI 1.22 to 4.48, p = 0.010). Independent predictors of NOAF were transapical and transaortic approach as well as balloon postdilatation (HR 3.48, 95% CI 1.66 to 7.29, p = 0.001; HR 5.08, 95% CI 2.08 to 12.39, p <0.001; HR 2.76, 95% CI 1.25 to 6.08, p = 0.012, respectively). In conclusion, preexisting AF is common in patients undergoing TAVI and is associated with a twofold increased risk of 1-year mortality. This negative effect is most pronounced in patients discharged with single antiplatelet therapy compared with other antithrombotic regimens.
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Biviano AB, Nazif T, Dizon J, Garan H, Fleitman J, Hassan D, Kapadia S, Babaliaros V, Xu K, Parvataneni R, Rodes-Cabau J, Szeto WY, Fearon WF, Dvir D, Dewey T, Williams M, Mack MJ, Webb JG, Miller DC, Smith CR, Leon MB, Kodali S. Atrial Fibrillation Is Associated With Increased Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights From the Placement of Aortic Transcatheter Valve (PARTNER) Trial. Circ Cardiovasc Interv 2016; 9:e002766. [PMID: 26733582 DOI: 10.1161/circinterventions.115.002766] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study sought to evaluate the impact of atrial fibrillation (AF) on clinical outcomes in patients undergoing transcatheter aortic valve replacement. METHODS AND RESULTS Data were evaluated in 1879 patients with baseline and discharge ECGs who underwent transcatheter aortic valve replacement in the Placement of AoRTic TraNscathetER Valve (PARTNER) trial. A total of 1262 patients manifested sinus rhythm (SR) at baseline/SR at discharge, 113 SR baseline/AF discharge, and 470 AF baseline/AF discharge. Patients who converted from SR to AF by discharge had the highest rates of all-cause mortality at 30 days (P<0.0001 across all groups; 14.2% SR/AF versus 2.6% SR/SR; adjusted hazard ratio [HR]=3.41; P=0.0002) and over 2-fold difference at 1 year (P<0.0001 across all groups; 35.7% SR/AF versus 15.8% SR/SR; adjusted HR=2.14; P<0.0001). The presence of AF on baseline or discharge ECG was a predictor of 1-year mortality (adjusted HR=2.14 for SR/AF group and HR=1.88 for AF/AF groups; P<0.0001 for both groups versus SR/SR). For patients discharged in AF, those with lower ventricular response (ie, <90 bpm) experienced less 1-year all-cause mortality (HR=0.74; P=0.04). CONCLUSIONS After transcatheter aortic valve replacement, the presence of AF at discharge, and particularly, the conversion to AF by discharge and higher ventricular response are associated with increased mortality. These data underscore the deleterious impact of AF, as well as the need for targeted interventions to improve clinical outcomes, in patients undergoing transcatheter aortic valve replacement. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894.
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Affiliation(s)
- Angelo B Biviano
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.).
| | - Tamim Nazif
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Jose Dizon
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Hasan Garan
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Jessica Fleitman
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Dua Hassan
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Samir Kapadia
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Vasilis Babaliaros
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Ke Xu
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Rupa Parvataneni
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Josep Rodes-Cabau
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Wilson Y Szeto
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - William F Fearon
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Danny Dvir
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Todd Dewey
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Mathew Williams
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Michael J Mack
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - John G Webb
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - D Craig Miller
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Craig R Smith
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Martin B Leon
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Susheel Kodali
- From the Department of Medicine (A.B.B., T.N., J.D., H.G., J.F., D.H., M.B.L., S. Kodali) and Department of Surgery (C.R.S.), Columbia University Medical Center, New York Presbyterian Hospital, NY; Department of Cardiovascular Medicine, Cleveland Clinic, OH (S. Kapadia); Division of Cardiology, Emory University, Atlanta, GA (V.B.); Cardiovascular Research Foundation, New York, NY (K.X., R.P., M.B.L.); Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada (J.R.-C.); Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Department of Medicine (W.F.F.) and Department of Cardiovascular Surgery (D.C.M.), Stanford University, CA; Department of Medicine, Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada (D.D., J.G.W.); Thoracic Surgery, Medical City Dallas, TX (T.D.); Department of Cardiothoracic Medicine and Department of Medicine, NYU Langone Medical Center, New York, NY (M.W.); Cardiothoracic Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
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Hannan EL, Samadashvili Z, Jordan D, Sundt TM, Stamato NJ, Lahey SJ, Gold JP, Wechsler A, Ashraf MH, Ruiz C, Wilson S, Smith CR. Thirty-Day Readmissions After Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis in New York State. Circ Cardiovasc Interv 2016; 8:e002744. [PMID: 26227347 DOI: 10.1161/circinterventions.115.002744] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several studies have compared short-term and medium-term mortality rates for patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR), but no studies have compared short-term readmission rates for the 2 procedures. METHODS AND RESULTS New York's Cardiac Surgery Reporting System was used to propensity match 617 TAVI and 1981 SAVR patients using numerous patient risk factors contained in the registry. The 389 propensity-matched pairs were then used to analyze differences in readmission rates between the 2 groups. TAVI and SAVR readmission rates were also compared for patients with a history of congestive heart failure and for patients aged ≥80. Also, reasons for readmission for TAVI and SAVR patients were examined and compared. Readmission rates were not statistically different for all propensity-matched TAVI and SAVR patients (respective rates, 18.8% and 19.3%; P=0.86). After further adjustment using a logistic regression model, there was still no significant difference (adjusted odds ratio, 0.97; 95% confidence interval [0.68-1.39]). For patients aged ≥80, the 30-day readmission rates were 19.9% and 22.0% (P=0.59), and when further adjusted using the logistic regression model, adjusted odds ratio=0.89 (0.55-1.45). For patients with a history of congestive heart failure, the respective rates were 22.8% and 20.4% (P=0.56), and with further adjustment, adjusted odds ratio became 1.15 (0.72-1.82). CONCLUSIONS There are no statistically significant differences between TAVI and SAVR patients in short-term readmission rates.
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Affiliation(s)
- Edward L Hannan
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.).
| | - Zaza Samadashvili
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Desmond Jordan
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Thoralf M Sundt
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Nicholas J Stamato
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Stephen J Lahey
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Jeffrey P Gold
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Andrew Wechsler
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Mohammed H Ashraf
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Carlos Ruiz
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Sean Wilson
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
| | - Craig R Smith
- From the School of Public Health, University at Albany, State University of New York, Albany (E.L.H., Z.S.); Department of Anesthesiology (D.J.) and Department of Surgery (C.R.S.), Columbia-Presbyterian Medical Center, New York, NY; Heart Center and Institute for Heart, Vascular and Stroke, Massachusetts General Hospital, Boston (T.M.S.); Department of Cardiology, Campbell County Memorial Hospital, Gillette, WY (N.J.S.); Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.); University of Nebraska Medical Center, Omaha (J.P.G.); Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA (A.W.); Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY (M.H.A.); Division of Structural and Congenital Heart Disease, Lenox Hill Hospital, New York, NY (C.R.); and Department of Surgery, The Valley Hospital, Ridgewood, NJ (S.W.)
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Tarantini G, Mojoli M, Windecker S, Wendler O, Lefèvre T, Saia F, Walther T, Rubino P, Bartorelli AL, Napodano M, D’Onofrio A, Gerosa G, Iliceto S, Vahanian A. Prevalence and Impact of Atrial Fibrillation in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2016; 9:937-46. [DOI: 10.1016/j.jcin.2016.01.037] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/14/2016] [Accepted: 01/28/2016] [Indexed: 11/26/2022]
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Raiten JM, Ghadimi K, Augoustides JGT, Ramakrishna H, Patel PA, Weiss SJ, Gutsche JT. Atrial fibrillation after cardiac surgery: clinical update on mechanisms and prophylactic strategies. J Cardiothorac Vasc Anesth 2016; 29:806-16. [PMID: 26009291 DOI: 10.1053/j.jvca.2015.01.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Jesse M Raiten
- Cardiovascular Critical Care Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kamrouz Ghadimi
- Division of CT Anesthesiology and Critical Care Medicine, Department of Anesthesiology, School of Medicine, Duke University, Durham, NC
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Departmsent of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | | | - Prakash A Patel
- Cardiovascular and Thoracic Section, Departmsent of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Departmsent of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Departmsent of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Chopard R, Teiger E, Meneveau N, Chocron S, Gilard M, Laskar M, Eltchaninoff H, Iung B, Leprince P, Chevreul K, Prat A, Lievre M, Leguerrier A, Donzeau-gouge P, Fajadet J, Mouillet G, Schiele F. Baseline Characteristics and Prognostic Implications of Pre-Existing and New-Onset Atrial Fibrillation After Transcatheter Aortic Valve Implantation. JACC Cardiovasc Interv 2015; 8:1346-55. [DOI: 10.1016/j.jcin.2015.06.010] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/16/2015] [Accepted: 06/04/2015] [Indexed: 11/23/2022]
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Yankelson L, Steinvil A, Gershovitz L, Leshem-Rubinow E, Furer A, Viskin S, Keren G, Banai S, Finkelstein A. Atrial fibrillation, stroke, and mortality rates after transcatheter aortic valve implantation. Am J Cardiol 2014; 114:1861-6. [PMID: 25438914 DOI: 10.1016/j.amjcard.2014.09.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/17/2014] [Accepted: 09/17/2014] [Indexed: 11/26/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is considered a suitable treatment for patients with severe symptomatic aortic stenosis and high operative risk. Our aim was to evaluate the effect of preprocedural and new-onset atrial fibrillation (NOAF) on mortality and stroke in patients who underwent TAVI. We performed a single-center study of 380 consecutive patients enrolled to a TAVI registry. NOAF was defined as postprocedural atrial fibrillation (AF) occurring within 30 days after the procedure. Patients were followed up for a mean of 528 ± 364 days. During follow-up, 19 (5%) new episodes of stroke occurred, of whom 6 and 18 cases occurred within 30 days and 1 year, respectively. Overall mortality during the follow-up was 68 (20%), of those 12 and 58 patients died within 30 days and 1 year, respectively. NOAF occurred in 31 (8.2%) patients and was not associated with higher stroke or mortality rates at 30 days or 1 year of follow-up. Notably, compared with patients without previous AF, patients with previous AF at baseline had increased rates of stroke and mortality at 1-year follow-up (2.1% vs 9.6%, p = 0.01, and 8.2% vs 34.9%, p <0.01; respectively). In multivariate analysis, AF at baseline but not NOAF was a significant predictor of mortality throughout the follow-up period (HR 2.2, 95% confidence interval 1.3 to 3.8, p = 0.003, and HR 1.5, 95% confidence interval 0.5 to 4.1, p = 0.390, respectively). In conclusion, previous AF at baseline but not NOAF significantly increases stroke and mortality rates after TAVI. The inclusion of AF into future TAVI risk stratification scores should be strongly considered.
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Barbash IM, Minha S, Ben-Dor I, Dvir D, Torguson R, Aly M, Bond E, Satler LF, Pichard AD, Waksman R. Predictors and clinical implications of atrial fibrillation in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2014; 85:468-77. [DOI: 10.1002/ccd.25708] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 10/10/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Israel M. Barbash
- Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Sa'ar Minha
- Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Itsik Ben-Dor
- Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Danny Dvir
- Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Rebecca Torguson
- Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Muhammad Aly
- Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Elizabeth Bond
- Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Lowell F. Satler
- Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Augusto D. Pichard
- Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
| | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center; Washington DC
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Nagaraja V, Raval J, Eslick GD, Ong ATL. Transcatheter versus surgical aortic valve replacement: a systematic review and meta-analysis of randomised and non-randomised trials. Open Heart 2014; 1:e000013. [PMID: 25332780 PMCID: PMC4189306 DOI: 10.1136/openhrt-2013-000013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 05/26/2014] [Accepted: 07/15/2014] [Indexed: 12/18/2022] Open
Abstract
Introduction Many patients deemed inoperable for surgical aortic valve replacement (SAVR) have been treated successfully by transcatheter aortic-valve replacement (TAVR). This meta-analysis is designed to evaluate the performance of TAVR in comparison with SAVR. Methods A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, the Cochrane library, Google Scholar, Science Direct and Web of Science. Original data were abstracted from each study and used to calculate a pooled OR and 95% CI. Results Among three randomised controlled trials (RCTs), differences between the two cohorts were not statistically significant for the frequency of stroke (OR=1.94, 95% CI=0.813 to 4.633), incidence of myocardial infarction (MI), (OR=0.765, 95% CI=0.05 to 11.76) 30-day mortality rate, 1-year mortality rate (0.82, 95% CI=0.62 to 1.09) and acute kidney injury incidence rate. The non-RCTs demonstrated that the TAVR group had an amplified frequency aortic regurgitation at discharge (OR=5.465, 95% CI=3.441 to 8.680). While differences between the two cohorts were not statistically significant for the incidence of MI (OR=0.697, 95% CI=0.22 to 2.21), stroke (OR=0.575, 95% CI=0.263 to 1.259), acute renal failure requiring haemodialysis (OR=0.943, 95% CI=0.276 to 3.222), 30-day mortality (OR=0.869, 95% CI=0.621 to 1.216) and the need for a pacemaker (OR=1.832, 95% CI=0.869 to 3.862), a lower incidence of patients needing transfusion (OR=0.349, 95% CI=0.121 to 1.005) and new-onset atrial fibrillation (OR=0.296, 95% CI=0.124 to 0.706) was seen in the TAVR group. Conclusions Randomised and observational evidence adjusted on the baseline patient’s characteristics finds a similar risk for 30 days mortality, 1-year mortality, stroke, MI and acute kidney injury in TAVR and SAVR.
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Affiliation(s)
- Vinayak Nagaraja
- Prince of Wales Clinical School, University of New South Wales, Prince of Wales Hospital, Australia ; The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Sydney, NSW, Australia
| | - Jwalant Raval
- Department of Cardiology, Blacktown Hospital, Australia
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Sydney, NSW, Australia
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van der Boon RMA, Houthuizen P, Nuis RJ, van Mieghem NM, Prinzen F, de Jaegere PPT. Clinical implications of conduction abnormalities and arrhythmias after transcatheter aortic valve implantation. Curr Cardiol Rep 2014; 16:429. [PMID: 24281975 DOI: 10.1007/s11886-013-0429-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has become an established treatment option for patients with aortic stenosis at prohibitive risk to undergo surgical aortic valve replacement. Despite conveying obvious clinical benefits and a decreasing frequency of complications, the occurrence of new conduction abnormalities and arrhythmias remains an important issue. Generally considered a minor complication, they may have a profound impact on prognosis and quality of life after TAVI. Therefore the purpose of this review is to assess and discuss the available information on clinical implications of both new conduction abnormalities and arrhythmias after TAVI.
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Affiliation(s)
- Robert M A van der Boon
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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Seco M, Martinez G, Bannon PG, Cartwright BL, Adams M, Ng M, Wilson MK, Vallely MP. Transapical Aortic Valve Implantation—An Australian Experience. Heart Lung Circ 2014; 23:462-8. [DOI: 10.1016/j.hlc.2013.10.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 10/21/2013] [Accepted: 10/24/2013] [Indexed: 11/22/2022]
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Tanawuttiwat T, O'Neill BP, Cohen MG, Chinthakanan O, Heldman AW, Martinez CA, Alfonso CE, Mitrani RD, Macon CJ, Carrillo RG, Williams DB, O'Neill WW, Myerburg RJ. New-onset atrial fibrillation after aortic valve replacement: comparison of transfemoral, transapical, transaortic, and surgical approaches. J Am Coll Cardiol 2014; 63:1510-9. [PMID: 24486264 DOI: 10.1016/j.jacc.2013.11.046] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 10/10/2013] [Accepted: 11/19/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study sought to determine the incidence of new-onset atrial fibrillation (AF) associated with different methods of isolated aortic valve replacement (AVR)-transfemoral (TF), transapical (TA), and transaortic (TAo) catheter-based valve replacement and conventional surgical approaches. BACKGROUND The relative incidences of AF associated with the various access routes for AVR have not been well characterized. METHODS In this single-center, retrospective cohort study, we evaluated a total of 231 consecutive patients who underwent AVR for degenerative aortic stenosis (AS) between March 2010 and September 2012. Patients with a history of paroxysmal, persistent, or chronic AF, with bicuspid aortic valves, and patients who died within 48 h after AVR were excluded. A total of 123 patients (53% of total group) qualified for inclusion. Data on documented episodes of new-onset AF, along with all clinical, echocardiographic, procedural, and 30-day follow-up data, were collated. RESULTS AF occurred in 52 patients (42.3%). AF incidence varied according to the procedural method. AF occurred in 60% of patients who underwent surgical AVR (SAVR), in 53% after TA-TAVR, in 33% after TAo-TAVR cases, and 14% after TF-TAVR. The episodes occurred at a median time interval of 53 (25th to 75th percentile, 41 to 87) h after completion of the procedure. Procedures without pericardiotomy had an 82% risk reduction of AF compared with those with pericardiotomy (adjusted odds ratio: 0.18; 95% confidence interval: 0.05 to 0.59). CONCLUSIONS AF was a common complication of AVR with a cumulative incidence of >40% in elderly patients with degenerative AS who underwent either SAVR or TAVR. AF was most common with SAVR and least common with TF-TAVR. Procedures without pericardiotomy were associated with a lower incidence of AF.
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Affiliation(s)
- Tanyanan Tanawuttiwat
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Brian P O'Neill
- Temple Heart and Vascular Center, Temple University, Philadelphia, Pennsylvania (formerly at Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida)
| | - Mauricio G Cohen
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Orawee Chinthakanan
- Department of Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand
| | - Alan W Heldman
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Claudia A Martinez
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Carlos E Alfonso
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Raul D Mitrani
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Conrad J Macon
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Roger G Carrillo
- Cardiothoracic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Donald B Williams
- Cardiothoracic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - William W O'Neill
- Center of Structural Heart Disease, Henry Ford Hospital and Medical Group, Detroit, Michigan
| | - Robert J Myerburg
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
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Ghadimi K, Patel PA, Gutsche JT, Sophocles A, Anwaruddin S, Szeto WY, Augoustides JG. Perioperative Conduction Disturbances After Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2013; 27:1414-20. [DOI: 10.1053/j.jvca.2013.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Indexed: 11/11/2022]
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Abstract
The introduction of transcatheter aortic valve insertion (TAVI) has transformed the care provided for patients with severe aortic stenosis. The uptake of this procedure is increasing rapidly, and clinicians from all disciplines are likely to increasingly encounter patients being assessed for or having undergone this intervention. Successful TAVI heavily relies on careful and comprehensive imaging assessment, before, during and after the procedure, using a range of modalities. This review outlines the background and development of TAVI, describes the nature of the procedure and considers the contribution of imaging techniques, both to successful intervention and to potential complications.
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Affiliation(s)
- B Clayton
- Cardiology Department, Derriford Hospital, Plymouth, UK
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Panchal HB, Ladia V, Desai S, Shah T, Ramu V. A meta-analysis of mortality and major adverse cardiovascular and cerebrovascular events following transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis. Am J Cardiol 2013; 112:850-60. [PMID: 23756547 DOI: 10.1016/j.amjcard.2013.05.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/02/2013] [Accepted: 05/02/2013] [Indexed: 11/19/2022]
Abstract
The purpose of this meta-analysis was to compare postprocedural mortality and major adverse cardiovascular and cerebrovascular events between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) for severe aortic stenosis. Seventeen studies (n = 4,659) comparing TAVI (n = 2,267) and SAVR (n = 2,392) were included. End points were baseline logistic European System for Cardiac Operative Risk Evaluation score, all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, transient ischemic attack, and major bleeding events. Mean differences or risk ratios with 95% confidence intervals were computed, and p values <0.05 were considered significant. The population was matched for risk between the 2 groups on the basis of logistic European System for Cardiac Operative Risk Evaluation score for all outcomes except 30-day all-cause mortality, which had a high-risk population in the TAVI group (p = 0.02). There was no significant difference found in all-cause mortality at 30 days (p = 0.97) and at an average of 85 weeks (p = 0.07). There was no significant difference in cardiovascular mortality (p = 0.54) as well as the incidence of myocardial infarction (p = 0.59), stroke (p = 0.36), and transient ischemic attack (p = 0.85) at averages of 86, 72, 66, and 89 weeks, respectively. Compared with patients who underwent TAVI, those who underwent SAVR had a significantly higher frequency of major bleeding events (p <0.0001) at mean follow-up of 66 weeks. In conclusion, TAVI has similar cardiovascular and all-cause mortality to SAVR at early and long-term follow-up. TAVI is superior to SAVR for major bleeding complications and noninferior to SAVR for postprocedural myocardial infarctions and cerebrovascular events. TAVI is a safe alternative to SAVR in selected high-risk elderly patients with severe aortic stenosis.
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Affiliation(s)
- Hemang B Panchal
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA.
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Cao C, Ang SC, Indraratna P, Manganas C, Bannon P, Black D, Tian D, Yan TD. Systematic review and meta-analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis. Ann Cardiothorac Surg 2013; 2:10-23. [PMID: 23977554 DOI: 10.3978/j.issn.2225-319x.2012.11.09] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 11/15/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has emerged as an acceptable treatment modality for patients with severe aortic stenosis who are deemed inoperable by conventional surgical aortic valve replacement (AVR). However, the role of TAVI in patients who are potential surgical candidates remains controversial. METHODS A systematic review was conducted using five electronic databases, identifying all relevant studies with comparative data on TAVI versus AVR. The primary endpoint was all-cause mortality. A number of periprocedural outcomes were also assessed according to the Valve Academic Research Consortium endpoint definitions. RESULTS Fourteen studies were quantitatively assessed and included for meta-analysis, including two randomized controlled trials and eleven observational studies. Results indicated no significant differences between TAVI and AVR in terms of all-cause and cardiovascular related mortality, stroke, myocardial infarction or acute renal failure. A subgroup analysis of randomized controlled trials identified a higher combined incidence of stroke or transient ischemic attacks in the TAVI group compared to the AVR group. TAVI was also found to be associated with a significantly higher incidence of vascular complications, permanent pacemaker requirement and moderate or severe aortic regurgitation. However, patients who underwent AVR were more likely to experience major bleeding. Both treatment modalities appeared to effectively reduce the transvalvular mean pressure gradient. CONCLUSIONS The available data on TAVI versus AVR for patients at a higher surgical risk showed that major adverse outcomes such as mortality and stroke appeared to be similar between the two treatment modalities. Evidence on the outcomes of TAVI compared with AVR in the current literature is limited by inconsistent patient selection criteria, heterogeneous definitions of clinical endpoints and relatively short follow-up periods. The indications for TAVI should therefore be limited to inoperable surgical candidates until long-term data become available.
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Affiliation(s)
- Christopher Cao
- The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia; ; Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia
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Tang GHL, Lansman SL, Cohen M, Spielvogel D, Cuomo L, Ahmad H, Dutta T. Transcatheter Aortic Valve Replacement: Current Developments, Ongoing Issues, Future Outlook. Cardiol Rev 2013; 21:55-76. [DOI: 10.1097/crd.0b013e318283bb3d] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Stortecky S, Buellesfeld L, Wenaweser P, Heg D, Pilgrim T, Khattab AA, Gloekler S, Huber C, Nietlispach F, Meier B, Jüni P, Windecker S. Atrial fibrillation and aortic stenosis: impact on clinical outcomes among patients undergoing transcatheter aortic valve implantation. Circ Cardiovasc Interv 2013; 6:77-84. [PMID: 23386662 DOI: 10.1161/circinterventions.112.000124] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is an important risk factor for stroke and is common among elderly patients undergoing transcatheter aortic valve implantation. The aim of this study was to assess the impact of AF on clinical outcomes among patients undergoing transcatheter aortic valve implantation. METHODS AND RESULTS Between August 2007 and October 2011, a total of 389 high-risk patients undergoing transcatheter aortic valve implantation were included into a prospective registry. AF was recorded in 131 patients (33.7%) with a mean CHA(2)DS(2)-VASC score of 4.5±1.2 and was paroxysmal in 26 (25.0%), persistent in 8 (7.7%), and permanent in 70 patients (67.3%). Patients with and without AF had similar baseline characteristics except for fewer revascularization procedures (coronary artery bypass grafting: 12% versus 22%; P=0.03) among AF patients. At 1 year, all-cause mortality was higher among patients with AF (30.9%) compared with those without AF (13.9%; hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.43-3.90; P=0.0008). This was observed irrespective of the type of AF (permanent, HR, 2.47; 95% CI, 1.40-4.38; persistent, HR, 3.60; 95% CI, 1.10-11.78; paroxysmal, HR, 2.88; 95% CI, 1.37-6.05). Mortality gradually increased with higher CHA(2)DS(2)-VASC scores (score 1-3: HR, 2.20; 95% CI, 0.92-5.27; score 6-8: HR, 4.12; 95% CI, 2.07-8.20). The risks of stroke (3.9% versus 5.1%; HR, 0.76; 95% CI, 0.23-1.96; P=0.47) and life-threatening bleeding (19.8% versus 14.7%; HR, 1.37; 95% CI, 0.86-2.19; P=0.19) were similar among patients with and without AF. CONCLUSIONS AF is common among high-risk patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and is associated with a >2-fold increased risk of all-cause and cardiovascular mortality, irrespective of the type of AF. The gradient of risk directly correlates with the CHA(2)DS(2)-VASC score.
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Affiliation(s)
- Stefan Stortecky
- Departments of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
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Reidy C, Sophocles A, Ramakrishna H, Ghadimi K, Patel PA, Augoustides JG. Challenges After the First Decade of Transcatheter Aortic Valve Replacement: Focus on Vascular Complications, Stroke, and Paravalvular Leak. J Cardiothorac Vasc Anesth 2013; 27:184-9. [DOI: 10.1053/j.jvca.2012.09.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Indexed: 02/06/2023]
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