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Ugwu JK, Kandah DR, Ndulue JK, Ebiem OP, Ugwu-Erugo JN, Hamilton R, Osei K, Taskesen T, Shivapour DM, Chawla A, Marcus RH. Comparative Outcomes of TAVR in Mixed Aortic Valve Disease and Aortic Stenosis: A Meta-analysis. Cardiol Ther 2023; 12:143-157. [PMID: 36567395 PMCID: PMC9986165 DOI: 10.1007/s40119-022-00293-3] [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: 10/04/2022] [Accepted: 11/28/2022] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) has become a suitable alternative to surgical aortic valve replacement (SAVR) for the treatment of symptomatic severe aortic stenosis (AS). A high proportion of patients with AS have mixed aortic valve disease (MAVD) with mild or more concurrent aortic regurgitation (AR). Differential outcomes of TAVR among patients with AS and MAVD have not been well characterized. We compared 1-year mortalities following TAVR among patients with MAVD and AS. METHODS We conducted a meta-analysis of studies published in PubMed/Medline. The primary outcome was 1-year all-cause mortality following TAVR among patients with MAVD vs. AS. Secondary endpoints were: (1) incidence of AR within 30 days following TAVR (post TAVR AR); and (2) 1-year all-cause mortality within each group stratified according to severity of post TAVR AR. RESULTS Nine studies involving 9505 participants were included in the analysis. At 1 year following TAVR, mortality was lower in MAVD than in AS; HR 0.89, 95% CI 0.81-0.98. The mortality advantage increased when pre-TAVR AR was moderate or more; HR 0.84, 95% CI 0.72-0.99. The mortality advantage was attenuated after correction for publication bias. There was a higher risk of post TAVR AR in the MAVD group; OR 1.51, 95% CI 1.20-1.90 but the impact on mortality of moderate vs. mild post TAVR AR was greater among patients with AS than in patients with MAVD HR 1.67 95% CI 0.89-3.14 vs. 0.93 95% CI 0.47-1.85. CONCLUSIONS Patients with MAVD have similar or improved survival 1 year after TAVR compared to those with AS.
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Affiliation(s)
- Justin K Ugwu
- Department of Cardiovascular Medicine, MercyOne Des Moines Medical Center, 1111 6Th Ave, Des Moines, IA, 50314, United States of America.
| | - Daniel R Kandah
- Internal Medicine Residency, MercyOne Des Moines Medical Center, Des Moines, IA, United States of America
| | - Jideofor K Ndulue
- Providence Medical Group, Chehalis Family Medicine, Chehalis, WA, United States of America
| | - Okechukwu P Ebiem
- Department of Hospital Medicine, Miami Valley Hospital, Dayton, OH, United States of America
| | | | - Russell Hamilton
- Department of Cardiovascular Medicine, MercyOne Des Moines Medical Center, 1111 6Th Ave, Des Moines, IA, 50314, United States of America
| | - Kofi Osei
- Department of Cardiovascular Medicine, MercyOne Des Moines Medical Center, 1111 6Th Ave, Des Moines, IA, 50314, United States of America
| | - Tuncay Taskesen
- Department of Cardiovascular Medicine, MercyOne Des Moines Medical Center, 1111 6Th Ave, Des Moines, IA, 50314, United States of America
| | - Daniel M Shivapour
- Department of Cardiovascular Medicine, MercyOne Des Moines Medical Center, 1111 6Th Ave, Des Moines, IA, 50314, United States of America
| | - Atul Chawla
- Department of Cardiovascular Medicine, MercyOne Des Moines Medical Center, 1111 6Th Ave, Des Moines, IA, 50314, United States of America
| | - Richard H Marcus
- Department of Cardiovascular Medicine, MercyOne Des Moines Medical Center, 1111 6Th Ave, Des Moines, IA, 50314, United States of America
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Shivapour DM, Javed O, Wu Y, Brinza E, Hornacek D, Conic J, Gornik HL, Kim ESH. Changes in Carotid Duplex Ultrasound Velocities After Aortic Valve Replacement for Severe Aortic Stenosis. J Ultrasound Med 2020; 39:139-145. [PMID: 31267549 DOI: 10.1002/jum.15087] [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] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/31/2019] [Accepted: 06/12/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The peak systolic velocity (PSV) and end-diastolic velocity (EDV) obtained by carotid duplex ultrasound (CDU) imaging of the internal carotid arteries (ICAs) are parameters used to determine the severity of ICA stenosis. Severe aortic stenosis (AS) results in a parvus-et-tardus pattern on spectral Doppler waveforms; however, the impact of severe AS on CDU velocities is unclear. The purpose of this study was to assess the impact of severe AS on CDU velocities by evaluating changes in CDU velocities before and after aortic valve replacement (AVR) METHODS: A single-center retrospective review of patients with severe AS who underwent surgical AVR and who had preoperative and postoperative CDU examinations performed within 12 months of each other was conducted. Patients with any carotid intervention between the preoperative and postoperative CDU were excluded. RESULTS We identified 92 patients who satisfied all inclusion criteria. The mean age was 72.2 years; 71.7% were men; the mean preoperative aortic valve area ± SD was 0.8 ± 0.2 cm2 ; and the mean time from preoperative to postoperative AVR CDU was 182.3 ± 98.4 days. The peak aortic valve gradient decreased from 62.5 to 22.0 mm Hg after AVR (P < .001); however, there were no significant changes in the PSV or EDV in either the right or left ICA. CONCLUSIONS Although severe AS may cause characteristic changes in the spectral Doppler waveform on CDU imaging, there is no significant effect on the ICA PSV or EDV. Adjustments in velocity criteria to determine the degree of carotid artery stenosis in patients with substantial AS may not be necessary.
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Affiliation(s)
- Daniel M Shivapour
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Omair Javed
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Yuping Wu
- Department of Mathematics, Cleveland State University, Cleveland, Ohio, USA
| | - Ellen Brinza
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Deborah Hornacek
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Juliana Conic
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Heather L Gornik
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Esther S H Kim
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Yeh RW, Rosenfield K, Zelevinsky K, Mauri L, Sakhuja R, Shivapour DM, Lovett A, Weiner BH, Jacobs AK, Normand SLT. Sources of Hospital Variation in Short-Term Readmission Rates After Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2012; 5:227-36. [DOI: 10.1161/circinterventions.111.967638] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robert W. Yeh
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.W.Y., K.R., D.S.); the Department of Health Care Policy, Harvard Medical School, Boston, MA (K.Z., A.L., S.-L.T.N.); the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Wellmont CVA Heart Institute, Kingsport, TN (R.S.); St Vincent Hospital, Worcester, MA (B.H.W.); the Department of Medicine, Section of
| | - Kenneth Rosenfield
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.W.Y., K.R., D.S.); the Department of Health Care Policy, Harvard Medical School, Boston, MA (K.Z., A.L., S.-L.T.N.); the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Wellmont CVA Heart Institute, Kingsport, TN (R.S.); St Vincent Hospital, Worcester, MA (B.H.W.); the Department of Medicine, Section of
| | - Katya Zelevinsky
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.W.Y., K.R., D.S.); the Department of Health Care Policy, Harvard Medical School, Boston, MA (K.Z., A.L., S.-L.T.N.); the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Wellmont CVA Heart Institute, Kingsport, TN (R.S.); St Vincent Hospital, Worcester, MA (B.H.W.); the Department of Medicine, Section of
| | - Laura Mauri
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.W.Y., K.R., D.S.); the Department of Health Care Policy, Harvard Medical School, Boston, MA (K.Z., A.L., S.-L.T.N.); the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Wellmont CVA Heart Institute, Kingsport, TN (R.S.); St Vincent Hospital, Worcester, MA (B.H.W.); the Department of Medicine, Section of
| | - Rahul Sakhuja
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.W.Y., K.R., D.S.); the Department of Health Care Policy, Harvard Medical School, Boston, MA (K.Z., A.L., S.-L.T.N.); the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Wellmont CVA Heart Institute, Kingsport, TN (R.S.); St Vincent Hospital, Worcester, MA (B.H.W.); the Department of Medicine, Section of
| | - Daniel M. Shivapour
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.W.Y., K.R., D.S.); the Department of Health Care Policy, Harvard Medical School, Boston, MA (K.Z., A.L., S.-L.T.N.); the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Wellmont CVA Heart Institute, Kingsport, TN (R.S.); St Vincent Hospital, Worcester, MA (B.H.W.); the Department of Medicine, Section of
| | - Ann Lovett
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.W.Y., K.R., D.S.); the Department of Health Care Policy, Harvard Medical School, Boston, MA (K.Z., A.L., S.-L.T.N.); the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Wellmont CVA Heart Institute, Kingsport, TN (R.S.); St Vincent Hospital, Worcester, MA (B.H.W.); the Department of Medicine, Section of
| | - Bonnie H. Weiner
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.W.Y., K.R., D.S.); the Department of Health Care Policy, Harvard Medical School, Boston, MA (K.Z., A.L., S.-L.T.N.); the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Wellmont CVA Heart Institute, Kingsport, TN (R.S.); St Vincent Hospital, Worcester, MA (B.H.W.); the Department of Medicine, Section of
| | - Alice K. Jacobs
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.W.Y., K.R., D.S.); the Department of Health Care Policy, Harvard Medical School, Boston, MA (K.Z., A.L., S.-L.T.N.); the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Wellmont CVA Heart Institute, Kingsport, TN (R.S.); St Vincent Hospital, Worcester, MA (B.H.W.); the Department of Medicine, Section of
| | - Sharon-Lise T. Normand
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.W.Y., K.R., D.S.); the Department of Health Care Policy, Harvard Medical School, Boston, MA (K.Z., A.L., S.-L.T.N.); the Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); Wellmont CVA Heart Institute, Kingsport, TN (R.S.); St Vincent Hospital, Worcester, MA (B.H.W.); the Department of Medicine, Section of
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