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Amien B, Appleby C, Mills J, Sandhu K, Harrington D. Acute Aortic Regurgitation After Transcatheter Aortic Valve Implantation Procedure. Cureus 2023; 15:e50345. [PMID: 38149064 PMCID: PMC10750444 DOI: 10.7759/cureus.50345] [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] [Accepted: 12/11/2023] [Indexed: 12/28/2023] Open
Abstract
This study reports the case of a 75-year-old woman who developed aortic regurgitation (AR) a few hours after transcatheter aortic valve implantation (TAVI). The patient underwent the TAVI procedure for aortic stenosis and became hypotensive in recovery. A transthoracic echo revealed cardiac tamponade and around 1500 ml of blood was drained over several hours. Further advice was sought from the surgical team, and a transoesophageal echo revealed significant AR, which was confirmed by a transthoracic echo performed the next day. The patient underwent an emergency surgical aortic valve replacement. This case study demonstrates one of the complications of the TAVI procedure, acute AR, which was diagnosed a few hours after the procedure.
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Affiliation(s)
- Bothayna Amien
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, GBR
| | - Clare Appleby
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, GBR
| | - Joe Mills
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, GBR
| | - Kully Sandhu
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, GBR
| | - Deborah Harrington
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, GBR
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Cuko B, Baudo M, Ternacle J, Leroux L, Modine T. One-Stage Transcatheter Aortic Valve Implantation and Transcatheter Edge-to-Edge Tricuspid Valve Repair for Double Valve Dysfunction in a High-Risk Patient. Cureus 2023; 15:e45648. [PMID: 37868418 PMCID: PMC10590086 DOI: 10.7759/cureus.45648] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
A 75-year-old female patient was referred to our institution for severe symptomatic low-flow low-gradient aortic valve stenosis and tricuspid valve regurgitation (TR) associated with heart failure. After multidisciplinary discussion, the patient was scheduled for one-stage totally percutaneous treatment of her valve lesions by transcatheter aortic valve implantation (TAVI) and transcatheter edge-to-edge tricuspid valve repair (TEER) through transfemoral access. The patient had an uneventful hospital stay and was discharged home on the third postoperative day. During the following 24 months, the patient did well with regression of her heart failure signs and symptoms.
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Affiliation(s)
- Besart Cuko
- Department of Cardiology and Cardiovascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux, FRA
| | - Massimo Baudo
- Cardiac Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, ITA
| | - Julien Ternacle
- Department of Cardiology and Cardiovascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Bordeaux, FRA
| | - Lionel Leroux
- Department of Cardiology and Cardiovascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux, FRA
| | - Thomas Modine
- Department of Cardiology and Cardiovascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux, FRA
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Benaicha K, Aldroubi B, Yousuf P, Nath R, Saveeta F, Kanwal F, Fatima T, Hirani S. Factors Associated With Acute Kidney Injury in Patients Undergoing Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e45131. [PMID: 37842473 PMCID: PMC10569799 DOI: 10.7759/cureus.45131] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
The aim of this meta-analysis is to assess the effect of different independent predictors on acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI). This meta-analysis adhered to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive database search was conducted using PubMed, Web of Science, and Scopus for the period from January 1, 2015, to August 15, 2023. The following key terms were employed: "transcatheter aortic valve implantation" OR "transcatheter aortic valve replacement" AND "acute kidney injury" OR "acute renal failure." Our search was limited to studies published exclusively in the English language. The statistical analysis was conducted using RevMan version 5.4.1 (The Cochrane Collaboration). Estimates were presented as odds ratio (OR) with 95% confidence interval (CI) for categorical variables, while continuous variables were reported as mean difference (MD) with 95% CI. A total of 19 studies met the selection criteria and were included in the meta-analysis. The pooled incidence of AKI was reported as 20% (95% CI: 18-20%). Factors significantly associated with post-TAVI AKI encompass hypertension, chronic kidney disease (CKD), low estimated glomerular filtration rate (eGFR), high baseline creatinine levels, peripheral vascular disease (PVD), Society of Thoracic Surgeons (STS) score, European System for Cardiac Operative Risk Evaluation (EUROscore) II, and the transfemoral surgical approach.
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Affiliation(s)
- Karima Benaicha
- Internal Medicine, University Hospital Isaad Hassani Beni Messous, Algiers, DZA
| | | | - Paras Yousuf
- Emergency Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | | | - Fnu Saveeta
- Internal Medicine, People's University of Medical and Health Sciences, Nawabshah, PAK
| | - Fnu Kanwal
- Medical College, Chandka Medical College, Larkana, PAK
| | - Tehreem Fatima
- Internal Medicine, United Medical and Dental College, Creek General Hospital, Karachi, PAK
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Mohammed F, Gubitosa JC, Huffman TR, Abdul-Waheed M, Rafeedheen R. A Case of Cardiac Arrest Due to Transcatheter Aortic Valve Infolding. Cureus 2023; 15:e43847. [PMID: 37736431 PMCID: PMC10510568 DOI: 10.7759/cureus.43847] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
Prosthetic valvular infolding during transcatheter aortic valve implantation (TAVI) is an under-recognized yet significant complication that can occur. Here, we describe the case of a 61-year-old male with a history of heart failure with reduced ejection fraction (HFrEF) and low-flow, low-gradient severe aortic valve stenosis of a bicuspid aortic valve who presented to undergo TAVI. During the procedure, repositioning of the valve resulted in prosthetic valvular infolding and resultant severe aortic regurgitation (AR), culminating in cardiac arrest. Swift balloon valvuloplasty corrected the valve geometry and eliminated any AR, allowing hemodynamic recovery and completion of the procedure. Our case and review highlight methods, both angiographic and echocardiographic, to recognize prosthetic valvular infolding the moment it presents, as well as strategies to correct the infolding with minimal detriment to the patient.
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Affiliation(s)
- Fawaz Mohammed
- Internal Medicine, University of Kentucky College of Medicine, Bowling Green, USA
| | - James C Gubitosa
- Cardiology, University of Kentucky College of Medicine, Bowling Green, USA
| | - Travis R Huffman
- Cardiology, University of Kentucky College of Medicine, Bowling Green, USA
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Al-Hammadi M, Fakhroo L, Bukamal N. A Clinical Audit on the Indications for Intervention With Transcatheter Aortic Valve Implantation Over Surgical Aortic Valve Replacement in Aortic Stenosis Patients in Mohammed Bin Khalifa Bin Salman Al Khalifa Specialist Cardiac Centre. Cureus 2023; 15:e39249. [PMID: 37378157 PMCID: PMC10291915 DOI: 10.7759/cureus.39249] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Transcatheter aortic valve implantation (TAVI) is a novel treatment strategy used to treat patients with symptomatic aortic stenosis. It utilizes a percutaneous approach and is preferred over surgical aortic valve replacement (SAVR) in patients at high surgical risk. The aim of this study was to audit the indications of the intervention with TAVI over SAVR in Bahrain Defence Force Hospital, Mohammed Bin Khalifa Bin Sulman AlKhalifa Cardiac Centre (BDF-MKCC), as well as note the outcomes of patients who underwent TAVI. Methods The indications for allocating aortic stenosis patients to TAVI over SAVR in BDF-MKCC were studied with regard to the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery (ESC/EACTS) guidelines published in 2017. Data from 82 patients, which accounts for all patients who underwent TAVI, were collected retrospectively from electronic medical records and the percentage of compliance was calculated and analyzed. Results The compliance percentages of the 23 parameters for the intervention with TAVI that have been set by the ESC/EACTS are calculated, where BDF-MKCC were fully adherent to 12 out of the 23 standards. Moreover, the total number of patients that are compliant with all standards is 13 out of 82 (15.85%) compliant patients. Conclusion The centre showed non-compliance to many of the published standards. Hence, we created a checklist to ensure that the international guidelines are followed. We are looking forward to re-audit this aspect in the near future, to make certain that changes were done. We would also like to do a comparative study to compare the patients' outcomes before and after implementing the 2017 ESC/EACTS guidelines. Furthermore, we call for further studies to be conducted in this field and that is to evaluate the standards themselves as well as the safety of TAVI in those who are not eligible for it according to the ESC/EACTS.
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Affiliation(s)
| | - Latifa Fakhroo
- General Practice, Royal College of Surgeons in Ireland, Busaiteen, BHR
| | - Nazar Bukamal
- Consultant Cardiothoracic Anaesthesia and Critical Care, Mohammed Bin Khalifa Bin Salman Al Khalifa Specialist Cardiac Centre, Awali, BHR
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Atoe-Imagbe OM, Azzu A, Aiwuyo HO, Osarenkhoe JO. Challenging Decision-Making Between Transcatheter Aortic Valve Implantation and Aortic Valve Surgery: A Case of a Jehovah's Witness Patient With Severe Symptomatic Aortic Stenosis Coexisting With Severe Mitral Regurgitation and Bicuspid Aortic Valve. Cureus 2023; 15:e34973. [PMID: 36938227 PMCID: PMC10019555 DOI: 10.7759/cureus.34973] [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] [Accepted: 02/14/2023] [Indexed: 02/16/2023] Open
Abstract
A 73-year-old Jehovah's witness man with a bicuspid aortic valve and a history of epilepsy presented to the emergency room with chest pain and dyspnea. Echocardiography revealed normal left ventricular systolic function, but also revealed severe aortic stenosis and severe mitral regurgitation. Coronary angiography and computerized tomography angiography ruled out any significant coronary artery disease and aortic dissection, respectively. In view of his religious views, transcatheter aortic valve implantation was considered more suitable than aortic valve surgery and was successful with a stable postoperative state. This case reaffirms that autonomy should be maintained while considering the best interest of patients in decision-making.
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Affiliation(s)
- Osagioduwa Mike Atoe-Imagbe
- Medicine, Delta State University Teaching Hospital, Oghara, NGA
- Medicine, Betsi Cadwaladr University Health Board, Bangor, GBR
| | | | - Henry O Aiwuyo
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - John O Osarenkhoe
- Medicine and Surgery, Igbinedion University Teaching Hospital, Benin City, NGA
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Büttner S, Zöller C, Patyna S, Gradascevic A, Weiler H, Rosenberg M, Walther T, Zeiher AM, Geiger H, Vasa-Nicotera M, Hauser IA, Fichtlscherer S. Risk of graft loss in kidney transplant recipients after aortic valve replacement. Biomol Biomed 2023; 23:145-152. [PMID: 35880351 PMCID: PMC9901896 DOI: 10.17305/bjbms.2022.7720] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/11/2022] [Indexed: 02/08/2023]
Abstract
Surgical aortic valve replacement (SAVR) in kidney transplant recipients (KTR) is associated with high morbidity and mortality, and an increased risk of postoperative graft failure potentially leading to graft loss. Transcatheter aortic valve implantation (TAVI) emerged as an alternative in high-risk patients. However, data on TAVI in kidney transplant recipients are limited. We performed a retrospective analysis of 40 KTR in which aortic valve replacement was performed at our center between 2005 and 2015. The outcomes and follow-up of TAVI (n=20; 2010-2015) and SAVR (n=20; 2005-2015) were analyzed with respect to patient and graft survival. Baseline characteristics in both groups were comparable. Hospital stay after TAVI was significantly shorter compared to SAVR (19 [11.5-21.75] days vs. 33 [21-62] days, p=0.001). Acute graft failure occurred more frequently after SAVR (45% vs. 89.5%; p=0.006). Thirty-day mortality was 10% in both groups. However, in-hospital mortality reached 25% in the SAVR group (TAVI 10%), indicating a more complicated course after surgery. Moreover, during a median follow-up time of 1928 days in TAVI patients and 2717 days in patients after SAVR, graft loss occurred only in the surgically treated group (n=7). While one-year survival after TAVR was 90% compared to 69% after SAVR, long-term follow-up showed comparable results (at 5 years: TAVI 58% vs. 52% SAVR; log-rank-test: p=0.86). In KTR, TAVI can be performed with good mid- to long-term results. Compared to SAVR, renal outcomes seem to be improved after TAVI, suggesting better graft survival.
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Affiliation(s)
- Stefan Büttner
- Medical Clinic III – Department of Nephrology, University Hospital Frankfurt, Frankfurt am Main, Germany,Medical Clinic I – Cardiology, Pneumology, Nephrology and Intensive Care Medicine, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany,Correspondence to Stefan Büttner:
| | - Carolin Zöller
- Medical Clinic III – Department of Nephrology, University Hospital Frankfurt, Frankfurt am Main, Germany,Medical Clinic II – Nephrology, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany,Medical Clinic III – Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Sammy Patyna
- Medical Clinic III – Department of Nephrology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Anisa Gradascevic
- Medical Clinic I – Cardiology, Pneumology, Nephrology and Intensive Care Medicine, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Helge Weiler
- Medical Clinic I – Cardiology, Pneumology, Nephrology and Intensive Care Medicine, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Mark Rosenberg
- Medical Clinic I – Cardiology, Pneumology, Nephrology and Intensive Care Medicine, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Thomas Walther
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andreas M Zeiher
- Medical Clinic III – Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Helmut Geiger
- Medical Clinic III – Department of Nephrology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Mariuca Vasa-Nicotera
- Medical Clinic III – Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ingeborg A Hauser
- Medical Clinic III – Department of Nephrology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stephan Fichtlscherer
- Medical Clinic III – Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main, Germany
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Muacevic A, Adler JR. A Case of Acute Ischemic Stroke Treated With Alteplase Immediately After Transcatheter Aortic Valve Implantation: Which Procedures or Surgeries are Considered Contraindications to Thrombolytics? Cureus 2022; 14:e30136. [PMID: 36238419 PMCID: PMC9551621 DOI: 10.7759/cureus.30136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Undergoing a major surgery within 14 days is considered a contraindication for intravenous alteplase. However, there is no consensus as to what qualifies as major surgery or an invasive procedure. Occasionally, determining whether a procedure is "invasive" or too risky in the setting of emergency ischemic stroke thrombolytic management can be challenging. Stroke neurologists may not be able to make such a decision on their own. Guidance or clearance from the physicians who performed the procedure is essential. We report the case of a patient who received intravenous alteplase after developing a stroke immediately following transcatheter aortic valve implantation (TAVI).
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Anayo L, Rogers P, Long L, Dalby M, Taylor R. Exercise-based cardiac rehabilitation for patients following open surgical aortic valve replacement and transcatheter aortic valve implant: a systematic review and meta-analysis. Open Heart 2019; 6:e000922. [PMID: 31168371 PMCID: PMC6519423 DOI: 10.1136/openhrt-2018-000922] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 02/14/2019] [Accepted: 02/16/2019] [Indexed: 01/04/2023] Open
Abstract
Objectives Exercise-based cardiac rehabilitation (CR) may be beneficial to patients following transcatheter aortic valve implantation (TAVI) and open surgical aortic valve replacement (SAVR). We aimed to undertake a systematic review and meta-analysis to evaluate the efficacy, safety and costs of exercise-based CR post-TAVI and post-SAVR. Methods We searched numerous databases, including Embase, CENTRAL and MEDLINE, up to October 2017. We included randomised controlled trials (RCTs) and non-randomised controlled trials (non-RCTs) of exercise-based CR compared with no exercise control in TAVI or SAVR patients ≥18 years. Data extraction and risk of bias assessments were performed independently by two reviewers. Narrative synthesis and meta-analysis (where appropriate) were carried out for all relevant outcomes, and a Grading of Recommendations Assessment, Development and Evaluation (GRADE) analysis was also performed. Results Six studies, all at low risk of bias, were included: three RCTs and three non-RCTs (total of 27 TAVI, 99 SAVR and 129 mixed patients), with follow-up of 2-12 months. There was an increase in pooled exercise capacity (standardised mean difference: 0.41, 95% CI 0.11 to 0.70; moderate certainty evidence as assessed by GRADE), with exercise-based rehabilitation compared with control. Data on other outcomes including quality of life and clinical events were limited. Conclusions Exercise-based CR probably improves exercise capacity of post-TAVI and post-SAVR patients in the short term. Well conducted multicentre fully powered RCTs of ≥12 months follow-up are needed to fully assess the clinical and cost-effectiveness of exercise-based CR in this patient population. PROSPERO Protocol Registration Number CRD42017084716.
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Affiliation(s)
- Lizette Anayo
- Institure of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
- Home Address, Kingswood, Bristol, UK
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Paula Rogers
- Royal Brompton & Harefield NHS Foundation Trust Hospital, Uxbridge, UK
| | - Linda Long
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Miles Dalby
- Royal Brompton & Harefield NHS Foundation Trust Hospital, Uxbridge, UK
| | - Rod Taylor
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
- Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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