Safety of shorter length of hospital stay for patients undergoing minimalist transcatheter aortic valve replacement

Background. Physiotherapy prior to open-heart surgery lowers the rate of pneumonia and length of the hospital stay. Pneumonia is a major contributor to short-term mortality following transcatheter aortic valve replacement (TAVR). Hence, we hypothesized that pre- and intensified postprocedural physiotherapy in patients undergoing TAVR might impact the net functional and clinical outcome. Methods and Results. The 4P-TAVR study was a prospective, monocentric, randomized trial. The study was designed to compare the efficacy and safety of intensified periprocedural physiotherapy including inspiratory muscle training versus standard postprocedural physiotherapy. Patients were randomized in a 1 : 1 fashion. 108 patients were included and followed up for 90 days after TAVR. While patients in group A (control group: 50 patients, age: 81.7 ± 5.0 years, 52% male) did not receive physiotherapy prior to TAVR, group B (intervention group: 58 patients, age: 82.2 ± 5.82 years, 47% male) participated in intensive physiotherapy. Compared to the control group, patients in the interventional group showed a lower incidence of postinterventional pneumonia (10 [20.0%] vs. 3 [5.1%], p = 0.016 ) and had a 3-day shorter mean hospital stay (13.5 ± 6.1 days vs. 10.1 ± 4.7 days, p = 0.02 ). The primary composite endpoint of mortality and rehospitalization was not different between the groups. Conclusion. Intensified physiotherapy is safe and has positive effects on clinical outcomes up to 90 days after TAVR but has no impact on the primary combined endpoint of mortality and rehospitalization. Longer follow-up, a multicenter design, and a higher number of subjects are needed to confirm these preliminary results. This trial is registered with DRKS00017239.

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Clinical Outcome and Safety of Transcaval Access for Transcatheter Aortic Valve Replacement as Compared to Other Alternative Approaches

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.731639 ◽

2021 ◽

Vol 8 ◽

Author(s):

Israel M. Barbash ◽

Amit Segev ◽

Anat Berkovitch ◽

Paul Fefer ◽

Elad Maor ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Hospital Stay ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Kidney Injury ◽

Transfemoral Approach ◽

Entire Cohort ◽

Transcatheter Aortic Valve ◽

Artery Disease

Background: A small proportion of patients in need of transcatheter aortic valve replacement (TAVR) are not suitable for the transfemoral approach due to peripheral artery disease. Alternative TAVR approaches are associated with short- and long-term hazards. A novel technique of caval-aortic (transcaval) access for TAVR has been utilized as an alternative access technique.Aim: To compare safety and efficacy of transcaval access as compared to other alternative access (axillary or apical) for TAVR.Methods: A single-center, retrospective analysis of consecutive patients undergoing alternative access for TAVR. Events were adjudicated according to VARC-2 criteria.Results: A total of 185 patients were included in the present analysis. Mean age was 81 years with a small majority for male gender (54%). Of the entire cohort, 20 patients (12%) underwent transcaval TAVR, and 165 patients (82%) underwent TAVR using alternative access. Overall, baseline characteristics were comparable between the two groups. General anesthesia was not utilized in transcaval patients; however, it was routinely used in nearly all alternative access patients. TAVR device success was comparable between the two groups (95%). Acute kidney injury occurred significantly less frequently among transcaval patients as compared to alternative access patients (5 vs. 12%, p = 0.05). Hospital stay was shorter for transcaval patients (6.3 days vs. 14.4; p < 0.001). No difference in early or 30-day mortality (10 vs. 7.9%, p = 0.74) was noted between groups.Conclusions: In patients who cannot undergo TAVR via the trans-femoral approach due to peripheral vascular disease, transcaval access is a safe approach as compared to other alternative access techniques, with lower risk of kidney injury and shorter hospital stay.

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TRANSCATHETER AORTIC VALVE REPLACEMENT IN BRITISH COLUMBIA. IMPLICATIONS OF VALVE SELECTION ON PACEMAKER RATES, HOSPITAL STAY, AND READMISSION

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2017.07.037 ◽

2017 ◽

Vol 33 (10) ◽

pp. S9-S10

Author(s):

J. Webb ◽

B. Catlin ◽

A. Chan ◽

J. Charania ◽

A. Cheung ◽

...

Keyword(s):

British Columbia ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Hospital Stay ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Transcatheter Aortic Valve

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Right ventricular function and outcome in patients undergoing transcatheter aortic valve replacement

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa342 ◽

2020 ◽

Author(s):

Matthias Koschutnik ◽

Varius Dannenberg ◽

Christian Nitsche ◽

Carolina Donà ◽

Jolanta M Siller-Matula ◽

...

Keyword(s):

Heart Failure ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Right Ventricular ◽

Hospital Stay ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Heart Failure Hospitalization ◽

Transcatheter Aortic Valve ◽

Rv Function

Abstract Aims Right ventricular dysfunction (RVD) on echocardiography has been shown to predict outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). However, a comparison with the gold standard, RV ejection fraction (EF) on cardiovascular magnetic resonance (CMR), has never been performed. Methods and results Consecutive patients scheduled for TAVR underwent echocardiography and CMR. RV fractional area change (FAC), tricuspid annular plane systolic excursion, RV free-lateral-wall tissue Doppler (S’), and strain were assessed on echocardiography, and RVEF on CMR. Patients were prospectively followed. Adjusted regression analyses were used to report the strength of association per 1-SD decline for each RV function parameter with (i) N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels, (ii) prolonged in-hospital stay (>14 days), and (iii) a composite of heart failure hospitalization and death. Two hundred and four patients (80.9 ± 6.6 y/o; 51% female; EuroSCORE-II: 6.3 ± 5.1%) were included. At a cross-sectional level, all RV function parameters were associated with NT-proBNP levels, but only FAC and RVEF were significantly associated with a prolonged in-hospital stay [adjusted odds ratio 1.86, 95% confidence interval (CI) 1.07–3.21; P = 0.027 and 2.29, 95% CI 1.43–3.67; P = 0.001, respectively]. A total of 56 events occurred during follow-up (mean 13.7 ± 9.5 months). After adjustment for the EuroSCORE-II, only RVEF was significantly associated with the composite endpoint (adjusted hazard ratio 1.70, 95% CI 1.32–2.20; P < 0.001). Conclusion RVD as defined by echocardiography is associated with an advanced disease state but fails to predict outcomes after adjustment for pre-existing clinical risk factors in TAVR patients. In contrast, RVEF on CMR is independently associated with heart failure hospitalization and death.

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