scholarly journals Baseline frailty status and outcomes important for shared decision-making in older adults receiving transcatheter aortic valve implantation, a prospective observational study

2020 ◽  
Author(s):  
Elisabeth Skaar ◽  
Anja Øksnes ◽  
Leslie Sofia Pareja Eide ◽  
Tone Merete Norekvål ◽  
Anette Hylen Ranhoff ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Aortic Valve ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Shared Decision ◽  
Frailty Status ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

scholarly journals Butyrylcholinesterase as a perioperative complication marker in patients after transcatheter aortic valve implantation: a prospective observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e042857
Author(s):  
Bernhard Michels ◽  
Andreas Holzamer ◽  
Bernhard M Graf ◽  
Andre Bredthauer ◽  
Walter Petermichl ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Aortic Valve ◽  
Observational Study ◽  
Postoperative Period ◽  
Prospective Observational Study ◽  
Point Of Care ◽  
Demographic Data ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

ObjectivesTranscatheter aortic valve implantation (TAVI) is performed in elderly patients with severe aortic valve stenosis and increased operative risks. We tested the hypothesis that acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) have a predictive value for prevalent complications after TAVI and could serve as indicators of systemic inflammation in the early postoperative period.DesignProspective observational study.SettingThis study is a secondary analysis of multicentre CESARO- study.Participants48 patients with TAVI were included and 43 obtained the complete assessment.Primary and secondary outcome measuresPatients’ clinical parameters, demographic data, peripheral AChE and BChE activities and routine blood markers were assessed throughout the perioperative period using bedside point-of-care measurements for AChE and BChE. Postoperative complication screening was conducted up to the third postoperative day and included infections, delirium and heart-rhythm disturbances. After assessment, the patients were divided into complication and noncomplication group.ResultsOf 43 patients, 24 developed postsurgical complications (55.8%). Preoperative assessment showed no significant differences regarding demographic data and laboratory markers, but preoperative BChE levels were significantly lower in patients who developed postoperative complications (complication group 2589.2±556.4 vs noncomplication group 3295.7±628.0, Cohen’s r=0.514, p<0.001). In complication group, we observed an early, sustained reduction in BChE activity from preoperative to postoperative period. In complication group, BChE levels were significantly lower at each time point compared with noncomplication group. AChE activity showed no significant difference between both groups. Complication group also had longer stay in hospital overall.ConclusionBChE could be a useful perioperative biomarker to identify patients with a higher risk for postoperative complications after TAVI. By using point-of-care measurements, the levels of BChE are fast available and can lead to an early targeted therapy. Predicting the length of the hospital stay might play an important role in staff and resource management for these patients.Trial registration numberNCT01964274; Post-results.

Frailty Status and Outcomes After Transcatheter Aortic Valve Implantation

2016 ◽  
Vol 117 (12) ◽  
pp. 1966-1971 ◽  
Author(s):  
Chetan P. Huded ◽  
Jill M. Huded ◽  
Julie L. Friedman ◽  
Lillian R. Benck ◽  
Lee A. Lindquist ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Frailty Status ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

scholarly journals A Novel Electronic Frailty Index as a Predictor of Clinical Outcomes After Transcatheter Aortic Valve Implantation

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 819-819
Author(s):  
Maria Rangel ◽  
Rahul Annabathula ◽  
Kathryn Callahan ◽  
Nicholas Pajewski ◽  
Jeff Williamson ◽  
...  
Keyword(s):  
Older Adults ◽  
Aortic Valve ◽  
Clinical Outcomes ◽  
Transcatheter Aortic Valve Implantation ◽  
Frailty Index ◽  
Adverse Outcomes ◽  
Major Adverse Cardiovascular Events ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Transcatheter aortic valve implantation (TAVI) is becoming the preferred therapeutic approach for older adults with severe aortic valve disease. Frailty portends increase mortality and adverse outcomes after TAVI. We sought to evaluate an electronic Frailty Index (eFI) as a predictor for increased healthcare utilization, adverse clinical and functional outcomes. We retrospective studied 302 adults older than 65 years that underwent TAVI at our institution between October 2017 and September 2020. The mean age of the cohort was 79 ±6.94 years old; 43% were female. Frail individuals (eFI &gt;0.20), as compared to Fit (eFI &lt;0.10) and Prefrail (0.10&gt;eFI&lt;0.20), were more likely to have a higher society of thoracic surgeons score and a greater burden of comorbidities. Subjects classified as Prefrail/Frail had longer intensive care unit stay post-TAVI than fit individuals (&gt;24 hours: 17% vs 4%, respectively, p 0.02); and trended toward longer hospitalization time and discharge to a setting different than home. The Prefrail/Frail group also had a higher proportion of subjects with persistent New York Heart Association Class III heart failure symptoms 30 days post-TAVI as compared to Fit (14% vs 2%, p 0.04), however both groups demonstrated significant symptomatic improvement post-procedure. No significant differences in 30 day mortality, major adverse cardiovascular events or readmissions were found. TAVI is an effective treatment with a low incidence of early adverse clinical outcomes in older adults regardless of frailty status; eFI could help in identifying and targeting susceptible adults that may require additional resources to recover post-TAVI.

Avoidance of urinary catheterization to minimize in-hospital complications after transcatheter aortic valve implantation: An observational study

2017 ◽  
Vol 17 (1) ◽  
pp. 66-74 ◽  
Author(s):  
Sandra B Lauck ◽  
Jae-Yung Kwon ◽  
David A Wood ◽  
Jennifer Baumbusch ◽  
Tone M Norekvål ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Observational Study ◽  
Transcatheter Aortic Valve Implantation ◽  
Urinary Catheter ◽  
Retrospective Chart Review ◽  
Urinary Catheterization ◽  
Indwelling Catheter ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Background: Contemporary transcatheter aortic valve implantation (TAVI) devices and approach present opportunities to review historical practices initially informed by early treatment development and cardiac surgery. The avoidance of urinary catheterization in the older TAVI population is a strategy to minimize in-hospital complications. The purpose of the study was to explore elimination-related complications following the phased implementation of a default strategy of avoiding urinary catheterization in patients undergoing transfemoral (TF) TAVI. Methods: We conducted an observational study using a retrospective chart review of patients treated between 2011 and 2013 to identify patient characteristics, peri-procedure details, in-hospital outcomes and elimination-related complications in patients who did or did not receive a peri-procedure indwelling catheter. Descriptive analyses were used to report differences between the groups; we conducted a regression analysis to explore the relationship between the practice of urinary catheterization and total procedure time. Results: Of the 408 patients who underwent TF TAVR, 188 (46.1%) received a peri-procedure indwelling urinary catheter and 220 (53.9%) did not. There was no difference in in-hospital mortality (2.2%), disabling stroke (0.5%), or other major cardiac adverse events. The avoidance of a urinary catheter resulted in significantly lower rates of urinary tract infection requiring a new antibiotic regimen (1.4% versus 6.1%, p = 0.014), haematuria documented by medicine or nursing (3.7% versus 17.6%, p = 0.001), and the need for continuous bladder irrigation (2.7% versus 0%, p = 0.027). Conclusion: The avoidance of a urinary catheter may contribute to improved outcomes in patients undergoing TAVI. The intervention should be further evaluated within the broader study of minimalist TAVI.

scholarly journals Statin therapy for patients with aortic stenosis who underwent transcatheter aortic valve implantation: a report from a Japanese multicentre registry

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044319
Author(s):  
Fumiaki Yashima ◽  
Masahiko Hara ◽  
Taku Inohara ◽  
Masahiro Jinzaki ◽  
Hideyuki Shimizu ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Observational Study ◽  
Transcatheter Aortic Valve Implantation ◽  
Cardiovascular Mortality ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
The Impact

ObjectiveData on statin for patients with aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI) are limited. The present study aimed to evaluate the impact of statin on midterm mortality of TAVI patients.DesignObservational study.SettingThis study included patients with AS from a Japanese multicentre registry who underwent TAVI.ParticipantsThe overall cohort included 2588 patients (84.4±5.2 years); majority were women (69.3%). The Society of Thoracic Surgeons risk score was 6.55% (IQR 4.55%–9.50%), the Euro II score was 3.74% (IQR 2.34%–6.02%) and the Clinical Frailty Scale score was 3.9±1.2.InterventionsWe classified patients based on statin at admission and identified 936 matched pairs after propensity score matching.Primary and secondary outcome measuresThe outcomes were all-cause and cardiovascular mortality.ResultsThe median follow-up was 660 days. Statin at admission was associated with a significant reduction in all-cause mortality (adjusted HR (aHR) 0.76, 95% CI 0.58 to 0.99, p=0.04) and cardiovascular mortality (aHR 0.64, 95% CI 0.42 to 0.97, p=0.04). In the octogenarians, statin was associated with significantly lower all-cause mortality (aHR 0.87, 95% CI 0.75 to 0.99, p=0.04); however, the impact in the nonagenarians appeared to be lower (aHR 0.84, 95% CI 0.62 to 1.13, p=0.25). Comparing four groups according to previous coronary artery disease (CAD) and statin, there was a significant difference in all-cause mortality, and patients who did not receive statin despite previous CAD showed the worst prognosis (aHR 1.33, 95% CI 1.12 to 1.57 (patients who received statin without previous CAD as a reference), p<0.01).ConclusionsStatin for TAVI patients will be beneficial even in octogenarians, but the benefits may disappear in nonagenarians. In addition, statin will be essential for TAVI patients with CAD. Further research is warranted to confirm and generalise our findings since this study has the inherent limitations of an observational study and included only Japanese patients.Trial registration numberUMIN000020423.

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