CONTRIBUTION OF CT-DERIVED BODY FAT COMPOSITION WITH FRAILTY AND LENGTH OF HOSPITAL STAY FOLLOWING TRANSCATHER AORTIC VALVE REPLACEMENT

The number of patients with severe aortic stenosis (AS) and a history of prior cardiac surgery has increased. Prior cardiac surgery increases the risk of adverse outcomes in patients undergoing aortic valve replacement. To evaluate the impact of prior cardiac surgery on clinical endpoints in patients undergoing transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR), we performed a literature search using PubMed, Embase, Google Scholar, and Scopus databases. The clinical endpoints included in our study were 30-day mortality, 1–2-year mortality, acute kidney injury (AKI), bleeding, stroke, procedural time, and duration of hospital stay. Seven studies, which included a total of 8221 patients, were selected. Our study found that TAVR was associated with a lower incidence of stroke and bleeding complications. There was no significant difference in terms of AKI, 30-day all-cause mortality, and 1–2-year all-cause mortality between the two groups. The average procedure time and duration of hospital stay were 170 min less (p ≤ 0.01) and 3.6 days shorter (p < 0.01) in patients with TAVR, respectively. In patients with prior coronary artery bypass graft and severe AS, both TAVR and SAVR are reasonable options. However, TAVR may be associated with a lower incidence of complications like stroke and perioperative bleeding, in addition to a shorter length of stay.

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J-Shaped Upper Mini-Sternotomy Versus Full Sternotomy for Aortic Valve Replacement: A Comparative Study

The Heart Surgery Forum ◽

10.1532/hsf.2815 ◽

2020 ◽

Vol 23 (4) ◽

pp. E411-E415

Author(s):

Álvaro Borrero ◽

Tatiana Julieth Samboni ◽

Natalia Prado ◽

Diana Cristina Carrillo-Gómez ◽

German Camilo Giraldo-Gonzalez ◽

...

Keyword(s):

Intensive Care ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Hospital Stay ◽

Medical History ◽

Valve Replacement ◽

Clinical Care ◽

Aortic Surgery ◽

Lower Percentage ◽

Intensive Care Stay

Background: This study aims to compare the characteristics between patients who underwent aortic valve replacement (AVR) through a J-shaped upper mini-sternotomy (UMS) and patients who underwent full sternotomy (FS) in the basis of clinical care and hospital outcomes. Methods: A retrospective, cross-sectional study was conducted on adult patients who were subjected to AVR by UMS from 2014 to 2017, compared with a historical control of patients who had undergone UMS by FS from 2011 to 2014. Patients, who received combined valve replacement or aortic surgery, as well as heart valve reinterventions due to endocarditis, were excluded. Sociodemographic characteristics, medical history, hospital and intensive care stay, blood transfusions, complications, and mortality of both procedures were compared. Results: There were 57 patients under UMS and 99 patients under FS included in this study. The median age was 67 years, and 56.77% of the patients were male. No differences were observed in the past medical history and the type of valve implanted between the groups. During surgery, patients under UMS received a lower percentage of red blood cell and platelet transfusions compared with FS. However, UMS had a higher percentage of cryoprecipitate transfusion. Intensive care stay was shorter in UMS compared with FS (three days; interquartile range [IQR], 2–4; and four days; IQR, 2–6, respectively) without differences in overall hospital stay, postoperative complications, in-hospital mortality, and 30-day mortality. Conclusions: The J-shaped upper mini-sternotomy is a feasible surgical technique that does not increase in-hospital or 30-day mortality, neither hospital stay nor infectious complications.

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CRT-400.07 Risk Factors, Cause and Impact of Long Hospital Stay After Transcatheter Aortic Valve Replacement

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2015.12.230 ◽

2016 ◽

Vol 9 (4) ◽

pp. S43

Author(s):

Tomo Ando ◽

David Slovut ◽

Cynthia Taub

Keyword(s):

Risk Factors ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Hospital Stay ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Transcatheter Aortic Valve

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Use of Pre- and Intensified Postprocedural Physiotherapy in Patients with Symptomatic Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement Study (the 4P-TAVR Study)

Journal of Interventional Cardiology ◽

10.1155/2021/8894223 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

M. Weber ◽

U. Klein ◽

A. Weigert ◽

W. Schiller ◽

V. Bayley-Ezziddin ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Hospital Stay ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Open Heart Surgery ◽

Intervention Group ◽

Control Group ◽

Positive Effects ◽

Transcatheter Aortic Valve

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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Minimally invasive access type related to outcomes of sutureless and rapid deployment valves

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa154 ◽

2020 ◽

Vol 58 (5) ◽

pp. 1063-1071 ◽

Cited By ~ 1

Author(s):

Martin Andreas ◽

Paolo Berretta ◽

Marco Solinas ◽

Giuseppe Santarpino ◽

Utz Kappert ◽

...

Keyword(s):

Acute Kidney Injury ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Hospital Stay ◽

Valve Replacement ◽

Kidney Injury ◽

Stroke Rate ◽

International Registry ◽

Rapid Deployment

Abstract OBJECTIVES Minimally invasive surgical techniques with optimal outcomes are of paramount importance. Sutureless and rapid deployment aortic valves are increasingly implanted via minimally invasive approaches. We aimed to analyse the procedural outcomes of a full sternotomy (FS) compared with those of minimally invasive cardiac surgery (MICS) and further assess MICS, namely ministernotomy (MS) and anterior right thoracotomy (ART). METHODS We selected all isolated aortic valve replacements in the Sutureless and Rapid Deployment Aortic Valve Replacement International Registry (SURD-IR, n = 2257) and performed propensity score matching to compare aortic valve replacement through FS or MICS (n = 508/group) as well as through MS and ART accesses (n = 569/group). RESULTS Postoperative mortality was 1.6% in FS and MICS patients who had a mean logistic EuroSCORE of 11%. Cross-clamp and cardiopulmonary bypass (CPB) times were shorter in the FS group than in the MICS group (mean difference 3.2 and 9.2 min; P < 0.001). Patients undergoing FS had a higher rate of acute kidney injury (5.6% vs 2.8%; P = 0.012). Direct comparison of MS and ART revealed longer mean cross-clamp and CPB times (12 and 16.7 min) in the ART group (P < 0.001). The postoperative outcome revealed a higher stroke rate (3.2% vs 1.2%; P = 0.043) as well as a longer postoperative intensive care unit [2 (1–3) vs 1 (1–3) days; P = 0.009] and hospital stay [11 (8–16) vs 8 (7–12) days; P < 0.001] in the MS group than in the ART group. CONCLUSIONS According to this non-randomized international registry, FS resulted in a higher rate of acute kidney injury. The ART access showed a lower stroke rate than MS and a shorter hospital stay than all other accesses. All these findings may be related to underlying patient risk factors.

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