scholarly journals Incidence, determinants and consequences of delirium in older patients after transcatheter aortic valve implantation

2020 ◽  
Vol 49 (3) ◽  
pp. 389-394 ◽  
Author(s):  
Jeannette A Goudzwaard ◽  
Marjo J A G de Ronde-Tillmans ◽  
Tom A J de Jager ◽  
Mattie J Lenzen ◽  
Rutger-Jan Nuis ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Older Patients ◽  
Mortality Data ◽  
Transcatheter Aortic Valve ◽  
Procedural Time ◽  
Aortic Valve Implantation ◽  
One Year ◽  
Valve Implantation ◽  
Negative Health Outcomes

Abstract Background delirium is an event leading to negative health outcomes and increased mortality in patients. The aim of this study is to investigate the incidence, determinants and consequences of post-operative delirium (POD) in older patients undergoing transcatheter aortic valve implantation (TAVI). Methods The TAVI Care and Cure program is a prospective, observational registry in patients referred for TAVI at Erasmus University Medical Centre. The presence of delirium was evaluated by daily clinical assessment by a geriatrician pre- and up to 3 days post-TAVI. Mortality data were obtained from the Dutch Civil Registry. Results A total of 543 patients underwent TAVI between January 2014 and December 2017. Overall, the incidence of POD was 14% (75/543 patients) but declined from 18% in 2014 to 7% in 2017 (P = 0.009). Patients who developed POD were older (81.9 ± 5.8 versus 78.6 ± 8.3 years, P < 0.001), had higher prevalence of renal dysfunction and prior stroke (54% versus 40%, P = 0.02; 31% versus 18%, P = 0.01) and were more often frail (32% versus 25%, P = 0.02). From a procedural perspective, general anesthesia (odds ratios (OR), 2.31; 95% CI, 1.40–3.83; P = 0.001), non-transfemoral access (OR, 2.37; 95% CI, 1.20–4.70; P = 0.01) and longer procedural time (OR, 1.01; 95% CI, 1.01–1.02; P < 0.001) were significantly associated with POD. One-year survival rate was 68% among patients who had suffered a POD and was 85% in patients without a POD (hazard ratio’s 1.8 (95% CI 1.01–3.10), P = 0.045). Conclusion POD frequently occurs after TAVI and is associated with increased mortality. It might be speculated that patient selection and the minimalistic approach of TAVI may reduce the frequency of delirium.

Abstract 13947: The Acute and Long-term Effects of Transcatheter Aortic Valve Implantation on Aortic Stiffness and Hemodynamics

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Vasiliki Gardikioti ◽  
Dimitrios Terentes-printzios ◽  
Konstantinos Aznaouridis ◽  
George Latsios ◽  
Gerasimos Siasos ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Arterial Stiffness ◽  
Transcatheter Aortic Valve Implantation ◽  
Augmentation Index ◽  
Long Term Effects ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
One Year ◽  
Valve Implantation

Introduction: Transcatheter aortic valve implantation (TAVI) is a procedure that alters dramatically the hemodynamics in patients with severe aortic valve stenosis who undergo this procedure. Hypothesis: We investigated the hypothesis that arterial properties and hemodynamics are affected immediately after TAVI as well as in the long-term. Methods: We enrolled 90 patients (mean age 80.2 ± 8.1 years, 50% males) with severe symptomatic aortic stenosis undergoing TAVI. Carotid-femoral and brachial-ankle pulse wave velocity (cfPWV and baPWV) were used for the assessment of arterial stiffness. Augmentation index corrected for heart rate (AIx@75) and subendocardial viability ratio (SEVR) were measured non-invasively. Measurements were conducted at baseline, after the procedure (during hospitalization) and at 1 year. Results: Acutely after TAVI we observed a statistically significant increase in arterial stiffness (7.5 ± 1.5 m/s vs 8.4 ± 1.9 m/s, p=0.001 for cfPWV and 1,773 ± 459 cm/s vs 2,383 ± 645 cm/s, p<0.001 for baPWV) without a concomitant change in systolic blood pressure (Figure). One year later, arterial stiffness was still increased compared to pre-TAVI measurements (7.5 ± 1.5 m/s vs 8.7 ± 1.7 m/s, p<0.001 for cfPWV and 1,773 ± 459 cm/s vs 2,286 ± 575 cm/s, p<0.001 for baPWV). We also found a decrease in AIx@75 (32.2 ± 12.9 % vs 27.9± 8.4 %, p=0.016) after TAVI that was attenuated at 1-year follow-up (32.2 ± 12.9 % vs 29.8± 9.1 %, p=0.38). SEVR displayed an increase acutely after TAVI (131.2 ± 30.0 % vs 148.4± 36.1 %, p=0.002) and remained improved 1 year after the procedure (131.2 ± 30.0 % vs 146± 32.2 %, p=0.01). Conclusions: In conclusion, shortly after TAVI the aorta exhibits a "stiffer" behavior in response to the acute change in hemodynamics, which settles in the long term. Our findings further elucidate the hemodynamic consequences of TAVI and may entail a prognostic role in this growing population.

scholarly journals Incidental abnormal CT scan findings during transcatheter aortic valve implantation assessment: incidence and implications

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000855 ◽  
Author(s):  
Akshay Patel ◽  
Kajan Mahendran ◽  
Michael Collins ◽  
Mahmoud Abdelaziz ◽  
Saib Khogali ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Ct Scan ◽  
Clinical Significance ◽  
Transcatheter Aortic Valve Implantation ◽  
Incidental Findings ◽  
Mortality Data ◽  
Transcatheter Aortic Valve ◽  
Significant Difference ◽  
Aortic Valve Implantation ◽  
Valve Implantation

ObjectivesThe aim of this retrospective series is to describe the prevalence and clinical significance of the incidental findings found during pre–transcatheter aortic valve implantation (TAVI) work-up and to ascertain the clinical course of such patients.MethodsConsecutive patients undergoing TAVI from 2013 to 2015 where a TAVI CT assessment was performed (n=138) were included in the study. All incidental findings that were not expected from the patient’s history were discussed at the TAVI multidisciplinary meeting in order to ascertain the clinical significance of said findings and whether they would alter the proposed course of treatment. Mortality data were determined by careful retrospective case note and follow-up appointment analysis.ResultsSeventy-eight patients (57%) were found to have incidental findings on pre-TAVI CT scan. The majority of patients had benign pathology with high incidence in particular of diverticular disease, pleural effusions, gallstones, hiatus hernia and degenerative spinal disease. Vascular pathology such as superior mesenteric, renal and iliac artery stenoses and abdominal aortic aneurysm was detected in seven patients. In terms of long-term mortality data, we found no significant difference between those with incidental findings and those without (p=0.48). Survival as assessed by Kaplan-Meier analysis showed no significant difference between those with and without incidental abnormal CT scan findings (p=0.98).ConclusionsIncidental findings with potential for malignancy are common in an elderly, comorbid population. Ultimately, clinical correlation and prognosis must be swiftly ascertained in order to streamline the patients down the appropriate management pathway while avoiding unnecessary delay for treatment of their aortic stenosis.

Abstract 15761: New Onset Atrial Fibrillation After Transcatheter Aortic Valve Implantation: A Pooled Meta-Analysis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Arun Kanmanthareddy ◽  
Madhu Reddy ◽  
Venkata S Koripalli ◽  
Avanija Buddam ◽  
Nivedita Adabala ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Meta Analysis ◽  
Mortality Data ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
The Impact ◽  
New Onset

Introduction: Atrial fibrillation (AF) after cardiac surgery is associated with increased morbidity and mortality. Data comparing the occurrence of AF after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) is unknown. Methods: We identified all studies reporting outcomes after TAVI in all available electronic databases. Meta-analysis of all the studies was performed using random effects model to a) evaluate the incidence of AF and b) compare the incidence of AF between TAVI and SAVR. Results: The incidence of AF was reported in 7 studies, 5 prospective observational studies and 2 randomized controlled studies. The cumulative event rate for new onset AF at 30 days after TAVI was 0.1 (95% CI; 0.06 -0.17). Three studies reported incidence of AF after TAVI and SAVR. The odds ratio (OR) of developing new onset AF with TAVI compared to SAVR was 0.3 (95% CI; 0.10 - 0.88) at 30 days. One year outcome of new onset AF was reported in only two studies. Although, the incidence of AF was lower in the TAVI group, this did not reach statistical significance (OR 0.7, 95% CI; 0.46 -1.07). Conclusion: The incidence of new onset AF after TAVI is 10% within the first 30 days. This risk is 70% lower in patients undergoing TAVI compared to SAVR. The impact of AF after TAVI in terms of stroke, mortality and future recurrences of AF are unknown. Further studies are therefore necessary to study these outcomes.

P3370Prevalence of right ventricular dysfunction according to different parameters: basal and one year after transcatheter aortic valve implantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Pardo Sanz ◽  
C Santoro ◽  
R Hinojar ◽  
E Rajjoub ◽  
M Pascual ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Functional Evaluation ◽  
Transcatheter Aortic Valve ◽  
Number Of Patients ◽  
Aortic Valve Implantation ◽  
One Year ◽  
Valve Implantation ◽  
Cutting Point ◽  
Rv Function

Abstract Background Right ventricle (RV) is not often specifically studied in patients with severe aortic stenosis (AS). It's difficult to find the correct tool to assess RV function with echocardiographic parameters, and the percentage of patients with dysfunction may vary depending on the parameter that we use. The aim of the study was to evaluate the prevalence of RV dysfunction basal and one year after transcatheter aortic valve implantation (TAVI), according to different parameters. Methods Consecutive patients with severe AS undergoing TAVI from January 2016 to July 2017 were included. RV anatomical and functional parameters were analyzed according to ESC and ASE guidelines. RV dysfunction was assessed using tricuspid annular plane systolic excursion (TAPSE) <17 mm, fractional area change <35%, systolic movement of the RV lateral wall by tissue Doppler imaging (RV-S'TDI) <9.5 cm/s, global longitudinal (RV-GLS) and free wall strain (RV-FWS) using as cutting point [20]. Pre procedure echo, immediate post procedure and 1 year echo were analyzed. Statistical analysis was performed using SSPS version 22. Results The final study population consisted of 78 patients (115 patients were included, 37 were excluded due to suboptimal acoustic window for RV anatomical and functional evaluation), mean age 83.73±6.31 year-old, 38.2% females. We analyzed the percentages of RV dysfunction according to the different parameters evaluated before and in the control one year after. They are shown in Figure 1. Prevalence of RV dysfunction Conclusions The presence of RV dysfunction in patients with severe AS is higher than expected Our data suggest that RV function improve one year after TAVI, in terms of a reduction in the number of patients with dysfunction. The assessment of RV function is difficult, and there is no agreement on what tools are more accurate and useful. RV strain seems to be the most sensible parameter to assess RV function in patients with AS undergoing TAVI. Impact of these measurements in patients management needs further evaluation.

93The high burden of rehospitalisations following transcatheter aortic valve implantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D T Aagaard ◽  
E L Fosbol ◽  
O De Backer ◽  
E Borgersen ◽  
G Gislason ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Cox Regression ◽  
Chronic Obstructive ◽  
First Year ◽  
Factors Associated ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
One Year ◽  
Valve Implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) is a treatment option for severe symptomatic aortic stenosis in patients at increased surgical risk. Rehospitalisations following surgical aortic valve replacement are a strain on patients and society. However, data on the extent of the burden and cause of hospitalisations following TAVI are sparse. Purpose To examine rehospitalisations and factors associated with rehospitalisations in a one-year period following TAVI. Methods In this Danish nationwide observational cohort study, we identified all patients who underwent TAVI from January 2008 through June 2016 and were discharged alive by Danish nationwide health- and administrative registries. Subsequent rehospitalisations, defined as a hospital admission for at least one overnight stay, were classified as either cardiovascular or non-cardiovascular according to the discharge diagnosis codes. Factors associated with any rehospitalisation were identified using Cox regression. Results In total, 2,390 patients undergoing TAVI were included. The median age was 81 years (25th-75thpercentile 77–85 years of age) and men comprised 52% of the study population. Of all patients undergoing TAVI, 24% were hospitalised during the first 30 days after the procedure, while 54% were hospitalised during the first year. Among patients surviving the first year after the procedure, 25% were admitted to a hospital once, 14% were admitted twice, 8% were admitted three times, and 10% were admitted at least four times. Of all hospitalisations, 34% were due to a cardiovascular cause and 10% died during the one-year follow-up. Factors associated with any hospitalisation were chronic kidney disease (HR 1.72 [95% CI, 1.48–2.00]), peripheral vascular disease (HR 1.36 [95% CI, 1.16–1.59]), atrial fibrillation (HR 1.28 [95% CI 1.14–1.43]), ischemic heart disease (hazard ratio [HR] 1.23 [95% confidence interval [95% CI], 1.09–1.38]), and chronic obstructive pulmonary disease (HR 1.16 [95% CI, 1.02–1.33] (Figure). Forrest plot Conclusions In a nationwide, all-comers cohort of patients undergoing TAVI, 57% of patients were hospitalised at least once during the first-year post-procedure and approximately one-third of all hospitalisations was due to a cardiovascular cause. Focus on patient selection and prevention of readmissions after TAVI is warranted.

scholarly journals TCT-751 ONE-YEAR CLINICAL OUTCOMES ACCORDING TO ANTITHROMBOTIC REGIMEN AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION

2016 ◽  
Vol 68 (18) ◽  
pp. B303
Author(s):  
Giulio Stefanini ◽  
Giuseppe Bruschi ◽  
Anna Sonia Petronio ◽  
Cristina Giannini ◽  
Claudia Fiorina ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Clinical Outcomes ◽  
Transcatheter Aortic Valve Implantation ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
One Year ◽  
Valve Implantation
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