Patients undergoing urgent trans-aortic valve implantation suffer from an increased mortality rate

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Lux ◽  
L.F Veenstra ◽  
S Rasoul ◽  
S Kats ◽  
B Maesen ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Hospital Mortality ◽  
Aortic Valve Stenosis ◽  
Pacemaker Implantation ◽  
Chronic Obstructive Lung Disease ◽  
Rank Test ◽  
Chronic Obstructive ◽  
Unselected Patient ◽  
Device Placement ◽  
One Year

Abstract Introduction Information on the outcome of urgent Transcatheter valve implantations (TAVI) is scarce, but available data suggest that it could be a reasonable option for the treatment of decompensated severe aortic valve stenosis. The prospects of an all-comer urgent population, however, are unknown. Here we report our experience with clinically indicated urgent TAVI implantation in an unselected patient population with severe aortic valve stenosis (AS). Purpose To compare the outcome of patients undergoing urgent or elective TAVI and to identify potential predictors of outcome. Methods A retrospective, single centre study of AS patients undergoing femoral or apical TAVI between 01. 01.2013 and 30.09.2018 was performed. Demographic information, medical history, clinical and procedural data were collected from the local electronic database. Urgent implantation was defined as accelerated, in-hospital patient preparation and urgent device placement following an acute admission. Survival was investigated with Kaplan-Meier survival analysis and log-rank test. Regression analysis was performed to identify possible predictors of mortality. Results During the study period TAVI was performed in 631 patients, of whom 53 (8.4%) underwent urgent TAVI. In the case of urgent procedures, the median admission-to-procedure time was 18 [10–29] days. Age, gender and the prevalence of diabetes mellitus, chronic obstructive lung disease (COPD) and a glomerular filtration rate of ≤30ml/min was comparable among the groups. Patients in the urgent group had a lower BMI (26 [23–28] vs. 27 [24–30]; p<0.05), had more frequently an ejection fraction <30% (30% vs 4%p<0.001) and a higher Euroscore II (5.3 [3.4–10.9]% vs 2.9 [1.7–4.5]%; p<0.001). The rate of apical implantation and post-operative stroke, pacemaker implantation and renal failure did not differ between the groups. Urgent patients, however, needed longer post-procedural hospitalization (6 [4–9] vs 4 [3–6] days; p<0.001) and had higher in-hospital (11.3% vs 3,1%; <0.001) and one-year mortality rates (28.3% vs 8.5%; p<0.001). Urgency was an independent predictor of overall one-year mortality (HR 3.0, p=0.001) and worsened the survival of the individuals who were discharged from the hospital (out-of-hospital mortality at one-year; HR 2.8, p=0.011), but had no effect on in-hospital mortality. In-hospital mortality was mainly determined by apical access (OR 3.1; p=0.016) and major post-operative stroke (OR 8.8.; p=0.006), with both worsening overall 1-year survival too (HR 1.8 for apical access and 4.8 for stroke; p<0.05). Mortality after a successful hospital discharge was increased not only by urgency (HR 2.8, p=0.011), but by COPD (HR 2.1; p=0.04) and prolonged post-operative hospitalization (HR 1.05/day; p=0.001) as well. Conclusion Stabilizing AS patients can mitigate the effect of urgency on peri-procedural survival. Urgency remains, however, an important determinant of one-year TAVI outcome. Funding Acknowledgement Type of funding source: None

Use and outcomes of emergency treatment strategies in patients with aortic valve stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.M Piepenburg ◽  
K Kaier ◽  
C Olivier ◽  
M Zehender ◽  
C Bode ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Hospital Mortality ◽  
Valve Replacement ◽  
Aortic Valve Stenosis ◽  
Emergency Treatment ◽  
Funding Source ◽  
Artery Disease

Abstract Introduction and aim Current emergency treatment options for severe aortic valve stenosis include surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) and balloon valvuloplasty (BV). So far no larger patient population has been evaluated regarding clinical characteristics and outcomes. Therefore we aimed to describe the use and outcome of the three therapy options in a broad registry study. Method and results Using German nationwide electronic health records, we evaluated emergency admissions of symptomatic patients with severe aortic valve stenosis between 2014 and 2017. Patients were grouped according to SAVR, TAVR or BV only treatments. Primary outcome was in-hospital mortality. Secondary outcomes were stroke, acute kidney injury, periprocedural pacemaker implantation, delirium and prolonged mechanical ventilation >48 hours. Stepwise multivariable logistic regression analyses including baseline characteristics were performed to assess outcome risks. 8,651 patients with emergency admission for severe aortic valve stenosis were identified. The median age was 79 years and comorbidities included NYHA classes III-IV (52%), coronary artery disease (50%), atrial fibrillation (41%) and diabetes mellitus (33%). Overall in-hospital mortality was 6.2% during a mean length of stay of 22±15 days. TAVR was the most common treatment (6,357 [73.5%]), followed by SAVR (1,557 [18%]) and BV (737 8.5%]). Patients who were treated with TAVR or BV were significantly older than patients with SAVR (mean age 81.3±6.5 and 81.2±6.9 versus 67.2±11.0 years, p<0.001), had more relevant comorbidities (coronary artery disease 52–91% vs. 21.8%; p<0.001), worse NYHA classes III-IV (55–65% vs. 34.5%; p<0.001) and higher EuroSCORES (24.6±14.3 and 23.4±13.9 vs. 9.5±7.6; p<0.001) than SAVR patients. Patients treated with BV only had the highest in-hospital mortality compared with TAVR or SAVR (20.9% vs. 5.1 and 3.5%; p<0.001). Compared with BV only, SAVR patients (adjusted odds ratio [aOR] 0.25; 95% confidence interval [CI] 0.14–0.46; p<0.001) and TAVR patients (aOR 0.37; 95% CI 0.28–0.50; p<0.001) had a lower risk for in-hospital mortality. Conclusion In-hospital mortality for emergency patients with symptomatic severe aortic valve stenosis is high. Our results showed that BV only therapy was associated with highest mortality, which is in line with current research. Yet, there is a trend towards more TAVR interventions and this study might imply that balloon valvuloplasty alone is insufficient. The role of BV as a bridging strategy to TAVR or SAVR needs to be further investigated. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany

Abstract 276: Gender Disparity in the Treatment of Aortic Stenosis-an Analysis of the National Inpatient Sample 2009-2015

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Richard Tangel ◽  
Ankur Sethi ◽  
John Kassotis
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Gender Gap ◽  
Pacemaker Implantation ◽  
Gender Disparity ◽  
Chronic Obstructive ◽  
Surgical Aortic Valve Replacement ◽  
The Impact

Background: It is well known that there is a significant gender gap in both the referral and outcomes of patients eligible for cardiac surgery. The impact of transcatheter aortic valve replacement (TAVR) on the gender disparity in the management of aortic stenosis (AS) has not been well established. The aim of this study was to analyze the referrals to and outcomes of both surgical aortic valve replacement (SAVR) and TAVR for management of AS as a function of gender in a contemporary United States population. Methods: We used the National Inpatient database 2009-2015 to study the gender distribution of admissions for both SAVR and TAVR for the treatment of AS and its effect on inpatient outcomes. The survey estimation commands were used to determine weighted national estimates. Results: During the study period there were 3,443,274 (Males (M) 46.6 ± 0.1%; Females (F) 53.3 ± 0.1%) admissions for AS diagnosis, 325,264 SAVR (M 62.0 ± 0.2%; F 37.9 ± 0.2%) and 56,542 TAVR (M 52.6 ± 0.5%; F 47.3 ± 0.5%). The gender disparity was more prominent in Whites (Wh) than Non-whites (NWh) for both SAVR (Wh M 62.7 ± 0.2%, Wh F 37.2 ± 0.2%; NWh M 57.3 ± 0.5%, NWF 42.6 ± 0.5%) and TAVR (Wh M 53.1 ± 0.5%, Wh F 46.8 ± 0.5%; NWh M 47.2 ± 1.3%, NWh F 52.7 ± 1.3%). Female TAVR patients were older and more likely to have Medicare but less likely to have diabetes, chronic kidney disease (CKD), peripheral artery disease (PAD), prior coronary bypass surgery (CABG) and percutaneous coronary intervention (PCI), and chronic obstructive pulmonary disease (COPD). They also had lower Charlson comorbidity index (CCI). However, female TAVR patients had higher inpatient deaths (OR = 1.34;1.09-1.64), bleeding (OR = 1.51; 1.40-1.62) and stroke (OR = 1.47; 1.16-1.88), but a lower rate of pacemaker implantation (0.86; 0.76-0.97) and acute renal failure (ARF) (OR = 0.78; 0.71- 0.87). SAVR females were older, more likely to have Medicare, hypertension, and heart failure but less likely to have diabetes, CKD, PAD, prior CABG and PCI, and COPD. They also had lower CCI. SAVR female patients had higher inpatient deaths (OR = 1.40; 1.29-1.53), pacemaker implantation (OR =1.19; 1.11-1.28), blood transfusion (OR = 1.40; 1.35-1.45), and stroke (OR =1.19; 1.08-1.30), but lower ARF (OR = 0.80; 0.76-0.83). Conclusion: A gender disparity in the management of aortic stenosis continues to exist; however, our study showed that TAVR appears to bridge this gap. The reduction in gender disparity was most pronounced among Non-white patients. Despite having less comorbidities, outcomes after both SAVR and TAVR remain worse in women.

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.

Abstract 520: Should Bilateral Internal Thoracic Artery Grafting be Used in Patients with Peripheral Vascular Disease?

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Nadav Teich ◽  
Benjamin Medalion ◽  
Dmitry Pevni ◽  
Rephael Mohr ◽  
Amir Kramer ◽  
...  
Keyword(s):  
Vascular Disease ◽  
Internal Thoracic Artery ◽  
Cox Model ◽  
Chronic Obstructive Lung Disease ◽  
Emergency Operation ◽  
Rank Test ◽  
Chronic Obstructive ◽  
Increased Risk ◽  
Bilateral Internal Thoracic Artery ◽  
Sternal Wound Infections

Background: The potential survival benefit of Bilateral Internal Thoracic Artery (BITA) compared to Single Internal Thoracic Artery (SITA) grafting in peripheral or cerebral vascular disease (PVD) patients is questionable, due to their short life expectancy and increased risk of sternal wound infection. Methods: Six hundreds and four Patients with PVD who underwent BITA grafting between 1996 and 2010 were compared with 478 PVD patients who underwent SITA grafting. Results: Patients undergoing SITA were older, more often female, more likely to have chronic obstructive lung disease, EF<30% ,Diabetes, renal insufficiency, congestive heart failure and emergency operation. Euroscore of SITA patients was significantly higher(10.1 ±3.1vs. 8.1± 3.3 %,p<0.001) Operative mortality (4.4% vs. 5.0% in BITA and SITA)and sternal wound infections (4.4% vs. 3.6%) were not significantly different between groups. Median follow-up was 9.50 (95%CI 8.83-10.16) years. Ten-year survival (Kaplan-Meier ) of the SITA and BITA groups were not significantly different (45.1±4.7% vs. 50.1±3.4%, P =0.736, Log Rank test) and assignment to the BITA group was not associated with better propensity-adjusted survival (HR 1.050, 95% CI: 0.875-1.261, P =0.600) ( Stratified COX model. ) Conclusions: This study shows. that, early and long-term outcomes of BITA grafting in patients with PVD are not better than those of SITA grafting. Early mortality from non-cardiac causes ,reduces the influence of the type of conduit used(BITA or SITA) on survival. Selective use of BITA in lower-risk PVD patients might un-mask the benefits of BITA grafting

One-Year Results of Transcatheter Aortic Valve Implantation in Severe Symptomatic Aortic Valve Stenosis

2011 ◽  
Vol 107 (11) ◽  
pp. 1687-1692 ◽  
Author(s):  
Michael Gotzmann ◽  
Waldemar Bojara ◽  
Michael Lindstaedt ◽  
Aydan Ewers ◽  
Leif Bösche ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Aortic Valve Stenosis ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
One Year ◽  
Valve Implantation

scholarly journals The COPD Assessment Test as a Prognostic Marker in Interstitial Lung Disease

2016 ◽  
Vol 10 ◽  
pp. CCRPM.S40792 ◽  
Author(s):  
Fujiko Someya ◽  
Takao Nakagawa ◽  
Naoki Mugii
Keyword(s):  
Carbon Monoxide ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Rank Test ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Lung Diffusion ◽  
Diffusion Capacity ◽  
Copd Assessment Test ◽  
One Year

The chronic obstructive pulmonary disease (COPD) Assessment Test (CAT), which was developed to measure the health status of patients with COPD, was applied to patients with interstitial lung disease, aiming to examine the CAT as a predictor of outcome. Over a follow-up period of more than one year, 101 consecutive patients with interstitial lung disease were evaluated by the CAT. The CAT scores of 40 in total were categorized into four subsets according to the severity. Patients with higher (more severe) scores exhibited lower forced vital capacity and lung diffusion capacity for carbon monoxide. The survival rate was significantly lower in patients with higher scores (log-rank test, P = 0.0002), and the hazard ratios for death of the higher scores and lower lung diffusion capacity for carbon monoxide were independently significant. These findings suggest that CAT can indicate the risk of mortality in patients with interstitial lung disease.

Impact of chronic obstructive pulmonary disease on survival and symptoms of severe aortic valve stenosis

2015 ◽  
Vol 49 (1) ◽  
pp. 49-55 ◽  
Author(s):  
Mikael K. Poulsen ◽  
Jordi S. Dahl ◽  
Bo J. Kjeldsen ◽  
Knud Nørregaard-Hansen ◽  
Knud Erik Pedersen ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Aortic Valve ◽  
Pulmonary Disease ◽  
Aortic Valve Stenosis ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Contemporary trends in the management of aortic stenosis in the USA

2019 ◽  
Vol 41 (8) ◽  
pp. 921-928 ◽  
Author(s):  
Mohamad Alkhouli ◽  
Fahad Alqahtani ◽  
Khaled M Ziada ◽  
Sami Aljohani ◽  
David R Holmes ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Hospital Mortality ◽  
Valve Replacement ◽  
Temporal Trends ◽  
Pacemaker Implantation ◽  
Nationwide Survey ◽  
Transcatheter Aortic Valve ◽  
The Usa

Abstract Aims To assess the contemporary trends in aortic stenosis (AS) interventions in the USA before and after the introduction of transcatheter aortic valve implantation (TAVI). Methods and results We utilized the National-Inpatient-Sample to assess temporal trends in the incidence, cost, and outcomes of AS interventions between 1 January 2003 and 31 December 2016. During the study’s period, AS interventions increased from 96 to 137 per 100 000 individuals &gt; 60 years old, P &lt; 0.001. In-hospital expenditure on AS interventions increased from $2.28 billion in 2003 to $4.33 in 2016 P &lt; 0.001. Among patients who underwent aortic valve replacement, the proportion of TAVI increased from 11.9% in 2012 to 43.2% in 2016 (P &lt; 0.001). Males and Hispanics had lower proportions of TAVI compared with females and White patients. Adjusted in-hospital mortality of isolated SAVR decreased from 5.4% in 2003 to 3.3% in 2016 (P &lt; 0.001), whereas adjusted in-hospital mortality of TAVI decreased from 4.7% in 2012 to 2.2% in 2016, P &lt; 0.001. The incidence of new dialysis, permanent pacemaker implantation, and blood transfusion decreased after both TAVI and SAVR between 2012 and 2016. However, the rate of post-operative stroke did not significantly decrease. Length of stay and cost of hospitalization decreased after both SAVR and TAVI, although the later remained higher with TAVI. Rates of non-home discharge decreased over time after TAVI but remained stable after isolated SAVR. Conclusion This nationwide survey documents the increasing incidence of AS interventions, the rising cost of modern AS care, and the paradigm shift in aortic valve replacement practice in the USA.

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