Procedural and remote outcome among patients undergoing urgent trans-catheter aortic valve implantation

Abstract Background Severe aortic stenosis patients suffer frequent heart failure decompensations events often requiring hospitalization. In extreme situations patients can be found with pulmonary edema and cardiogenic shock, unresponsive to medical treatment. Urgent trans-catheter aortic valve implantation (TAVI) has emerged as a treatment option for these high-risk patients. Methods We investigated 3,599 patients undergoing TAVI. Subjects were divided into two groups based on procedure urgency: patients who were electively hospitalized for the procedure (N=3,448) and those who had an urgent TAVI (N=151). Peri-procedural complications were documented according to the VARC-2 criteria. In hospital and 1-year mortality rates were prospectively documented. Results Mean age of the study population was 82±7, of whom 52% were female. Peri-procedural complication rates was significantly higher among patients with an urgent indication for TAVI compared to those having an elective procedure: valve malposition 3.6% vs. 0.6% (p-value=0.023), valve migration 3.2% vs. 0.9% (p-value=0.016), post procedure myocardial infarction 3.7% vs. 0.3% (p-value=0.004), and stage 3 acute kidney injury 2.6% vs. 0.5%, (p-value=0.02). Univariate analysis found that patients with urgent indication for TAVI had significantly higher in hospital mortality (5.8% vs. 1.4%, p-value<0.001). similarly, multivariate analysis adjusted for age, gender and cardio-vascular risk factors found that patients with urgent indication had more than 5-folds increased risk of in-hospital mortality (OR 5.94, 95% CI 2.28–15.43, p-value<0.001). Kaplan-Meier's survival analysis showed that patients undergoing urgent TAVI had higher 1-year mortality rates compared to patients undergoing an elective TAVI procedure (p-value log-rank<0.001, Figure). Multivariate analysis found they had more than 2-folds increased risk of mortality at 1-year (HR 2.27, 95% CI 1.53–3.38, p<0.001 compared to those having an elective procedure. Conclusions Patients with urgent indication for TAVI have higher in-hospital mortality and higher peri-procedural complication rates. However, if these patients survive the index hospitalization, they enjoy good prognosis. Kaplan-Meier's survival analysis Funding Acknowledgement Type of funding source: None

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Urgent transcatheter aortic valve implantation in an all-comer population: a single-centre experience

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02347-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Arpad Lux ◽

Leo F. Veenstra ◽

Suzanne Kats ◽

Wim Dohmen ◽

Jos G. Maessen ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Mortality Rates ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Complication Rates ◽

Single Centre ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Background When compared with older reports of untreated symptomatic aortic valve stenosis (AoS), urgent transcatheter aortic valve implantation (u-TAVI) seems to improve mortality rates. We performed a single centre, retrospective cohort analysis to characterize our u-TAVI population and to identify potential predictors of worse outcomes. Methods We performed a retrospective analysis of 631 consecutive TAVI patients between 2013 and 2018. Of these patients, 53 were categorized as u-TAVI. Data was collected from the local electronic database. Results Urgent patients had more often a severely decreased left ventricular ejection fraction (LVEF < 30%) and increased creatinine levels (115.5 [88–147] vs 94.5 [78–116] mmol/l; p = 0.001). Urgent patients were hospitalised for 18 [10–28] days before and discharged 6 [4–9] days after the implantation. The incidence of peri-procedural complications and apical implantations was comparable among the study groups. Urgent patients had higher in-hospital (11.3% vs 3.1%; p = 0.011) and 1-year mortality rates (28.2% vs 8.5%, p < 0.001). An increased risk of one-year mortality was associated with urgency (HR 3.5; p < 0.001), apical access (HR 1.9; p = 0.016) and cerebrovascular complications (HR 4.3; p = 0.002). Within the urgent group, the length of pre-hospital admission was the only significant predictor of 1-year mortality (HR 1.037/day; p = 0.003). Conclusions Compared to elective procedures, u-TAVI led to increased mortality and comparable complication rates. This detrimental effect is most likely related to the length of pre-procedural hospitalisation of urgent patients.

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Temporal trends in utilization of transcatheter aortic valve implantation and patient characteristics – a nationwide cohort study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2618 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J.E Strange ◽

C Sindet-Pedersen ◽

G Gislason ◽

C Torp-Pedersen ◽

E.L Fosboel ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Temporal Trends ◽

Patient Characteristics ◽

P Value ◽

Transcatheter Aortic Valve ◽

History Of ◽

Aortic Valve Implantation ◽

Valve Implantation ◽

First Time

Abstract Introduction In recent years, there has been a surge in the utilization of transcatheter aortic valve implantation (TAVI) for the treatment of severe symptomatic aortic stenosis. Randomized controlled trials have compared TAVI to surgical aortic valve replacement (SAVR) in patients at high-, intermediate-, and low perioperative risk. As TAVI continues to be utilized in patients with lower risk profiles, it is important to investigate the temporal trends in “real-world” patients undergoing TAVI. Purpose To investigate temporal trends in the utilization of TAVI and examine changes in patient characteristics of patients undergoing first-time TAVI. Methods Using complete Danish nationwide registries, we included all patients undergoing first-time TAVI between 2008 and 2017. To compare patient characteristics, the study population was stratified according to calendar year in the following groups: 2008–2009, 2010–2011, 2012–2013, 2014–2015, and 2016–2017. Results We identified 3,534 patients undergoing first-time TAVI. In 2008–2009, 180 patients underwent first-time TAVI compared with 1,417 patients in 2016–2017, resulting in a 687% increase in TAVI procedures performed. During the study period, the median age remained stable (2008–2009: Median age 82 year [25th–75th percentile: 78–85] vs. 2016–2017: Median age 81 years [25th–75th percentile: 76–85]; P-value: 0.06). The proportion of men undergoing first-time TAVI increased over the years (2008–2009: 49.4% vs 2016–2017: 54.9%; P-value for trend: <0.05), also the proportion with diabetes increased (2008–2009: 12.2% vs. 2016–2017: 19.3%; P-value for trend: <0.05). The proportion of patients with a history of stroke decreased over the years (2008–2009: 13.9% vs. 2016–2017: 12.1%; P-value for trend: <0.05). The same trend was seen in patients with a history of myocardial infarction (2008–2009: 24.4% vs. 2016–2017: 11.9%; P-value for trend: <0.05), ischaemic heart disease (2008–2009: 71.7% vs. 2016–2017: 29.4%; P-value for trend: <0.05), and heart failure (2008–2009: 45.6% vs. 2016–2017: 29.4%; P-value for trend: <0.05). Conclusions In this nationwide study, there was a marked increase in the utilization of TAVI in the years 2008–2017. Patients undergoing first-time TAVI had a decreasing comorbidity burden, while the age of the patients at first-time TAVI remained stable. Funding Acknowledgement Type of funding source: None

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Abstract 12809: Pre-Procedural Aortic Valve Area Predicts Degree of Thrombocytopenia Following Trans-Catheter Aortic Valve Implantation

Circulation ◽

10.1161/circ.130.suppl_2.12809 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Elizabeth Retzer ◽

Corey Tabit ◽

Jonathan Paul ◽

Sandeep Nathan ◽

Janet Friant ◽

...

Keyword(s):

Aortic Valve ◽

Antiplatelet Therapy ◽

Pearson Correlation ◽

P Value ◽

Aortic Valve Area ◽

Surgical Aortic Valve Replacement ◽

Percutaneous Balloon ◽

Aortic Valve Implantation ◽

Valve Implantation ◽

Valve Area

Introduction: Thrombocytopenia (TP) has been described following percutaneous balloon aortic valvuloplasty (BAV) and surgical aortic valve replacement (SAVR), but only recently noted following trans-catheter aortic valve implantation (TAVI). While transient, the TP may be severe leading to increased bleeding. Methods: We conducted a retrospective analysis of all patients undergoing TAVI with either a 23mm or 26mm Edwards Sapien valve (Edward Lifesciences, Irvine, California) at our institution.. The effect of multiple independent variables on % platelet change after TAVI were analyzed using paired and unpaired T-tests, two-way ANOVA, and Chi-square tests as appropriate. Platelet % change was correlated with aortic valve area using Pearson correlation. A p-value of <0.05 was considered statistically significant. Results: A total of 33 patients (54.5% male, median age 79.3, mean valve area 0.76 cm2) were included in this analysis. The degree of aortic valve stenosis significantly correlated with post-procedural TP severity (Figure 1). The degree of TP post TAVI was found to be significantly lower in those patients who received BAV prior to their TAVI procedure (p < 0.01). Conclusions: Post-TAVI TP correlates with the degree of pre-procedure aortic stenosis. Given the need for peri-procedural anticoagulation and post-procedural dual antiplatelet therapy, this finding can help identify patients at risk for symptomatic TP and may help guide post procedure antiplatelet therapy. Further studies are needed to elucidate the underlying mechanism.

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Transcatheter aortic valve implantation not preceded by balloon valvuloplasty in a patient with increased risk of stroke – a

Advances in Interventional Cardiology ◽

10.5114/pwki.2012.28073 ◽

2012 ◽

Vol 1 ◽

pp. 70-74

Author(s):

Wojciech Zimoch ◽

Dorota Kustrzycka-Kratochwil ◽

Artur Telichowski ◽

Zdzisław Falkiewicz ◽

Piotr Kubler ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Balloon Valvuloplasty ◽

Transcatheter Aortic Valve ◽

Increased Risk ◽

Aortic Valve Implantation ◽

Valve Implantation

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P1018Evolution of atrioventricular conduction disorders after TAVI

European Heart Journal ◽

10.1093/eurheartj/ehz747.0609 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D Irles ◽

F Salerno ◽

R Cassagneau ◽

R Eschallier ◽

C Maupain ◽

...

Keyword(s):

Multivariate Analysis ◽

Primary Endpoint ◽

Univariate Analysis ◽

P Value ◽

Conduction Disorders ◽

Av Conduction ◽

One Year ◽

The One ◽

Valve Implantation

Abstract Background The evolution of atrioventricular block (AVB) after Trans Aortic Valve Implantation (TAVI) is poorly understood, and indications of pacemaker (PM) implantation after TAVI not well defined. Modern PM algorithms can help studying the evolution of these AV conduction disorders after TAVI. SafeR® mode (Sorin® PM) allows to monitor precisely the AV conduction and to store AVB episodes in the PM memory as intracardiac electrograms, which can be re-read and validated afterwards. Methods From November 2015 and January 2017, all patients implanted in one of the 19 French enrolling centers with a Sorin® PM set in SafeR® mode after TAVI could be prospectively included in the study. All the PM interrogation files were centrally collected. The primary endpoint (PE) was the presence of at least one episode of high grade AVB (HG-AVB) beyond day 7 (D7) to one year after the TAVI. It could be validated either by the presence of a HG-AVB on EKG or telemetry, or by the confirmation of a HG-AVB in the PM memory files. Results 273 patients were included in the study, the PE was assessable in 197 patients. PE was validated in 74.6% patients. In univariate analysis, the use of an oversized prothesis or balloon, and all early episodes of HG-AVB (all those occurring up to D7) influence the validation of the PE. Other AV conduction disorders have no influence on the PE (Table). In multivariate analysis, only HG-AVB occurring between D2 and D7 has a significant influence on the PE. Factors influencing HG-AVB after TAVI Studied factor HG-AVB episode(s) during the one year follow up No HG-AVB episode during the one year follow up p value RBBB before TAVI (%) 41 34 0,346 Low implantation (>6mm) (%) 59 37 0,156 Use of Autoexpansive Valve (%) 62 62 0,990 Oversizing (%) 19 6 0,022 HG-AVB per TAVI (%) 56 30 0,001 HG-AVB D0-D1 (%) 53 24 0,001 HG-AVB D2-D7 (%) 68 34 0,001 New or wiser LBBB and improvement of PR interval after TAVI (%) 30 39 0,253 Influence of predefined factors on the Primary Endpoint. Conclusion The analysis of the SafeR® algorithm files in patients implanted with a PM after TAVI show a high incidence of HG-AVB during the one year follow up. In multivariate analysis, only HG-AVB occurring between D2 and D7 significantly influence the PE, confirming that AV conduction disorders occurring during the first 24 hours may spontaneously normalize. Acknowledgement/Funding Microport CRM

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P1752 Prognostic role of Multilayer Strain Speckle Tracking Echocardiography in patients with severe aortic stenosis treated with Transcatheter Aortic Valve Implantation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1111 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

S Cimino ◽

V Maestrini ◽

S Monosilio ◽

F Luongo ◽

M Neccia ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Transcatheter Aortic Valve Implantation ◽

Global Longitudinal Strain ◽

Myocardial Strain ◽

Lv Function ◽

P Value ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Background Myocardial Strain evaluation helps to assess the efficacy of therapeutic interventions and to predict the prognosis and clinical outcomes. The aim of the present study was to assess whether Multilayer Global longitudinal Strain (GLS) can be useful in estimation of left ventricle (LV) function in patients with severe symptomatic aortic stenosis (AS) who have undergone transcatheter aortic valve implantation (TAVI). Methods 35 patients with severe AS who successfully underwent TAVI, were enrolled in the study. GLS was measured from the endocardial layer (Endo-LS), epicardial layer (Epi-LS) and full thickness of myocardium before the procedure. Analysis included other parameters such as age, sex, LV volumes and ejection fraction (LVEF), type of prosthesis implanted, right ventricular (RV) dimension and function. Occurrence of cardiovascular (CV) events (rehospitalization for HF or CV death) were collected after 24 months follow-up.Results: CV events occurred in 7 patients (20%). Patients were divided in two groups accordingly with CV events occurrence. No differences in baseline, demographic, echocardiographic and procedural characteristics were found. Patients who developed CV events had a more impaired pre-procedural GLS (-10.2 ± 2.4% vs -12.6 ± 2.2%, p = 0.029), mostly due to his subendocardial layer (Endo-LS -10.8 ± 2 vs -13.9 ± 2, p = 0.003). Moreover, by ROC curve analysis, a cut-off value of -12.4% of endo LS was associated with CV events (sensitivity of 83% and specificity of 65 %, AUC 0.8, p = 0.024), with a log-rank p value assessed by survival analysis of 0.044. Conclusion Multilayer GLS analysis could provide additional information for prognosis stratification in patients with severe symptomatic AS before TAVI, above and beyond assessment of LVEF alone. Parameter Event-group (7/35 pz= 20%) Non-event group (28/35 pz= 80%) p Age (y.o) 86 ± 4 80 ± 7 NS LVEDV (ml) 112 ± 34 94 ± 32 NS LVESV (ml) 51.2 ± 6 56.9 ± 6 NS LVEF(%) 55.7 ± 6 56.9 ± 6 NS AVA (cm2) 0.77 ± 0.2 0.73 ± 0.2 NS GLS (%) -10.2 ± 2.4 -12.6 ± 2.2 0.029 Endo-LS (%) -10.8 ± 2 -13.9 ± 2 0.003 Epi-LS (%) -10.2 ± 2 -11.9 ± 2 NS Abstract P1752 Figure.

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P1854Clinical implications of physical function and resilience in patients undergoing transcatheter aortic valve implantation

European Heart Journal ◽

10.1093/eurheartj/ehz748.0605 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

B R Lindman ◽

K Goel ◽

J M O'leary ◽

C M Barker ◽

V Rajagopal ◽

...

Keyword(s):

Aortic Valve ◽

Physical Function ◽

Transcatheter Aortic Valve Implantation ◽

Gait Speed ◽

P Value ◽

Meaningful Improvement ◽

Transcatheter Aortic Valve ◽

Speed Change ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Background Gait speed, as a measure of physical function and marker of frailty, is now routinely screened when evaluating patients with aortic stenosis (AS) for transcatheter aortic valve implantation (TAVI). Assessment of physical function is important to identify patients for whom TAVI may be futile and to assign patients to a procedural risk category. After TAVI, patients may exhibit physical resilience (improvement in physical function) or vulnerability (worsening). Characterizing the trajectory and clinical consequences of physical function after TAVI represent knowledge gaps in the field. Purpose Evaluate associations between physical resilience (improved gait speed) vs vulnerability (decline) after TAVI and subsequent death/hospitalization. Methods The REPRISE III trial compared a mechanically-expanded vs a self-expanding valve in 912 high/extreme risk patients with symptomatic AS. Patients (n=587) who underwent valve implantation and who had a gait speed recorded both pre- and 1-year post-TAVI were analyzed. Gait speed is based on the 5m walk test (slow: 5m in >6s, <0.83m/s; normal: ≥0.83m/s). Trajectory of physical function after TAVI was characterized in 2 ways. Model 1 examined 4 groups based on slow or normal gait speeds at baseline and 1-year post-TAVI. Model 2 examined gait speed change pre-TAVI to 1 year (adjusted for baseline gait speed). Using a landmark approach, the relationships between baseline and 1-year gait speed were evaluated in multivariable Cox PH models of outcomes between 1 and 2 years post-TAVI. Results A clinically-meaningful improvement (≥0.1m/s), no change (±0.1m/s), or decline (≥0.1/ms) in gait speed 1 year after TAVI was observed in 39%, 36%, and 26% of patients, respectively. Among the 4 groups defined by pre- and 1-year post-TAVI gait speeds, 1 to 2 year mortality or hospitalization rates were: 6.6% (normal/normal), 20.9% (normal/slow), 8.0% (slow/normal), and 21.5% (slow/slow). Adjusted hazard ratios of the 2 models are shown (Table). Table. Outcome by Change in Gait Speed Death/Hospitalization P-value Death P-value Hospitalization P-value Adjusted HR [95% CI] Adjusted HR [95% CI] Adjusted HR [95% CI] Model 1: Baseline/1 year Gait Speed (Normal/Normal (n=150) [referent]) Normal/Slow (n=59) 3.82 [1.61, 9.08] <0.01 2.75 [0.96, 7.86] 0.06 7.31 [1.94, 27.58] <0.01 Slow/Normal (n=114) 1.39 [0.53, 3.59] 0.50 1.44 [0.50, 4.12] 0.50 1.69 [0.38, 7.60] 0.49 Slow/Slow (n=253) 3.88 [1.91, 7.91] <0.01 2.36 [1.02, 5.46] 0.045 3.89 [1.14, 13.27] 0.03 Model 2: Gait speed change Baseline to 1 year per 0.1m/s increase 0.83 [0.74, 0.92] <0.01 0.92 [0.80, 1.04] 0.19 0.75 [0.64, 0.88] <0.01 Conclusion These data reveal there is marked heterogeneity in the trajectory of physical function after TAVI and that this trajectory–more so than baseline physical function–is clinically consequential. Identifying and optimizing factors associated with physical resilience after TAVI may improve outcomes. Acknowledgement/Funding Boston Scientific

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In-Hospital Mortality and Complication Rates According to Health Insurance Data in Patients Undergoing Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies in Germany

Annals of Surgical Oncology ◽

10.1245/s10434-020-09301-z ◽

2020 ◽

Author(s):

Lisa Überrück ◽

Giorgi Nadiradze ◽

Can Yurttas ◽

Alfred Königsrainer ◽

Ingmar Königsrainer ◽

...

Keyword(s):

Hospital Mortality ◽

Hospital Stay ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Diagnosis Related Groups ◽

Mortality Rates ◽

Complication Rates ◽

Billing Data ◽

Health Insurance Data

Abstract Background Morbidity and in-hospital mortality rates of patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Germany are not known. Methods From 2009 to 2018 all patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Germany were retrospectively analyzed regarding morbidity and in-hospital mortality rates according to nationwide hospital billing data based on diagnosis-related groups (DRG). The “failure to rescue” (FTR) index, characterizing patients who died after severe but potentially manageable complications, was calculated. Results In total, 8463 patients were included and analyzed. Female sex predominated (1.5:1). Colonic origin of peritoneal metastasis was highest throughout all years, reaching its highest level in 2017 (55%; n = 563) and its lowest level in 2012 (40%; n = 349). Median length of hospital stay reached its maximum in 2017 at 23.9 days and its minimum in 2010 at 22.0 days. Analysis of the total FTR index showed a noticeable improvement over the years, reaching its lowest values in 2017 (9.8%) and 2018 (8.8%). The FTR index for sepsis, peritonitis, and pulmonary complications significantly improved over time. Of the 8463 included patients, 290 died during hospital stay, reflecting an in-hospital mortality rate of 3.4%. Conclusion In-hospital mortality after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is reasonably low compared with other surgical procedures. The improvement in the FTR index reflects efforts to centralize treatment at specialized high-volume centers.

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