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

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

scholarly journals Epidemiological Features of Aortic Stenosis in a French Nationwide Study: 10‐Year Trends and New Challenges

2020 ◽  
Vol 9 (23) ◽  
Author(s):  
Clémence Grave ◽  
Yves Juillière ◽  
Philippe Tuppin ◽  
Alain Weill ◽  
Amélie Gabet ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Temporal Trends ◽  
Patient Characteristics ◽  
Death Certificates ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Background Aortic stenosis (AS) is one of the most common forms of valvular heart disease. Our aim was to estimate the burden of AS in the hospital in France, describe patient characteristics, and evaluate the mortality rate and temporal trends. Methods and Results All patients hospitalized for AS in France between 2006 and 2016 were identified from the national hospital discharge database. Patients’ sociodemographic, medical, and surgical characteristics and temporal trends were described. All AS‐related deaths between 2000 and 2014 were identified using death certificates. In 2016, 26 071 patients were hospitalized for AS: 56.5% were men with an average age of 77 years. The all‐cause mortality rate at 1 year postindex stay was 11%. The rate of patients hospitalized for AS increased by 59% between 2006 and 2016, reaching 38.7/100 000 person‐years in 2016. This increase was most pronounced in patients aged >75 years. The number of transcatheter aortic valve implantations increased following their introduction in 2010. In 2016, 44% of patients were treated with aortic valve surgery during the index hospital stay or following year (mean age, 71.5 years), and 34% were treated with transcatheter aortic valve implantation (mean age, 83.0 years). In 2014, 6186 deaths caused by AS were identified in death certificates: 41.6% were men with an average age of 87 years. The age‐standardized mortality rate increased by 5% between 2000 and 2014, reaching 8.5/100 000 person‐years in 2014. Conclusions The rate of patients hospitalized for AS increased in recent years in line with the higher life expectancy and introduction of transcatheter aortic valve implantation. Mortality increased more moderately.

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

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.

scholarly journals P1831 Predictors and clinical consequences of silent ischaemic brain lesions following transcatheter aortic valve implantation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A I Nagy ◽  
A I Bartykowszki ◽  
A I Varga ◽  
F Suhai ◽  
A A Apor ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Brain Mri ◽  
Brain Lesions ◽  
Transcatheter Aortic Valve ◽  
Cognitive Trajectory ◽  
Ischaemic Brain ◽  
History Of ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Funding Acknowledgements This study was supported by the János Bolyai Scholarship of the Hungarian Academy of Sciences Background A number of studies aimed to identify the predictors of periprocedural cerebral embolizations related to transcatheter aortic valve implantation (TAVI). Much less investigated is the prevalence and determinants of subacute ischaemic brain lesions that develop following TAVI. Purpose We sought to identify predictors of subacute clinically silent ischaemic brain lesions in patients following TAVI. Methods Patients were included from the Rule out Transcatheter Aortic Valve Thrombosis with Post Implantation Computed Tomography (RETORIC) prospective trial. Echocardiography and brain MRI were performed after TAVI procedure, before hospital discharge. Cardiac CT was performed 6 months later to identify subclinical leaflet thrombosis (HALT), as well as repeat brain MRI, to identify any silent ischaemic lesions that appeared since the intervention. The cognitive trajectory of patients was assessed using the Addenbrookes cognitive test (ACE), performed shortly after TAVI and at 6-month follow-up (FU). All-cause mortality data was retrieved from the National Mortality Database. Results 79 consecutive patients were included in the present analysis. 28% had known history of atrial fibrillation (AF). 33% of the cohort was treated with oral anticoagulant, of these 56% with single and 25% with dual antiplatelet therapy (DAPT). The mean CHA2DS2VASC score was 4. From discharge to the 6-month FU, 20 patients (25%) developed new silent ischaemic brain lesions on MRI. Clinically manifest stroke did not occur. On the 6-month CT, HALT was identified in 6 patients (8%). Clinical and imaging parameters, including age, body mass index, hypertension, dyslipidaemia, diabetes, smoking, statin-, OAC- and DAPT therapy, history of AF, history of stroke, echocardiographic metrics of left ventricular (ejection fraction, stroke volume index) and atrial (left atrial strain) function as well as HALT were analysed for association with ischaemic brain lesions. Of the above, only HALT showed significant association (OR:6,58; p = 0.04) with silent brain embolizations. The cognitive trajectory from discharge till 6-month FU did not differ between patients with or without ischaemic focuses (ΔACEscore: 1.0 vs. 0.1; p = NS). Over a median FU of 553 (IQR 453 – 665) days, 8 patients died; 2 with and 6 without ischaemic lesions. Kaplan-Meyer analysis showed no difference in outcome between the two groups (p = 0.68) Conclusion Subclinical leaflet thrombosis was identified as a significant predictor of subacute silent ischaemic brain lesions after TAVI. These lesions did not affect the overall cognitive performance or outcome of the patients.

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

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

scholarly journals Sleep Quality in Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI)

2021 ◽  
Vol 18 (16) ◽  
pp. 8889
Author(s):  
Giulia Lorenzoni ◽  
Danila Azzolina ◽  
Chiara Fraccaro ◽  
Caterina Zoccarato ◽  
Clara Minto ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Sleep Quality ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
P Value ◽  
Transfemoral Approach ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

The present study aimed to analyze sleep quality and quality of Life (QoL) in patients undergoing Transcatheter Aortic Valve Implantation (TAVI). It was conducted at the Interventional Cardiology Unit of the Department of Cardiac, Thoracic, Vascular Sciences and Public Health of the University of Padova on 27 adult patients who underwent TAVI via the transfemoral approach. Patients completed two validated instruments, i.e., the Pittsburgh Sleep Quality Index (PSQI) and the EuroQoL (EQ-5D-5L), on the day of discharge and one month after the hospital discharge. Twenty-seven patients were enrolled with a severe aortic stenosis diagnosis, treated with transfemoral TAVI procedure. The study population included seventeen poor sleepers and ten good sleepers with a median age of 81.92 years overall. The global PSQI evaluation revealed a small significant improvement at follow-up (p-value 0.007). Small positive changes were detected in the Self-care and Usual activity domains of the EQ-5D-5L and the EQ-VAS. No correlation was detected between EQ-5D-5L and sleep quality. The present study confirms the importance of sleep quality monitoring in patients who undergo TAVI procedure for aortic stenosis treatment.

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