scholarly journals Effect of concomitant atrioventricular valve regurgitation on the outcome after transcatheter aortic-valve implantation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Drakopoulou ◽  
M Karmpalioti ◽  
C Simopoulou ◽  
G Oikonomou ◽  
A Apostolos ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Tricuspid Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Valve Regurgitation ◽  
Tricuspid Valve Regurgitation ◽  
Transcatheter Aortic Valve ◽  
Significant Difference ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
The Impact

Abstract Background Many patients undergoing transcatheter aortic valve implantation (TAVI) have concomitant mitral regurgitation (MR) of moderate grade or more. The impact of coexistent tricuspid regurgitation (TR) remains to be determined. Methods Patients with severe and symptomatic aortic stenosis [effective orifice area (EOA)≤1cm2] referred for TAVI at our institution were consecutively enrolled. Prospectively collected demographic, laboratory and echocardiographic data were retrospectively analysed. Patients were divided into 4 groups according to MR and TR severity pre-procedurally: no/mild MR and TR, moderate/severe MR, moderate/severe TR, moderate/severe MR and TR. Primary clinical endpoint was all-cause mortality, as defined by the criteria proposed by the Valve Academic Research Consortium2. Results A total of 244 consecutive patients were enrolled in the study: 148 (60.7%) patients no/mild MR and TR, 32 (13.1%) moderate/severe MR, 35 (14.3%) moderate/severe TR, 29 (11.9%) moderate/severe MR and TR pre-procedurally. There was significant difference in pre-procedural pulmonary artery systolic pressure (PASP) among groups (no/mild MR and TR: 40.8±10 mmHg, moderate/severe MR: 46.6±11.2 mmHg, moderate/severe TR: 49.9±13mmHg, moderate/severe MR and TR: 59.8±15.2mmHg, p<0.0001). The Kaplan–Meier curves for 2 year mortality showed that the severity of TR was associated with poor survival. Interestingly, patients with moderate/severe MR and TR had the worse survival (no/mild MR and TR (91.2%), moderate/severe MR (78.1%), moderate/severe TR (62.9%), moderate/severe MR and TR (62.1%), p<0.0001). Conclusion The presence of concomitant moderate or severe mitral and tricuspid valve regurgitation was associated with the higher mortality. This suggests that a thorough evaluation of the mechanisms underlying concomitant mitral and tricuspid valve regurgitation should be performed to determine the best strategy for avoiding TAVI-related futility. FUNDunding Acknowledgement Type of funding sources: None.

P918Tricuspid regurgitation in patients undergoing transcatheter aortic valve implantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Shamekhi ◽  
A Stundl ◽  
B Al-Kassou ◽  
M Weber ◽  
A Sedaghat ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Tricuspid Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Tricuspid Regurgitation ◽  
Valve Regurgitation ◽  
Tricuspid Valve Regurgitation ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) has become the treatment of choice in elderly patients with severe aortic stenosis and increased surgical risk. A significant number of these elderly patients have concomitant tricuspid valve regurgitation. The impact on outcome, however, is still matter of debate. Objectives In this prospective observational study, we investigated the impact of concomitant tricuspid regurgitation (TR) on outcome in patients undergoing transcatheter aortic valve implantation. Methods Between February 2008 and May 2018, 1411 patients with severe symptomatic aortic stenosis and increased operative risk underwent TAVI at the Heart Center Bonn and participated in this study, after written informed consent was obtained. Before TAVI procedure, all patients underwent a careful cardiac evaluation and interdisciplinary discussion within the local, institutional Heart Team. The pre-interventional 3D echocardiography was used to determine the degree of tricuspid valve regurgitation. According to the severity of TR, patients were divided into two groups; patients with TR < II and patients with moderate to severe TR ≥ II andcompared regarding rates of mortality after 1 year of follow-up between the two groups. Results Out of 1411 TAVI patients, 802 (56.8%) had tricuspid regurgitation < II, 610 (43.2%) patients suffered from tricuspid regurgitation ≥ II. The mean age of our study population was 81.1 (±6.5). The baseline characteristics did not differ significantly between the two groups, such as extracardiac arteriopathy (TR < II: 44% vs TR ≥ II: 41.6%; p=0.37), diabetes (TR < II: 27.5% vs TR ≥ II: 27.7%; p=0.92) or arterial hypertension (TR < II: 91% vs TR ≥ II: 93.2%; p=0.64). However, patients with concomitant TR ≥ II had significantly more often NYHA class IV (TR < II: 5.0% vs TR ≥ II: 15.4%; p<0.001) and a higher logistic EuroSCORE (TR < II: 12.9 (8.8/21.2) vs TR ≥ II: 20.6 (13.1/33.4); p<0.001). Additionally, patients with a TR ≥ II had significantly more often a concomitant mitral regurgitation ≥ II (TR < II: 43.3% vs TR ≥ II: 60.4%; p<0.001). Comparing rates of mortality, we found a significant association between the degree of tricuspid regurgitation and 1-year mortality in patients undergoing TAVI (TR < II: 85 (10.6%) vs. TR ≥ II: 136 (22.3%); p<0.001), as presented in Figure 1. Figure 1 Conclusion Moderate to severe tricuspid valve regurgitation is associated with higher rates of mortality in patients undergoing transcatheter aortic valve implantation. Our results are hypothesis-generating and it has to be elucidated whether the severity of TR is only a surrogate for more advanced stage of aortic stenosis or whether it is causative so that mortality could be reduced by its treatment. Acknowledgement/Funding None

Comparison of general anaesthesia and non-general anaesthesia approach in transfemoral transcatheter aortic valve implantation

Heart ◽  
2018 ◽  
Vol 104 (19) ◽  
pp. 1621-1628 ◽  
Author(s):  
Mehdi Eskandari ◽  
Omar Aldalati ◽  
Rafal Dworakowski ◽  
Jonathan A Byrne ◽  
Emma Alcock ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
General Anaesthesia ◽  
Transcatheter Aortic Valve Implantation ◽  
Transcatheter Aortic Valve ◽  
Significant Difference ◽  
Aortic Valve Implantation ◽  
The Uk ◽  
Valve Implantation ◽  
The Impact

ObjectivePerforming transfemoral transcatheter aortic valve implantation (TAVI) without general anaesthesia (GA) has been increasingly adopted. We sought to study the impact of GA and non-GA approaches on procedural outcome and 30-day and 1-year mortality in transfemoral TAVI.MethodsThe UK TAVI registry holds information for every TAVI procedure in the UK. We analysed the data for patients implanted during 2013–2014 using either an Edwards Sapien or a Medtronic CoreValve prosthesis. Propensity score-matching analysis was performed to adjust for confounding factors.Results2243 patients were studied (aged 81.4±7.5 years, 1195 males). 1816 (81%) underwent TAVI with GA and 427 (19%) without GA. Transoesophageal echocardiography (TOE) was used in 92.3% of GA and 12.4% of non-GA cases (p<0.001). There was no significant difference in the rate of successful valve deployment (GA 97.2% vs non-GA 95.7%, p=0.104) and in the incidence of more than mild aortic regurgitation (AR) at the end of the procedure (GA 5.6% vs non-GA 7.0%, p=0.295). However, procedure time was longer (131±60 vs 121±60mins, p=0.002) and length of stay was greater (8.0±13.5 vs 5.7±5.5 days, p<0.001) for GA cases. 30-day and 1-year mortality rates did not differ between the GA and non-GA cases. After propensity matching, these results remained unchanged. A second propensity analysis (adjusted for mode of anaesthesia) did not show an association between use of TOE and rate of successful valve deployment or frequency of significant AR. Neither was TOE associated with a longer procedural time or greater length of stay.ConclusionProcedure outcome, and 30-day and 1-year mortality are not influenced by mode of anaesthesia. However, GA is associated with longer procedure duration and greater length of stay.

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.

Quantifying the Impact of Care Fragmentation on Outcomes After Transcatheter Aortic Valve Implantation

2020 ◽  
Vol 128 ◽  
pp. 113-119
Author(s):  
Sameer A. Hirji ◽  
Cheryl K. Zogg ◽  
Muthiah Vaduganathan ◽  
Spencer Kiehm ◽  
Edward D. Percy ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
The Impact ◽  
Care Fragmentation
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