scholarly journals Smartwatch Facilitated Remote Health Care for Patients Undergoing Transcatheter Aortic Valve Replacement Amid COVID-19 Pandemic

2021 ◽  
Author(s):  
Xianbao Liu ◽  
Jiaqi Fan ◽  
Yuchao Guo ◽  
Hanyi Dai ◽  
Jianguo Xu ◽  
...  
Keyword(s):  
Health Care ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Heart Team ◽  
Transcatheter Aortic Valve ◽  
Remote Health ◽  
New Onset

BACKGROUND The novel coronavirus disease-2019 (COVID-19 Pandemic) has brought difficulties to the management of patients undergoing transcatheter aortic valve replacement (TAVR). OBJECTIVES This prospective, observational cohort study sought to evaluate the feasibility of a novel, virtual, and remote health care strategy for TAVR patients with smart wearable devices. METHODS A total of 100 consecutive severe aortic stenosis patients who underwent elective transfemoral TAVR were enrolled and each received a HUAWEI smartwatch at least one day before TAVR. Vital signs were continuously tracked and recorded. Single lead electrocardiogram (ECG) was recorded periodically after TAVR. A designated heart team member was to provide remote data-assisted health care to address the medical demand. RESULTS Thirty-eight cardiac events were reported in 34 patients after discharge, with most of the events (76.0%) were detected and confirmed by the smartwatch. Six patients were advised and readmitted to the hospital for arrhythmia events, among whom, four received pacemaker implantations. The remaining 28 (82.4%) patients received telemedicine monitoring instead of face-to-face clinical visits, and three of them received new medication treatment under a doctor's online guidance of doctors. New-onset LBBB was found in 48 patients with transient and recovered spontaneously in 30 patients, while new-onset atrial fibrillation in 4 patients. There were no significant differences in the average weekly heart rates, the ratio of abnormal or low oxygen saturation when compared with the baseline. The average daily steps increased over time significantly (baseline, 870±1353 steps; first week, 1986±2406 steps; second week, 2707±2716 steps; third week, 3059±3036 steps; fourth week, 3678±3485 steps, p < 0.001). CONCLUSIONS Smartwatch can facilitate remote health care for patients undergoing TAVR during COVID-19 and enables a novel remote follow-up strategy. The majority of cardiac clinical events that occurred within 30-day follow-up were detected by the smartwatch, mainly due to the record of conduction abnormality. (SMART Watch Facilitated Early Discharge in Patients undergoing Transcatheter Aortic Valve Replacement, NCT04454177).

scholarly journals Transcatheter Aortic Valve Replacement: The Experience of One Brazilian Health Care Center

2018 ◽  
Author(s):  
Fabiula Schwartz Azevedo ◽  
Marcelo Goulart Correa ◽  
Débora Holanda Gonçalves Paula ◽  
Alex dos Santos Felix ◽  
Luciano Herman Juaçaba Belém ◽  
...  
Keyword(s):  
Health Care ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Care Center ◽  
Health Care Center ◽  
Transcatheter Aortic Valve

scholarly journals More in, better out? Successful valve-in-valve procedure of an iatrogenic ventricular septal defect following transcatheter aortic valve replacement: a case report

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Klaus-Dieter Hönemann ◽  
Steffen Hofmann ◽  
Frank Ritter ◽  
Gerold Mönnig
Keyword(s):  
Aortic Valve ◽  
Ventricular Septal Defect ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Septal Defect ◽  
Left Ventricular ◽  
Heart Team ◽  
Transcatheter Aortic Valve ◽  
Valve In Valve

Abstract Background A rare, but serious, complication following transcatheter aortic valve replacement (TAVR) is the occurrence of an iatrogenic ventricular septal defect (VSD). Case summary We describe a case of an 80-year-old female who was referred with severe aortic stenosis for TAVR. Following thorough evaluation, the heart team consensus was to proceed with implantation via a transapical approach of an ACURATE neo M 25 mm valve (Boston Scientific, Natick, MA, USA). The valve was deployed harnessing transoesophageal echocardiographic (TOE) guidance under rapid pacing with post-dilation. Directly afterwards a very high VSD close to the aortic annulus was detected. As the patient was haemodynamically stable, the procedure was ended. The next day another TOE revealed a shunt volume (left-to-right ventricle) between 50% and 60%. Because the defect was partly located between the stent struts of the ACURATE valve decision was made to fix this leakage with implantation of a further valve and we chose an EVOLUT Pro 29 mm (Medtronic Inc., Minneapolis, MN, USA). The valve-in-valve was implanted 2–3 mm below the lower edge of the first valve, more towards the left ventricular outflow tract (LVOT) with excellent result: VSD was reduced to a very small residual shunt without any hemodynamic relevance. Discussion We suggest that an iatrogenic VSD located near the annulus may be treated percutaneously in a bail-out situation with implantation of a second valve that should be implanted slightly more into the LVOT to cover the VSD.

30-day readmission after TAVR (Transcatheter Aortic Valve Replacement (TAVR) in patients with malignancy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18620-e18620
Author(s):  
Shristi Upadhyay Upadhyay Banskota ◽  
Miguel Salazar ◽  
Estefania Gauto ◽  
Hugo Macchi ◽  
Prajwal Shrestha ◽  
...  
Keyword(s):  
Health Care ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Readmission Rate ◽  
Hospital Readmissions ◽  
Care Burden ◽  
Transcatheter Aortic Valve ◽  
Health Care Burden

e18620 Background: Hospital readmissions after cardiac procedures are increasingly the major focus of quality improvement efforts. Although some reflect appropriate care, others are potentially preventable readmissions (PPRs). We aim to describe the burden, timing, and factors associated with readmissions after transcatheter aortic valve replacement (TAVR) in patients with malignancy. Methods: We performed a retrospective study of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an index admission for TAVR with a concomitant diagnosis of malignancy. We aimed to identify 30-day readmission rate, mortality, healthcare related utilization of resources and other independent predictors of readmission. Results: A total of 2,213 patients with malignancy underwent TAVR. The 30-days readmission rate was 16% (n=355). Main causes of readmissions were found to be heart failure, sepsis, acute hypercapnic respiratory failure, coronary artery disease with angina, and AKI with ATN. Readmitted patients were more likely to come from small metropolitan areas (43.1% vs 33.6, p≤0.01), micropolitan areas (1.4% vs 0.35%, p≤0.01), rural hospital (20.3% vs 8.8%, p≤0.01), non-teaching hospital (23.5% vs 9.1%, p≤0.01), and small sized hospitals (11.5% vs 4%, p≤0.01). Patients re-admitted were more likely to have malnutrition (8% vs 3.2%, p≤0.01), new VTEs (3.8% vs 0.6, p≤0.01), AKI (26% vs 13.6%, p≤0.01) and deaths (4.6% vs 1.7%, p≤0.01). The total health care in-hospital economic burden of readmission was $5.9 million in total charges and $25 million in total costs. Independent predictors of readmission were disposition to short-term skilled nursing facilities, home-health care, and sepsis. Conclusions: We concluded that readmissions after TAVR in patients with malignancy are associated with higher in-hospital mortality rate and pose a higher health care burden. We also identified risk factors that can be targeted to decrease readmissions after TAVR, health care burden, and patient mortality.[Table: see text]

Abstract 15741: Long Term Survival Following Transcatheter Aortic Valve Replacement: Results From a Single US High Volume Center

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ricardo O Escarcega ◽  
Rebecca Torguson ◽  
Marco A Magalhaes ◽  
Nevin C Baker ◽  
Sa’ar Minha ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Term Survival ◽  
Transcatheter Aortic Valve ◽  
Significant Difference ◽  
Long Term Mortality

Introduction: Mortality following Transcatheter aortic valve replacement (TAVR) has been reported up to 5 years. However, mortality after 5 years remains unclear. Hypothesis: We aim to determine the mortality in patients undergoing TAVR >5 years follow up. Methods: From our institution’s prospectively collected TAVR database we analyzed all patients undergoing TAVR to a maximum follow up of 8 years. We divided our population into transapical TAVR (TA-TAVR) and transfemoral TAVR (TF-TAVR) groups. A Kaplan-Meier survival analysis was conducted. Results: A total of 511 patients who underwent TAVR were included in the analysis. Patients undergoing TA-TAVR had higher rates of peripheral vascular disease compared with TF-TAVR (56% vs 29%, p<0.001) and Society of Thoracic Surgeons Score (10.9 ± 4 vs 9.2 ± 4, p<0.001). TA-TAVR was associated with higher mortality at 1 year (32% vs 21%, p=0.01). However, there was no significant difference in very-long term mortality of patients undergoing TA-TAVR vs TF-TAVR (Figure). Conclusions: Long-term mortality following TAVR surpasses 50%. While in the first 2 years TA-TAVR is associated with higher mortality rates after three years the survival rates are similar in both approaches.

Identifying patients likely to be readmitted after transcatheter aortic valve replacement

Heart ◽  
2019 ◽  
Vol 106 (4) ◽  
pp. 256-260 ◽  
Author(s):  
Andrew Goldsweig ◽  
Herbert David Aronow
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Ventricular Systolic Dysfunction ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Routine Practice ◽  
Heart Team ◽  
Transcatheter Aortic Valve

Hospital readmission following transcatheter aortic valve replacement (TAVR) contributes considerably to the costs of care. Readmission rates following TAVR have been reported to be as high as 17.4% at 30 days and 53.2% at 1 year. Patient and procedural factors predict an increased likelihood of readmission including non-transfemoral access, acute and chronic kidney impairment, chronic lung disease, left ventricular systolic dysfunction, atrial fibrillation, major bleeding and prolonged index hospitalisation. Recent studies have also found the requirement for new pacemaker implantation and the severity of paravalvular aortic regurgitation and tricuspid regurgitation to be novel predictors of readmission. Post-TAVR readmission within 30 days of discharge is more likely to occur for non-cardiac than cardiac pathology, although readmission for cardiac causes, especially heart failure, predicts higher mortality than readmission for non-cardiac causes. To combat the risk of readmission and associated mortality, the routine practice of calculating and considering readmission risk should be adopted by the heart team. Furthermore, because most readmissions following TAVR occur for non-cardiac reasons, more holistic approaches to readmission prevention are necessary. Familiarity with the most common predictors and causes of readmission should guide the development of initiatives to address these conditions proactively.

Sign in / Sign up

Export Citation Format

Share Document