scholarly journals Calculated plasma volume status predicts outcomes after transcatheter aortic valve implantation

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001477
Author(s):  
Annette Marie Maznyczka ◽  
Mohamad Barakat ◽  
Omar Aldalati ◽  
Mehdi Eskandari ◽  
Ann Wollaston ◽  
...  
Keyword(s):  
New York ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Plasma Volume ◽  
Heart Association ◽  
Volume Status ◽  
Transcatheter Aortic Valve ◽  
New York Heart Association ◽  
Aortic Valve Implantation ◽  
Valve Implantation

ObjectivesCongestion can worsen outcomes after transcatheter aortic valve implantation (TAVI), but can be difficult to quantify non-invasively. We hypothesised that preprocedural plasma volume status (PVS), estimated using a validated formula that enumerates percentage change from ideal PV, would provide prognostic utility post-TAVI.MethodsThis retrospective cohort study identified patients who underwent TAVI (2007–2017) from a prospectively collected database. Actual ([1-haematocrit] × [a + (b × weight (Kg))] and ideal (c × weight (Kg)) PV were quantified from equations where a, b and c are sex-dependent constants. Calculated PVS was then derived (100% x [(actual – ideal PV)/ideal PV]).ResultsIn 564 patients (mean age 82±7 years, 49% male), mean PVS was −2.7±10.2%, with PV expansion (PVS >0%) evident in 39%. Only logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) independently predicted a PVS >0% (OR 1.85, p=0.002). On Cox analyses, a PVS >0% was associated with greater mortality at 3 (HR 2.29, 95% CI 1.11 to 4.74, p=0.03) and 12 months (HR 2.00, 95% CI 1.23 to 3.26, p=0.006) after TAVI, independently of, and incremental to, the EuroSCORE and New York Heart Association class. A PVS >0% was also independently associated with more days in intensive care (coefficient: 0.41, 95% CI 0.04 to 0.78, p=0.03) and in hospital (coefficient: 1.95, 95% CI 0.48 to 3.41, p=0.009).ConclusionHigher PVS values, calculated simply from weight and haematocrit, are associated with greater mortality and longer hospitalisation post-TAVI. PVS could help refine risk stratification and further investigations into the utility of PVS-guided management in TAVI patients is warranted.

In-Graft Endovascular Stenting Repair for Supravalvular Stenosis from Aortic Rupture after Balloon-Expanding Transcatheter Aortic Valve Implantation

2015 ◽  
Vol 10 (4) ◽  
pp. 276-278 ◽  
Author(s):  
Nobuyuki Furukawa ◽  
Werner Scholtz ◽  
Nikolaus Haas ◽  
Stephan Ensminger ◽  
Jan Gummert ◽  
...  
Keyword(s):  
New York ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Heart Association ◽  
York Heart Association Class ◽  
Transcatheter Aortic Valve ◽  
Association Class ◽  
New York Heart Association ◽  
Aortic Valve Implantation ◽  
Valve Implantation

An 81-year-old man with high-grade aortic valve stenosis and status post-coronary artery bypass grafting and supracoronary replacement of the ascending aorta was referred for transcatheter aortic valve implantation. He was in New York Heart Association class III and had dyspnea. After appropriate screening, we implanted a 29-mm SAPIEN XT valve (Edwards Lifesciences, Irvine, CA USA) through a transapical approach because of severe peripheral arterial occlusive disease. Postinterventional aortography revealed correct positioning and function of the valve and free coronary ostia but contrast extravasation in the vicinity of the interposed vascular prosthesis, resulting in severe luminal narrowing. We chose to manage the stenosis with an endovascular stent. After stenting, extravascular compression was markedly reduced, and the pressure gradient disappeared. The patient was discharged home on the 20th postoperative day. Three months later, computed tomography depicted correct positioning of both grafts. The patient's general health is good, and he is now in New York Heart Association class II. This case illustrates a complication of transcatheter aortic valve implantation specific for patients with an ascending aortic graft. Although stenting may be a good solution, as depicted by this case, self-expanding transcatheter aortic valves should be preferred in patients with ascending aortic grafts to avoid the described complication.

scholarly journals Calculated Plasma Volume Status Is Associated with Adverse Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation

2021 ◽  
Vol 10 (15) ◽  
pp. 3333
Author(s):  
Hatim Seoudy ◽  
Mohammed Saad ◽  
Mostafa Salem ◽  
Kassem Allouch ◽  
Johanne Frank ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Plasma Volume ◽  
Primary Endpoint ◽  
Heart Failure Hospitalization ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Background: Calculated plasma volume status (PVS) reflects volume overload based on the deviation of the estimated plasma volume (ePV) from the ideal plasma volume (iPV). Calculated PVS is associated with prognosis in the context of heart failure. This single-center study investigated the prognostic impact of PVS in patients undergoing transcatheter aortic valve implantation (TAVI). Methods: A total of 859 TAVI patients had been prospectively enrolled in an observational study and were included in the analysis. An optimal cutoff for PVS of −5.4% was determined by receiver operating characteristic curve analysis. The primary endpoint was a composite of all-cause mortality or heart failure hospitalization within 1 year after TAVI. Results: A total of 324 patients had a PVS < −5.4% (no congestion), while 535 patients showed a PVS ≥ −5.4% (congestion). The primary endpoint occurred more frequently in patients with a PVS ≥ −5.4% compared to patients with PVS < −5.4% (22.6% vs. 13.0%, p < 0.001). After multivariable adjustment, PVS was confirmed as a significant predictor of the primary endpoint (HR 1.53, 95% CI 1.05–2.22, p = 0.026). Conclusions: Elevated PVS, as a marker of subclinical congestion, is significantly associated with all-cause mortality and heart failure hospitalization within 1 year after TAVI.

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